When both the Federal Emergency Management Agency (FEMA) and the Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (ASPR) needed to prioritize hospital support in New England during the COVID-19 omicron variant surge in the beginning of January, they turned to the U.S. Army Engineer Research and Development Center’s (ERDC) Risk and Decision Science Team (RADST) led by Jeff Cegan.
ERDC's contribution, called data analytics, involves interpreting and analyzing data to help organizations make decisions — providing the science buttressing FEMA and ASPR’s request to the White House for emergency military medical personnel to be deployed to Rhode Island.
The request was granted, and the team’s analysis indicated the extra personnel likely staved off a collapse of the state’s hospital system under the onslaught of the omicron variant.
“On behalf my teammates, and particularly Dr. Ben Trump, I can say that supporting FEMA and ASPR during this pandemic has been the most rewarding experience in our professional careers,” Cegan said. “It’s been an honor to assist the emergency response and take an active role in trying to curb the pandemic and save lives.”
Since March 2020, RADST has been providing coronavirus response support to Region 1 for both FEMA and ASPR, an area encompassing the six New England states ― Maine, New Hampshire, Vermont, Massachusetts, Connecticut and Rhode Island. The collaboration started with a FEMA mission assignment and now operates under an interagency agreement between FEMA, ASPR and the U.S. Army Corps of Engineers.
“The partnership between FEMA and ASPR at both the regional and the national levels is what is enabling the identification and deployment of a variety of federal resources,” said Jameson Clem, FEMA deputy operations section chief, referring to the support that’s been allocated to the states’ healthcare systems.
Under the Stafford Act, FEMA has the statutory authority to compel coordination across government and non-government agencies and the resources to pay for their support.
“ASPR’s statutory authorities are outside of and independent of FEMA’s,” said Gary Kleinman, regional administrator for ASPR Region 1. “We respond to support state, local and tribal public health partners against the whole range of problem sets that they have, whether it’s the bad consequences of a natural disaster or the coronavirus epidemic.”
“The combined ability of the three federal agencies to grab information, make sense of it and then produce it in a way that’s valuable as info product or decision-making guidance is incomparable,” Kleinman said. “My team has access to the hospital data resources and provides the dataset and first-level analytics, and then we turn it over to RADST and they do some really great things with it.”
The RADST is under the purview of ERDC Senior Scientific Technical Manger Dr. Igor Linkov, and he thinks that someone might be skeptical if they heard that the Rhode Island healthcare system was struggling during the pandemic.
“Their system is ranked ninth best in the country, according to USNews.com.” Linkov said. “But our research shows that Rhode Island’s healthcare system is unique in that it is optimized to have higher bed occupancy rates than other states. This means that the impacts of COVID-19 hospitalizations, especially from the omicron variant, put an incredible additional strain on hospitals, especially in the Providence area. As a result, Rhode Island has limited surge capacity, and during a region-wide omicron surge, there are reduced options for transferring patients elsewhere.”
The team gathered qualitative and quantitative variables to make the assessment.
“From a qualitative standpoint, we examined the overall resiliency of each Region 1 state’s hospital referral regional systems, as well as hospitals’ surge capacity,” Trump said. “From a quantitative angle, we considered the relative timing of the omicron outbreak. In Rhode Island, the surge arrived very early, like Boston.”
Trump said that Rhode Island had roughly 75-80% hospital utilization throughout the entire pandemic. “Most importantly, both the hospital and the state regional referral systems were noting critical staff shortages, and a critical need we could address in the short term was moving labor around.”
The team has noticed that without interventions in hospital systems at critical times — either from a bed utilization standpoint or a labor standpoint ― “strange things start to happen” in terms of how the hospital functions and what the patient outcomes are.
“With regard to hospital function, you see increases in occurrences such as more employees taking sick leave or machines and equipment breaking,” Trump said. “With regard to patient outcomes, once you start breaking a 75-80% patient bed occupational rate, particularly in an intensive care unit setting, patient outcomes start deteriorating. Patient stays increase at a time when you need more beds, and you’re more likely to see fatalities.”
At that time, the RADST determined Rhode Island needed strategic and labor-based interventions. Both were awarded and are currently being implemented. The labor-based intervention was the White House allocation of military and National Disaster Medical System medical personnel immediately following FEMA’s data-based request. The strategic intervention is filtering patients with mild to moderate symptoms — the “quick throughput patients” to outlying hospitals in the system. Patients likely to progress into more severe COVID-19 symptoms would get transferred into the larger core hospitals.
“Rather than scatter resources throughout state, we’re make a concerted intervention to boost a select set of facilities, so they’re like a pressure release valve,” Trump said.
“All the states have been asking for assistance over time, and Rhode Island happened to be a really good use case for the skillset and the analysis that Cegan and his team brought to it, and the timing was exactly right,” Kleinman said. “They helped us predict when the optimal time was to inject assistance for the state.”
Clem said that RADST’s analytical methods to support FEMA Region 1 and ASPR Region 1 decision-making about Rhode Island missions have also been useful in similar situations facing the five other New England states.
“RADST analysts Jeff Cegan and Ben Trump, combined with peers from HHS/ASPR Region 1, took the approach of targeting their analysis to recommend the appropriate federal staffing resources, for the hospitals in greatest need, at the correct time and duration and directly led to the assignment of over a dozen federal teams to help New England hospitals.”
FEMA Region 1 Coordinating Officer Jarrett Devine appreciates the team’s contribution to FEMA’s and ASPR’s federal support efforts in New England.
“The RADST’s contributions to this COVID-19 response have been unprecedented, and the Rhode Island mission is one more successful mission they should proudly add to their very long list of accomplishments,” Devine said. “It’s an honor to work alongside them.”