FLC | USUHS co-authors guidance on working with military COVID-19 responders

USUHS co-authors guidance on working with military COVID-19 responders

April 8, 2020

The Uniformed Services University of the Health Sciences (USUHS) has collaborated with the University of California San Francisco (UCSF) and Hartford (Connecticut) HealthCare to provide civilian surgeons and other clinicians with guidance about working with the military in caring for COVID-19 patients.

The guidance, published April 6 by JAMA Surgery, draws on years of experience with military-civilian partnerships. Although most of this experience has involved trauma settings, the lessons learned can easily be adapted to military-civilian partnerships formed to respond to mass casualty incidents or to offload civilian hospitals during crises caused by infectious diseases. An example of a combined military-civilian disaster response occurred in Haiti in 2010, when the USNS Comfort was deployed to Port-au-Prince with US Navy personnel and civilian medical volunteers to care for the injuries resulting from the earthquake that devastated the island nation. Over a 40-day period, 927 operative procedures were performed on the ship through this collaborative effort.

With regard to the current pandemic, it makes sense for military assets to be used in areas of the US hit hardest by COVID-19, the authors wrote, but noted that these military platforms are designed for the care of combat casualties, not infectious disease. On the other hand, a portable military platform that is augmented with civilian medical personnel could offload large civilian trauma centers, freeing up staff, beds, and equipment in those civilian hospitals for the care of patients with COVID-19. The addition of civilian trauma teams to military surgical personnel would also help ensure that military treatment facilities (MTFs) are adequately staffed.

The authors listed several criteria that will be required for such a program to succeed:

Institutional commitment: A formal agreement must exist between the civilian trauma center and the deployed military asset. This agreement would include plans for how military medical personnel would be granted privileges and credentials through the partnering institution as well as coverage for malpractice. These personnel will also need access to the electronic medical record. Federalization of all licenses for the military teams must be granted, and there should be an agreement as to how billing for procedures performed at the military asset will be handled.

Governance and administration: The authors suggest that the ideal leadership model of these military platforms be flexible depending on the location, and proposed a co-leadership model, with military personnel reporting to their leadership and civilian personnel to the trauma director. Similarly, the trauma program manager must have a military co-partner. Patients treated in the military facility would still be entered into the American College of Surgeons (ACS) National Trauma Data Bank and the ACS trauma risk-adjusted quality and safety program.

Human resources: In addition to the two directors cited previously, other members of the trauma faculty, as well as trauma specialists in other aligned fields (eg, anesthesia, orthopedics, neurosurgery, emergency medicine, critical care, radiology, and vascular surgery) must support this new trauma care facility and be willing to work within the guidelines outlined for treating these patients. Nurses, advanced practice clinicians, and other allied health professionals should also be included in the plans.

Physical resources: Once established, the number of patients that can be treated in this temporary trauma facility must be determined. How many operating rooms will be included and how many intensive care unit beds will be available? Other facilities essential to caring for the trauma patient must be close by, such as the blood bank, radiology (radiography, computed tomography scans, and interventional facilities), and laboratory services. Restocking of supplies and surgical equipment should be considered as well. Communication with prehospital personnel is essential so that trauma patients can be delivered to the new temporary emergency facility. There must also be a plan to house and feed military personnel deployed to this location (with the exception of the US Navy ships that are self-contained).

Education: The civilian trauma teams will need an orientation to the facilities provided by the military (eg, ventilators and resuscitation equipment). Conversely, military medical personnel will have to know the trauma protocols and practice management guidelines of the partnering institution. Should the deployed military teams not be previously trained in trauma, the educational program developed through the ACS partnership with the US Department of Defense (the Military Health System Strategic Partnership, ACS) can be used to address knowledge gaps.

Evaluation: A weekly evaluation of the entire program by all involved personnel will be essential to its success. This could be done at the local level or by connecting similar settings nationwide via teleconferencing. These evaluations would include not only trauma patient outcomes, use of resources, lessons learned, and opportunities for improvement but also the success of the partnerships in fulfilling its mission: to enhance the care of patients with COVID-19 by augmenting trauma care.