11.2 Disaster Preparedness for the Cardiovascular Service Line

These proceedings summarize the educational activity of the 16th Biennial Meeting of the International Andreas Gruentzig Society held January 31-February 3, 2022 in Punta Cana, Dominican Republic

Faculty Disclosures     Vendor Acknowledgments

2022 IAGS Summary Document

Statement of Problem

The experience of COVID-19 is like nothing we have ever experienced before. The time interval from identification of the first case in Wuhan, China (December 31, 2019) until ­declaration of a “global pandemic” was 3 months (March 11, 2020). In the United States this interval was just 2 months (January 20, 2020-March 11, 2020), giving us little time to prepare for what was ahead. The initial phases of the pandemic were the most challenging for the healthcare system in the United States. At Piedmont Healthcare in Georgia, we were tasked with responding on a statewide level to what was to be an overwhelming medical crisis. We immediately established incident command centers and developed COVID testing protocols and processes, along with treatment, infection control, and prevention protocols. We were also challenged with determining both in-person and remote workforce requirements in response to isolation and “stay-at-home” orders issued by the federal government. Days seemed like years as most of this work was new to all of us, and was constructed on a daily basis as the world changed around us.

Interestingly, the Centers for Medicare and Medicaid Services (CMS) has an ­“Emergency Preparedness Rule,” but almost no healthcare system knew how to implement the recommendations, as they were built for single-hospital entities, and furthermore most of the responsive measures were designed for natural disasters and major trauma rather than pandemics. It was a new world order.

Gaps in knowledge

The “infrastructure” needed for a pandemic response was, and is, mostly unknown. Clearly, with the results of our recent experience, we know a lot more now than we used to know.  Most systems like ours brought together multidisciplinary teams at a Command Center to both develop and implement what was needed to care for our patients, our physicians, and our other staff.  These teams included members from administration, several medical subspecialties, including but not limited to infectious diseases, pulmonary and critical care medicine, primary care, and cardiology. We also had nursing, communications, human resources and staffing, supply chain, information technology, patient experience coordinators, and others. These teams met twice per day in the early days of the pandemic. Additionally, we established collaborative efforts with other healthcare systems in Georgia, with daily conference calls to compare notes on strategies developing within our respective institutions, all trying to share experiences and knowledge and coordinate our many efforts.

Possible solutions and future directions

The experience of COVID-19 has been a marathon and not a sprint. Outbreaks were not all occurring at the same time in different areas, some areas led and some lagged, even within the geography of our state. We also soon came to realize after the “first wave” that it was not over. At the time of this writing we have just passed our fifth surge, with a hopeful respite for a few months. The lessons have been profound, and it is safe to say that American medicine responded to the urgency at hand, and ultimately got control over the viral pandemic. Lessons learned were that while hospital-specific plans are good for a single entity, multihospital systems dealing with widespread events like a pandemic require a degree of coordination (“system-ness”) that demands a different kind of infrastructure. Now that we know this, we will have it in place for the next challenge. As the saying goes, “life as we knew it has changed forever.”