Safety plans learned during the deadly Ebola outbreak in 2015 are being put to good use during the COVID-19 pandemic of 2020. This is especially true when it comes to transporting patients with highly infectious diseases safely.
Although Johns Hopkins never treated a patient with Ebola, the 100-member Lifeline team did transport patients under investigation for the disease. As of April 22, the team had already transported 481 patients who were either known to be COVID-19-positive or were under investigation for the disease. Of these patients, 63% tested positive, says Heidi Hubble, M.H.A., director of operations for Johns Hopkins Lifeline critical care transportation.
Lifeline manages transport both within and between all five Johns Hopkins member hospitals in Maryland and Washington. While each hospital is equipped to manage patients with COVID-19, the most serious cases are routed to The Johns Hopkins Hospital.
Started in 2015, the Lifeline Special Operations Response Team (SORT) is a dedicated group of Lifeline staff members who are committed to moving patients with highly infectious disease safely. SORT team members attend quarterly training sessions and adhere to protocols specifically developed to minimize the risk of transmission during transport activities. To prepare for the COVID-19 response, SORT team coordinator Chad Bowman, M.S.N., worked with Hospital Epidemiology and Infection Control (HEIC) to adapt the protocols specifically for this pathogen. Among the changes were the addition of a safety officer to monitor every transport, and modification of treatment plans to mitigate aerosol generating therapies. SORT team members assist with training the entire Lifeline staff in donning and doffing the new personal protective equipment (PPE) ensemble.
The PPE requires some adjustment to workflow. “Obviously, we’re accustomed to standard PPE of gloves and isolation gowns, but the addition of the respiratory protective equipment, which includes a PAPR (powered air-purifying respirator ), just makes everything — including communication — a little bit more challenging,” says Hubble. “When we arrive at the sending facility, there’s a lot more preparation that happens outside of the [patient] room, before we actually go in.”
Jim Scheulen, M.B.A., chief administrative officer for emergency medicine and capacity management for Johns Hopkins Medicine, oversees the Lifeline team. He notes that getting patients safely from one place to another is a vital part of the institution’s response to COVID-19.
“Everybody has a role to play in a huge incident response like this,” says Scheulen. “Our role, honestly, is to do what we always do — and do it very well.”
Coronavirus Response Requires Teamwork
What has made adjusting to COVID-19 work so quickly is teamwork, says Shawn Trautman, nurse manager for Lifeline. “Every single team member has stepped up to the plate. They’ve been working long hours, they’re volunteering to come in extra,” he says. “Sometimes we will send out a page and crewmembers will come in from home just to help out with a transport. Many have taken on new leadership roles and continue to make improvements.”
The team has established a protocol to train reassigned staff members, including pediatric nurses, to serve as transport safety officers to observe each transport and ensure that all safety measures are properly followed. This helps protect the patient, transport team and hospital staff.
Another unanticipated change is moving patients in a prone, belly down position. “This turns out to be a very good therapy for these patients because it improves blood flow to certain areas of the lungs, which helps oxygen transfer into the bloodstream better,” Trautman says, adding that he expects it to become routine in COVID-19 transport. “Normally, this wouldn’t be much of a problem, but it can be quite challenging when you have a patient intubated with a tube coming out of their mouth.”
Coronavirus Crisis Calls Forth Innovation
Responding to the COVID-19 crisis is bringing innovations to policies, practices and procedures throughout Johns Hopkins Medicine. One example is the accelerated purchase of high-flow nasal cannula oxygen therapy equipment for the Lifeline team, which is a good alternative treatment for patients with acute respiratory failure. “This is a game-changer as it provides us with another treatment alternative for transport and may prevent the patient from being intubated,” says Hubble.
Trautman says the pandemic has caused Lifeline staff members to become expert about managing patients on ventilators because they do it every day. They share this knowledge with other staff members in the COVID-19 units, including respiratory therapists.
“I think the biggest thing is how fast we can roll some of these [procedural changes] out, how fast we can train this many people,” says Trautman. “If you asked me to write a training plan for all the things that we put in place [to handle this crisis], it would have taken a year. We put all this out and trained people in a matter of a month.”