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| May 18, 2020 |
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Experience of the SOCEUR Surgeon in response to the COVID first peak in Stuttgart, Germany COL Jay Baker, MD As an emergency medicine resident, I never imagined working for Special Operations Command Europe (SOCEUR), a two-star headquarters in Stuttgart, Germany, much less one that turned me into an international jetsetter. Since taking over this position in summer 2018, I’ve traveled for work to 11 European countries, with my family to seven more, and back and forth to CONUS several times yearly. I had briefly given up clinical emergency medicine again to live a globetrotting, expat way of life and was really enjoying it. That high-flying lifestyle all changed the last week of February upon returning from a brief TDY in Belgium. Despite the first reporting of a COVID-19 case cluster in Northern Italy, it was hard to comprehend the sudden war footing taken by my fellow command surgeons. A couple of full days racing to catch up convinced me to turn my small staff into a full-time coronavirus information processing machine, and we just managed to keep the epidemic inside medical lanes for a few days more. As COVID cases in Germany doubled every three days, I grew uneasy. My staff swam against the tidal wave of information that was rapidly swelling and I recognized a full SOCEUR staff effort would be required. To the great credit of the J3 operations officer, he embraced the ambiguous threat from the moment I walked into his office and announced, “Marcus, this is real.” SOCEUR began operating from that moment to implement USEUCOM’s Plan for Pandemic Influenza and Infectious Disease, and has been going gangbusters since that day. The viral threat grew exponentially as SOCEUR and the rest of the US military community in Europe raced to stay ahead. Reported cases in the local area grew in two weeks from 35 to 600, and some quick napkin math showed that cases would reach 10,000 in two more weeks if doubling continued unabated. Around this time, President Trump announced the travel ban from most of Europe, and the first cases in US Army Garrison Stuttgart started trickling in. Two buildings away, a super-spreader unwittingly unpinned a viral hand grenade that ended up taking out a significant amount of personnel both for isolation and quarantine. This unlucky event reached over to SOCEUR and took out our first couple of COVID-positives too. Game on. For all of us who’ve deployed, we know war is deadly serious business. We’ve seen and followed combat arms officers lead troops into battle, readied ourselves, and responded quickly and expertly according to the need. The first several weeks of COVID response was no different, but for the first time medical was suddenly thrust to the tip of the spear as the main effort. At a staff headquarters against this particular enemy, our task simply came down to knowledge management and execution. The volume of meetings and emails were incredible, as we fought to keep up with the news, the literature, CDC guidance, daily orders from two 4-star headquarters, and the hasty preparations of Garrison command. We churned and jammed out the products and guidance SOCEUR needed to respond effectively to a pandemic emergency, drawing up prevention products, case identification products, quarantine and isolation products, tracing and cleaning products, reporting products, and tracking products to monitor country-level risk across the area of operations. Not only were we flying the airplane while building it, we were drawing the blueprints too. Just in the nick of time, as Garrison shut down and SOCEUR implemented mission critical manning, we set the medical framework before losing half my office to isolation and quarantine for 14 days. Despite being ill, my team worked from home, eventually managing more than a handful of COVID-positive personnel and many, many more in quarantine. Meanwhile, Germany had shut down too, progressing through various stages of public health measures, from canceling schools to shutting groceries, etc… you know the rest. SOCEUR has since returned to higher manning levels with no permanent losses or even real scares across the command. We’re adjusting to the new operating environment and are increasing the readiness and capabilities of our forward deployed SOF elements. For example, we’re pushing CPAP and more oxygen to our medics downrange. Eastern Europe apparently learned from its western neighbors and has achieved much lower infection rates, at least for now. Our top concern is helping our deployed teams weather the following peaks, which, if the example of the 1918 flu pandemic is any clue, could be far greater. Strange bonus, I’ve become a pandemic emergency epidemiologist along the way. An Ode to the Class of 2020 MAJ Laura Tilley, MD FACEP On April 1, 2020, the Uniformed Services University of the Health Sciences (USUHS) graduated roughly 170 medical students and 60 graduate-level nursing students 6-weeks ahead of schedule in order to support the COVID-19 pandemic. The new physicians immediately began working in the Washington, D.C. area primarily screening incoming patients. The nursing graduates proceeded directly to their new duty assignments. Twenty of this year’s School of Medicine (SOM) graduates, roughly 12% of the class, were selected for Emergency Medicine residencies and will soon start their training at either military or civilian programs. Due to the unique military medicine curriculum at USUHS SOM, these students are particularly well trained in