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BAMC nurses: “It’s us against COVID”

Image of Group of nurses at a hospital. Click to open a larger version of the image. Brooke Army Medical Center nurses conduct a shift change briefing in a COVID-19 intensive care unit. (Photo by James Camilloci, Brooke Army Medical Center.)

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Coronavirus | Coronavirus | Nursing in the Military Health System

With the recent surge in COVID-19, the beds are quickly filling in the intensive care units at Brooke Army Medical Center, a sprawling military hospital and Level I Trauma Center in the heart of San Antonio.

Many patients are on ventilators or hooked by myriad tubes and wires to a heart-lung bypass machine as they battle a virus that has so far claimed more than 147,000 lives in the U.S. alone. In the trenches beside them are the frontline healthcare workers – technicians, nurses and physicians – the last line of defense for the most critically ill patients.

“Dealing with the virus on and off duty, the (personal protective equipment), the long shifts … to be honest, it takes a toll on the staff,” said Army Lt. Col. Trisha Bielski, chief, Critical Care Nursing Services. “I couldn’t be prouder of my team and the job they’ve done in incredibly challenging circumstances.”

Over the past few weeks, BAMC has taken on additional civilian trauma patients and doubled its ECMO capacity to try to absorb some of the most critically ill community members with COVID-19 and ease the burden on other hospitals, Bielski explained. While BAMC primarily cares for military beneficiaries, a special secretarial designee status enables the hospital to accept civilian ECMO patients and trauma patients, as part of its Level I Trauma mission, in coordination with the city.

In recent months, COVID and the expanded ECMO mission have transformed 3S from a bustling inpatient ward into an equipment-laden area devoid of the chatter of family and friends. The nurses’ colorful scrubs are now concealed by gowns, their faces obscured by masks and face shields. Technicians stand by patient doors with a clipboard, meticulously ticking off boxes on a checklist, ensuring everyone who enters or exits a room is properly donning and doffing PPE. With safety on the line, mistakes aren’t an option when it comes to PPE.

“We continually train our staff on PPE wear and stress the importance of all safety measures,” Bielski noted. “It takes time but it’s effective and, I hope, reassuring for our staff who are understandably nervous about contracting the virus.”

While beneficial to the healthcare system, the trauma and ECMO mission expansions have generated a need for additional nurses and technicians to increase BAMC’s bed capacity. In some cases, Bielski is able to borrow nursing support from the U.S. Army Institute of Surgical Research Burn Center, which is housed in BAMC, or from outpatient clinics and other wards.

“We’ve been very stretched,” Bielski said. “We are constantly assessing our staffing models to ensure we can manage our patient census while ensuring the safest care.”

For the nurses pulled from other work areas, it’s often an adjustment to shift from a clinic to an ICU, especially one such as 3S that requires such a high level of patient care.

“One of the biggest challenges is working with staff I have never before worked with,” said Army Capt. Amanda Crow, ICU clinical staff nurse and charge nurse. “Despite this challenge, I have been continually impressed by the professionalism and hard work of the providers and nurses I have just met. Everyone has been very supportive and helpful to one another during this trying time.”

Communication is key, particularly when donning PPE for hours at a time. “It’s draining to wear PPE over a 12-hour shift, but more importantly, it creates challenges in communication, whether to your peers or with our patients,” said Army Sgt. 1st Class Jeremiah Canter, critical care nursing service noncommissioned officer in charge.

Face masks create a barrier of sorts between staff and patient, an unfortunate hindrance to communication in an environment where human contact is already severely limited. Aside from the staff, a BAMC-supplied tablet is often a patient’s only link to the outside world and loved ones.

“It’s heartbreaking that our patients who are so critically ill can’t have the comfort of their family members at the bedside at this time,” Bielski said.

The nurses do their best to fill the void with technology, an avenue that has proven vital for patient communication and morale. Crow recalled caring for an elderly patient battling COVID and other conditions. With all medical interventions exhausted, the family made the difficult decision to move toward end-of-life care. Crow coordinated a group video chat with the patient’s spouse, children and grandchildren prior to withdrawal of care.

“The family was able to talk to their loved one, see her face, pray for her, sing to her, and let her know how much she meant to them,” Crow recalled. “It was a very moving experience, and I am grateful I was able to facilitate it. I would like to think that having that time with family brought her comfort in her final hours and gave her family closure.”

“We do the best we can to make them comfortable. We talk to them when we are bedside and try to arrange virtual chats,” said Canter. “It really lightens their spirits at a tough time.”

Crow was inspired to become a nurse after seeing how nurses supported her father, who was ill, and her family when growing up. After joining the Army, she became even more determined to become a nurse after her older brother was injured in an IED blast while deployed and spent months recovering from a traumatic brain injury at Walter Reed National Military Medical Center. “I was inspired by the care he received and wanted to pay it forward to other families.”

“This is a strenuous time to be working in healthcare, and we are all facing unprecedented challenges,” she said.  

“I feel as a critical care section, we are the COVID response team,” Canter added. “It’s us against COVID, and we have too much at stake to lose.”

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