Army partners with NYC responders to manage COVID-19 stress

Maj. Olli Toukolehto recognized the wear on the faces of healthcare workers each time he walked into the Javits Convention Center from his hotel in lower Manhattan.

He had witnessed the same strain on the faces of fellow soldiers while deployed during the Iraqi surge. Caring for COVID-19 patients in the nation’s coronavirus epicenter has taken a mental and physical toll on New York City doctors, nurses, and emergency medical technicians (EMTs), as the number of coronavirus deaths in the city nears 14,000.

Toukolehto, an Army psychiatrist and deputy department chief of adult behavioral health at Fort Belvoir, Virginia, has been deployed to New York City for more than a month, first as a COVID-19 physician, and then as a psychiatrist.

New role

As hospital workers toiled under increasing pressure to meet the demand for care, the officers’ roles changed. After meeting with New York City Emergency Management Commissioner Deanne Criswell late last month, Toukolehto and Col. Brandon Pretlow, 531st Hospital Center commander from Fort Campbell, Tennessee, formulated a plan to help healthcare workers on a more innate level by drawing on their past experiences. They shared insights and helped in the development of web-based trainings to help healthcare workers and first responders cope with the stresses and pressures of working in pandemic conditions.

To help NYC healthcare workers weather the crisis both at home and in the field, the Army partnered with the Greater New York Hospital Association, the NYC Fire Department, and the Department of Defense (DoD) in fielding a collaborative program to help healthcare workers maintain mental health. They would apply lessons from their military service to the pandemic crisis in the nation’s largest city where more than 43,000 remained hospitalized as of May 4, despite a recent decline in fatalities. The plan will be to eventually distribute the training to more than 150 New York hospitals.

“We've been at war for the last 18 years, and we've learned a lot about traumatic-event management and combat stress control,” said Pretlow, who leads about 800 Army, Air Force and Navy doctors, nurses and medical troops assigned to augment 11 hospitals within the New York City Health and Hospital Network. “So we could potentially share some of those ideas and things using some of our behavioral health professionals and have them kind of work hand-in-hand with the behavioral health professionals of the New York City.”

Providers working at New York’s strained hospitals experience symptoms similar to Army medics and soldiers at war: anxiety, stress and mental and physical fatigue, Pretlow said. Concerns of mental health came to the forefront when one of the city’s top ER physicians, Dr. Lorna Breen, reportedly died by suicide at her Virginia home last week.

Toukolehto, a 15-year veteran, deployed to a forward operating base in Iraq from 2006-2007 as a medical lab technician with the 10th Mountain Division. Now each day he makes resiliency training films designed to give hospitals a glimpse of how the military teaches service members skills that they may need when combating the stressors of extended deployments.

He worked in the middle of the conflict’s mass casualties during medical and security operations, often laboring around the clock. Toukolehto remembered the mental distress. He heard news of suicides. As an Army psychiatrist, he wants to help shield New York’s healthcare workers from the same fate.

“It doesn't matter how tough you are,” Toukolehto said. “If your resiliency is slowly being chipped away by the elements or physiological stress … it's rough. And I think that it’s maybe worse for some of the people here because at least [in Iraq] we had a date when we could leave the country. But here with COVID [19], a lot of people don't know how long this is going to keep going. So it makes people feel out of control, and can really feel overwhelming when you don't have an end date.”

A Battle on Two Fronts

The battle healthcare workers fight has a stark difference compared to deployed combat overseas. The nurses, doctors and EMTs bring the war home every day. They must carry the stresses with them into an enclosed household with other family members and sometimes that might spark domestic conflict. Workers under stress may turn to substance abuse, which may lead to domestic violence.

“People are obviously trying to cope with the stress, you know, in one way or another,” Toukolehto said. “And then when people are stressed out, their anger is more difficult to control because people are stuck inside … and they don't have their usual outlets or activities or work.”

Healthcare workers’ duties during this crisis have reached beyond their normal scope. They often act as surrogate family members for their patients, who must remain separated and quarantined from their families. The patients can only connect to family remotely, while healthcare workers must comfort some patients in their final moments. Some have also lost colleagues to the virus. And when a patient passes, they have little time before they are rushed to care for the next patient.

Col. David Benedek, MD, professor and chair of the Uniformed Services University (USU) psychiatry department, said the situation in New York presents a unique challenge, where healthcare workers and their family members live and work within enemy territory. Healthcare workers also must take on the somber task of telling patients’ family members that their loved ones have passed.

USU's Center for Traumatic Stress (CTS) developed materials to help overcome the associated stress. New York healthcare workers will have access to the expertise of DoD psychiatrists and behavioral analysts. Toukolehto connected the hospitals to the researchers at the Uniformed Services University and the CTS.

The Army-led task force envisions that the resiliency training curriculum will be helpful in teaching awareness and resiliency-related skills to behavioral health providers in New York hospitals. It takes practice to know how to cope with the stress, isolation, and long work hours during a pandemic, Toukolehto said. Each hospital in turn will tailor the curriculum to their community's culture, level of exposure, needs, and location.

“That was a very important priority: to make sure they can have a resource where they can get the evidence-based guidelines of how you build resilience and maintain the fighting force,” Toukolehto said.

Toukolehto and his staff have also provided needs-assessment surveys, similar to unit needs or battle assessments that soldiers conduct in the field. The intent of the surveys is to guide hospitals assess the psychological needs of their workers.

Finally, the task force will aid the training effort by sharing videos on unit-level combat and operational stress control small group presentations. Military behavioral specialists who are still working in the local New York hospitals will also share field their experiences and advice with their civilian peers. A chaplain will also be available to offer additional support in demonstrating how the military uses a broad range of interventions to build resiliency.

One of the missions of a CTS is to provide expertise in psychological consequences for victims and first responders, in the wake of disasters and pandemics. USU’s CTS has conducted research on nearly every U.S. disaster, from the bombings of 9/11 to the aftermath of hurricanes. Scientists at the center have collected data on natural disasters, mass shootings and airline crashes in addition to post-traumatic stress disorder and traumatic brain injuries.

The CTS assigns designated staff as “disaster experts” who use the research to translate the work into accessible materials for healthcare workers, educators and families. Civilian healthcare providers will learn how to manage their mental health, deal with fear and uncertainty, and how to speak to children about death. The CTS also developed guides on managing family conflict and the unique challenges of isolation.

While DoD recently closed the field hospital at Javits last week, Toukolehto said some unit members will remain behind to provide further support. He credits the Army’s pre-deployment resiliency training with helping many service members prepare for the unknown, should they be tasked to remain for a longer duration. He will continue to work with the Greater New York Hospital associations in the weeks to come.

“We were keeping an eye on our own troops also,” Toukolehto said. “So the (troops’ preparedness) really showed that the resilience training we get before deployment for a mission is very important.”

Read more: https://www.army.mil/article/235297/a_war_at_home_army_aids_nyc_caregive...