emergency management, emerging infectious disease, and disaster response. Please join me in congratulating them on this tremendous achievement. Their hard work and perseverance over the past years and particularly during the past few months, has not gone unnoticed. We look forward to welcoming them into the world of emergency medicine and seeing what they will accomplish. The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense.New York City Field Hospital Highlights Skills of Special Operations Forces Medics COL (ret) Melissa Givens, MD The New York-Presbyterian (NYP) Ryan F. Larkin Field Hospital is a 200+ bed field hospital adjacent to NYP Allen Hospital and located inside the “Bubble” within Columbia University’s Baker Athletic Complex. The NYP Ryan Larkin Field Hospital (NYP-RLFH) began providing critical surge capacity for inpatient medical care of COVID positive adults beginning in mid-April. After driving to NYC on April 2nd to see how I could help in the pandemic, I realized there were desperate medical staffing needs across NYC. I was connected by Dr. Steven Rush, a NY native physician who works with the Air Force pararescue community, to Dr. Laureen Hill, COO of NYP/Columbia University Irving Medical Center. Dr. Hill was leading an effort to construct overflow patient care spaces but did not yet have a means to staff the facility. After hearing my idea to staff the field hospital with veteran volunteers, we agreed to proceed with additional assistance from Dr. Kate Kemplin, a former EM nurse colleague. My intent to utilize Special Operations medics was built on a backbone of experience providing medical support for the Special Operations Community and Dr. Kemplin’s published expertise in defining Special Operations Medics’ competencies. After talking to Dr. Hill on the evening of April 4th, I tapped into my veteran network by posting a Google form on social media. In a few hours, around 50 people responded. The following day, the request for help was shared with several veterans groups and Special Operations Forces groups. Naming the hospital after Ryan Larkin, a Navy SEAL sniper and medic whose suicide represents the need to raise awareness for military traumatic brain injury, served as a rallying cry. While NYP was transforming a soccer field into a hospital, my team and I were forming teams of medical professionals ready to travel to NYC with only a few days notice. Hundreds of phone calls and emails were exchanged, and ultimately over 150 people agreed to travel to NYC, including many former Special Operations Forces medics. They knew little more than that they would be caring for COVID positive patients and NYP would provide lodging, food, and a fair wage. The underlying spirit amidst those who responded was one of servitude and a desire to help American citizens suffering during a pandemic. The advance team converged on NYC on April 8th and met with the NYP team already heavily involved in hospital construction. When the team took their first tour of the “Bubble,” the flooring was just being installed. The NYP team and the Ryan Larkin team quickly began to collaborate and merge into one cohesive team to facilitate the reception and on boarding of 150 clinical staff. Just one week and a day from the time the idea was exchanged between Dr Hill and I, the NYP-RLFH opened and received its first patients. At the writing of this article the field hospital continues to see patients and provide critical offloading to the taxed NYP hospital system. The field hospital has operated without a single employee falling ill to COVID despite caring only for COVID positive patients. The field hospital has also successfully employed Special Operations Forces medics practicing at an RN equivalent after a brief bridging period. Over 900 people have since volunteered using that original Google form, and with the help of Dr Steve Rush, many of these volunteers have been employed in hospitals across NYC. I feel so fortunate to be working with such motivated, skilled and caring individuals. The work they are doing is second to none and I will be forever grateful for their willingness to answer the call. Greetings from the Javits Center in New York City CDR Bradley Butler, MD FACEP FAAEM Greetings fellow GSACEP members from the Javits Center in NYC, where I am currently deployed in support of the COVID 19 response with JTF Silver Dragons alongside our colleagues from the Army, Air Force, and US Public Health Service. We have cared for over 2,000 patients at the Javits Center, on the USNS Comfort, and in the community! I have never been prouder to be an emergency physician, especially one in the military! As the current Emergency Medicine Specialty Leader for Navy Reserve Medicine, I am very proud of my Navy Reserve colleagues for their patriotic medical support of our country,our service members, and our allies serving around the world! Allow me to share some statistics on Navy Reserve Emergency Medicine. Currently we have nearly a third of our entire force deployed on active duty! Half are deployed CONUS in support of the COVID-19 response in NYC, and half OCONUS in support of military operations around the world. Our own recently promoted RDML Pamela Miller is leading many Navy Reserve efforts on the east coast, including the USNS Comfort mission in NYC. Two emergency physicians will be advising the Marine CENTCOM CG as MARCENT Surgeon (CAPT(sel) Delk) and MARCENT Deputy Surgeon (CDR Byrne). Another half dozen will be spinning up to deploy over the next six months. Most of us who deployed CONUS in support of the COVID-19 response waived