Dispatches From The California COVID-19 Front Line Day 4: Anatomy of a COVID-19 Transport

Here's your ticket pack your bag: time for jumpin' overboard
The transportation is here
Close enough but not too far, Maybe you know where you are
Fightin' fire with fire
Burning Down The House - Tom Jones


Previously on Dispatches

Dispatches From The California COVID-19 Front Line Day 1 Shelter From Storm
Dispatches From The California COVID-19 Front Line Day 2: GET TO DA CHOPPPA Ground versus Air
Dispatches From The California COVID-19 Front Line Day 3: Just Breathe

Day 4: Anatomy of a Transport:

0900: Team meeting (we have two primary pediatric teams. Each consists of a Transport Nurse, and Transport Respiratory Therapist, and two EMT's) We check our bags, our vents, the rigs, go up to the PICU and speak to the charge nurse to get a handle on how they are staffed, free beds and the like, then sit down with our MCP or medical control physician. The MCP is an Pediatric Intesivest who not only is on duty for the PICU but is also in overall command of the transport teams. When we get to a referring hospital this is who we speak too. Often we launch with the goal of simply laying eyes on the patient to determine if they need ICU level care or can be downgraded. Its a trust issue and we know how to triage these patients and the MD's trust us implicitly. We typically hire from within and they usually are existing PICU nurses and RCP's so that relationship already exists when we become part of the dedicated transport team.

After this we wait. If there are in house procedure like taking a child to MRI that is on a ventilator, we will often go as a replacement for a doctor as we can manage the airway and give the necessary sedation. Its like being out on transport just not leaving the building. We also if not out on transport attend Trauma team activation, Code Blue's, Rapid Responses, backup vascular access, and the like. This keeps us occupied.

1312: An outside hospital calls. The have a child with breathing difficulty. The Transfer Center asks a series of scripted questions and then they connected to the appropriate specialist MD at our hospital. The referring paints a picture of a kid that might need ICU care. However, this kid based on symptoms meets COVID-19 Rule Out Criteria The MCP activates our team. Down in the ambulance bay our pagers (Its actually an iPhone but its a app based paging system) goes off. Being first up, we stop what we were doing (in this case trying to get lunch) and head to the ambulance bay. Our EMT's are already loading our gurney that has all of our gear into one of the rigs. We stand outside the rig and give a pre departure brief. PPE is checked and double checked. We go over roles and expectations, PPE use, path of travel once we return to our hospital etc.

1330: We depart (we have a mandate to depart in less that 30 minutes). Once we leave, I start making calls. First is to the Administrative Nursing Supervisor to inform her that we have a r/o COVID. We give approximate times and she lets security know, informs both the acute care and ICU that we have an inbound patient. Both units will prepare until we make patient contact and make a determination of level of care. We also call the referring hospital and get nurse to nurse report. The nurse is busy so we wait 15 minutes and call back. Report makes the situation less clear. There are contradictions between the nurses observations and the MD's. But we will sort those out when we arrive and lay hands on our patient.

1550: We arrive. We unload and head into the ED. The patient is in isolation so I get a quick update from the nurse and me and my RCP don my PPE and enter the room and leave the EMT's outside. We get into the room and introduce ourselves to the parents and asses the kid. The parents are calm but concerned. We quickly determine that while the child needs to come we they do not need ICU level care. We finish our assessment, perform some interventions, explain the covid visiting policy to the parents, mask up the parent coming, and have the EMT's push the gurney into the room. Normally they would be with us the entire time but we are trying to minimize exposure . We put on a full set of ICU monitors, and conduct a return home brief. We go over what to do when we arrive etc. We also go over everybody roles and desired interventions should the patient de-compensate.

1630: We return to the rig and load. Once inside and settled, we make more calls. We update the nursing supervisor on our destination. Let the ICU charge nurse know she can stand down, and update the MCP.

1900: Unexpected traffic delays our arrival a bit. We pull in and unload and are met by en escort in full PPE. We have a designated path of travel and encounter few in the hallways. We get to the room, unload the patient and while the EMT's begin decontaminating the gear and the gurney, we give report outside of the room (after doffing our PPE) to the receiving nurse and MD. Report is a 5-10 minute blurb that goes into past medical history, history or present illness, interventions at the outside hospital, interventions on transport, labs, and a head to toe assessment. The EMT's having deconed the gear head down to decon the rig. After that is done the assist the housekeeper loading a hospital grade UV light that then zaps the interior for a good 15 minutes. Only then can we use the rig again.

1950: another page. We head out again and repeat the same process. By the time we are done with the second COVID run its now almost 2300 and well past our shift end.

The other team did 3 closer in transports and there were more stacked up for our night shift. Breathing and living in PPE all that time takes its toll

0110: With the charting now complete the narcotics returned, and the gear restocked. We will be back on at 0900

That's an exacting, grueling and nerve-wracking shift, no doubt.

Thank you to you, your team and all the first responders and medical professionals on the front line.