TABLE 3.
Summary of Pandemic Response Across Philadelphia Trauma Centers
| Workforce Planning |
| Integrate trauma representative into Incident Command Structure |
| Meet weekly with regional TMDs and TPMs |
| Train nontrauma general surgeons to augment critical care services |
| Expand anesthesia role to support Emergency Department intubations |
| Streamline trauma teams to balance clinical coverage while minimizing exposure |
| Activate reserve team members as needed to support high-volume clinical activity and to backfill staff quarantining/illness |
| Integrate telemedicine into bedside rounds and specialty consults with limitation of in-person visits to essential assessments (e.g. tertiary survey) |
| Dedicated teams perform high-demand procedures (e.g. vascular access, tracheostomy) |
| Trauma Bay and Resuscitation Changes |
| Screen and/or test patients for COVID-19 during intake and trauma resuscitation |
| Add physical barriers to isolate bays |
| Designate specific bays for use by COVID-confirmed or suspected patients |
| Convert patient assessment areas to negative-pressure if possible |
| Designate specific areas for donning and doffing of PPE |
| Remove unnecessary equipment |
| Limit personnel in the trauma bay to essential personnel only |
| Perform critical procedures by most experienced care team member |
| Perform AGPs (including intubation) in the trauma bay prior to transport |
| Employ in situ simulation to reinforce workflow and procedural changes |
| Radiology Protocols |
| Limit imaging to decision-critical studies as much as possible |
| Examine for findings consistent with COVID-19 infection on chest imaging |
| Operating Room Changes |
| Transport to OR by most direct route with staff in appropriate PPE |
| Designate specific operating room(s) with negative-pressure capability for COVID-confirmed or suspected patients |
| Convert existing ORs to negative-pressure capability if possible |
| Minimize personnel traffic in the OR |
| Designate “clean” runners outside the OR to obtain needed equipment and supplies |
| Consider reconfiguring OR rooms to augment PACU/ICU capacity |
| Operating and anesthesia team members wear appropriate PPE during AGPs |
| Blood Product Utilization |
| Collaborate with national organizations (e.g., American Red Cross) to sponsor blood donation drives |
| Limit nonemergent transfusions to preserve supply |
| Limit use of rare blood types |
| Education and Training of Housestaff |
| Convert educational and working conferences to teleconference format |
| Incorporate housestaff into procedural teams to maintain and bolster technical skills |
| Record and disseminate in-situ simulation for training |
CME, continuing medical education; GME, graduate medical education.