dwell and volunteered for the deployment. Nearly two thirds of those deployed CONUS were volunteers. At least three members have returned from a deployment within the last six months. Two members currently deployed both volunteered for the deployment and are less than a year out of finishing their EM residencies (ooh rah LT Reeder and LT McCreary!). An additional half dozen Navy Reserve emergency physicians volunteered to deploy in support of the COVID 19 response but were not needed, including retired Navy Reserve CDR Mark Plaster! All of this, in addition to supporting our own communities back home, taking care of COVID-19 patients in addition to our “regular” ED patients. It is certainly a great time to be an Emergency Physician with Navy Reserve Medicine. Thank you all for your service. You make me proud to humbly serve as your Specialty Leader! “Navy Reserve Emergency Medicine- a ready medical force ensuring a medically ready force” To read a first-hand account of day-to-day life at the Javits Center click here Joint Services Symposium on EM (JSSEM): Military, Tactical, and Operational Emergency (MTOE) Medicine Course CPT Jared Cohen, MD Can COVID keep military EM physicians from advancing the field? I don't think so! Dates for the 2020 Joint Services Symposium on Emergency Medicine have been set! This is the 5 year anniversary of what has proven to be a truly unrivaled readiness and networking opportunity. This tri-service national conference is open to all Military Emergency Physicians, PAs, and those interested in Operational Emergency Medicine. There is no other Emergency Medicine conference quite like it. SAVE THE DATE: Wednesday, September 2nd and Thursday September 3rd - San Antonio, Texas
What we need from you: **Put the date on your calendar. This conference is free for active duty military and will provide ample CME and ICTL/CMRP training** TO REGISTER FOR THE CONFERENCE: Conference Registration Conference Agenda: For those that want to be LECTURERS or ACTIVE PARTICIPANTS please email: Jared.L.Cohen.mil@mail.mil ➢ NOTE: Google Forms will not open on many Government computers 1) Attending Lecture slots: 15-20 minutes (15 slides max) 2) Lightning Lecture Competition: 10 minutes (10 slides max) 3) EM Military Residency Sim Wars Competition: 4) Research Abstract and Podium Competition: 5) Nominate yourself or colleagues for the EM Consultant Awards ❖ This year’s awards include (details can be found at link above): ➢ USA, USAF, and USN EM Physicians of the Year (one per service) FAQ: Q: Where should I stay? Q: When will I know if I was selected as a speaker or if my research was selected? Q: I want to come to the conference to learn and spend time with my colleagues after long periods of self-isolation. How do I sign up if I do not want to be a speaker? Q: If the conference is free, do I even have to register? IF YOU HAVE ANY ADDITIONAL QUESTIONS ABOUT JSSEM 2020, please contact Jared.L.Cohen.mil@mail.mil Humbled and Human CPT Matthew Mischo, MD I’ve been learning a lot about humility these past two months. Humbled, as I walk out of a child’s room after talking to her anxious father. Yes, this could be the virus you’ve heard about on the news. No, I’m not going to test your daughter for it. Yes, I know they’re saying everyone should be tested, but there are only six swabs left in the entire hospital. I know you’re frustrated. I am, too. I know I should be able to do more. I can call the hospital down the road, if you want, but I expect they’re in the exact same situation. Strangely, I have time to do that, for once. Humbled, as I talk with a friend from med school. A resident in pediatrics in a city harder hit than us, pulled from his clinic last week to man an adult ICU. Volunteering because he’s young, he’s healthy, he’s single, and we both know of providers who’ve died from this already. He doesn’t wear a uniform, but he understands that he signed up for this every bit as much as I did, despite social media posts from some medical peers claiming the opposite. Because he took an oath when he graduated medical school—the same oath I did—and one that comes with just as much duty as the one I swore in front of an American flag. But just because he probably won’t get sick, doesn’t mean he isn’t at risk for damage. That much is obvious as he tells me how he watched another patient die, and I hear in his voice that it’s shaken him. A patient his same age, without medical problems, either. Part of the job we signed up for, again, but that knowledge doesn’t make it any easier for him. Humbled, as I open the news on my phone, or check IHME predictions one more time. To see how a mindless string of protein a thousand times smaller than the width of a hair can bring a global society screeching to a halt. How it can force us, all together, to stop and realize just how very small we are. That despite our ability to reshape mountains and molecules, we are so, so very far from omnipotent. That the natural world isn’t cruel, or cold, or malicious. That it’s simply indifferent to the fate of the few billion organisms among its nearly-infinite, uncountable trillions who share the same inflated sense of self-importance that I do. And that feeling of powerlessness cuts me deep, especially for someone whose ego is perhaps a bit too large. Humbled, as I walk into a breakroom crowded with donated food. With cards from people I’ve never met filled with kind words I feel I’ve done little to deserve. As I hear story after story of helpers across the world, both large and small. Of teenagers manufacturing masks on 3-D printers inside their garages. Of neighbors supporting neighbors they scarcely talked to half a year ago. Of simple thank you’s, and genuine gestures of affection that mean so much more when handshakes and hugs are forbidden. Viruses may be indifferent, but my species certainly is not. And that doesn’t erase all of the above. Not the anxiety a parent feels, or the helplessness of a healer who has no tools left to heal. It doesn’t negate the fears of a society facing trade offs it never imagined, or the uncomfortable weight of existential truths that we can’t ignore in a time like this. But I think it’s important, nonetheless. Sometimes when your job is to look for suffering, suffering is all you’re inclined to find. And at the risk of sounding horribly cliche, it’s easy to forget how beautiful this indifferent world is, and how genuinely good the people living on it can be. That kindness and compassion may not be features of the landscape, but that humans carry so much of both with us. And that, more than anything else, leaves me humbled. Finding new roles and possibilities in the non-clinical setting: A medical student perspective during COVID-19 ENS Saki Kitadai It was shocking to find that email in my inbox on March 16th, addressed to our entire class from the Dean’s office. The words “rapidity” and “serious” were embedded within it, but one particular phrase hung heavily on my mind: today will be your final day. Due to COVID-19, we were dismissed from all clinical sites until further notice. I sat there stunned, less so by the inevitable decision that had been looming over our heads for weeks, but by a sense of loss that only grew in the following days as we transitioned from hospital to virtual learning. As a third-year medical student, this past year was about finally applying our classroom knowledge and learning from patients, clinical decision-making, and the triumphs and lessons embedded in the process of disease management. We’d been taught how to function on a multifaceted team, and act in our own capacity as students to help provide patient care. Finally, after spending most of the year learning about and experiencing a wide range of specialties, I had come across emergency medicine and felt like I’d found the field for me. I couldn’t wait to spend more time in the emergency department after my final clerkship. However, we had lost our hospital privileges overnight, and with them a sense of belonging that we’d nurtured over our year in the clinical environment. Looking back, I was my own biggest obstacle in the first few weeks away from the hospital. On one hand, there were the general worries brought on by the pandemic, including the high-risk members in my home, the health of family living far away, navigating social distancing in a small and overcrowded neighborhood, and having future plans placed on hold. On the other, I felt grief and guilt over my own inaction at a time when the entire healthcare system was under duress, and my own mentors and friends remained at the front lines of the crisis. If only I’d been further along in my training! If only my obligation was to get out there instead of staying in class! However, the initial panic eventually gave way to forward momentum. One of the wonderful things that I and many others have witnessed during the time is the ability of people to come together and build one another up in new and creative ways. I am proud of members of my own class who have taken the opportunity to mobilize volunteer groups, deliver groceries, and help with case tracking all over the country. I found my support in a group of fellow students who noticed that buildings and campuses all over Massachusetts were being vacated in the wake of the COVID outbreak, at the same time that organizations were urging local government to reduce the burden of disease among individuals experiencing homelessness and/or incarceration. Over the next few weeks, we wrote proposal letters to our university administrations advocating for dormitory spaces to be allocated to unhoused members of the community. Along with the help of my friends and mentors, I began facilitating an intercollegiate coalition of students from all over Greater Boston who have worked together to draft letters to school administrations and advocated to local legislators to increase housing supports using spare campus and hotel spaces. Through this process, I have met students and stakeholders of all backgrounds, learned more about the intersection of medicine, law, and public health than I ever did in my school courses, and have been humbled by those who have dedicated their entire careers to health equity and service. Furthermore, I have been reminded of the ways that emergency medicine is public health medicine, and how my ability to advocate for both medically and socially vulnerable populations will impact the acute illnesses that I hope to eventually manage in the emergency department. Despite the initial shock of being taken “out of action” in my clerkships, I am grateful for the opportunity to redefine what it means for me to take action outside of the hospital. That being said, THANK YOU to all those who continue to dedicate themselves to the health and care of others in the clinical setting! Upcoming events September 2-3, 2020 - Joint Services Symposium on EM September 17-18, 2020 - Madigan Emergency Medicine Residency 40th reunion Thanks to everyone that contributed to this issue and to the fight against COVID-19. To read additional stories and perspectives, check out the COVID-19 section of the GSACEP website. |
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