Back to Top Skip to main content Skip to sub-navigation

Palliative care provides comfort to COVID-19 patients, families

Image of Military health personnel taking care of a patient. Click to open a larger version of the image. Air Force 2nd Lt. Aundrea Temple, assigned to the 60th Medical Group, 60th Air Mobility Wing, Travis Air Force Base, Calif., cares for a patient at Dameron Hospital, California (Photo by: Army National Guard photo illustration by Staff Sgt. Eddie Siguenza).

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus

When COVID-19 was spreading across Italy in February 2020, all eyes at David Grant U.S. Air Force Medical Center at Travis Air Force Base, California were fixated on the unfolding pandemic, realizing their hospital may potentially be one of the first to be impacted.

Air Force Lt. Col. Laurie Migliore, acting director, Clinical Investigation Facility and director of Biobehavioral Research, along with essential medical personnel were charged with reviewing Grant's Crisis Standards of Care, particularly the availability of palliative care for potential COVID-19 patients.

Migliore said it became evident from seeing the death rates in Italy that DGMC may be impacted with unprecedented numbers of critically ill and potentially dying patients. They had to be ready to provide both medical and palliative care.

"Our goal was to develop a point of care tool that was targeted, practical and easy to use by frontline medical providers," said Migliore, who is also a registered nurse. "As the pandemic began to spread throughout the country, the volume of information evolved from scarce to the point of overwhelming."

Migliore developed a toolkit to provide guidance and information to medical personnel in four areas:

  • Basic understanding of palliative care and palliative care principles
  • Communication strategies and resources (getting on the same page, scripts)
  • Symptom management (alleviating pain, breathlessness, anxiety, etc.)
  • Support for caregivers (dealing with blame, guilt, anger, grief, death/dying)

Palliative care is specialty medical care for individuals with serious illnesses and is often provided by specially-trained teams of doctors, nurses, social workers, chaplains, and therapists.

Air Force Reserve Col. Stephen Hernandez, who was activated and deployed to New York City in April 2020, supported FEMA-led operations in New York. During his deployment, he served as the deputy team lead at Lincoln Medical Center in the Bronx, New York. He became a wealth of knowledge for Migliore with direct exposure to COVID-19 patients and their palliative needs.

During Hernandez's six weeks at the medical center, palliative care for COVID-19 patients was almost non-existent. He stated if the frontline medical staff had access to something similar to the toolkit the Grant team is developing, they could have focused more on providing palliative care rather than only life-prolonging care.

"Palliative care is important during a pandemic to optimize patient and family quality of life and to mitigate suffering among people with a serious illness," said Hernandez, who served as the chief nurse for more than 60 other reservists providing care at Lincoln. "It also has the potential to maximize and conserve limited resources to focus on seriously ill patients who have a higher likelihood of recovery."

Based on the evolving pandemic and feedback from Hernandez, Migliore and the staff supporting the project began a PICO (Population, Intervention, Comparison, Outcome and Time) analysis, literature review and toolkit development.

Military health personnel providing curbside COVID-19 testing
Air Force Maj. Alisha Florence and Senior Airman Rachael Tuczynski, nurses assigned to the 60th Medical Group, 60th Air Mobility Wing, Travis Air Force Base, California, gather information and perform preliminary patient checks outside of Adventist Health Lodi Memorial hospital in Lodi, California, July 29, 2020. The medical team, in support of Task Force 46, Joint Force Land Component Command, U.S. Army North, helped initiate curbside checks as a way to expedite care for growing COVID-19 cases in this San Joaquin County facility (Photo by: Army National Guard Staff Sgt. Eddie Siguenza).

They also submitted a grant proposal to purchase tablets and other technology required to provide communication between patients and their families.

Migliore said that the PICO analysis and literature review identified three primary needs by staff and patients during the pandemic.

  • Critical need for frontline/primary care staff to receive rapid palliative care training
  • Access to existing palliative care specialists as consultants and subject matter experts
  • Need for regular palliative education and training

About a year after the project began, the toolkit is now available, empowering frontline medical staff and bridging the gap in palliative care.

"The toolkit focuses on palliative care, communication, symptom management, and support of caregivers," said Migliore, who was personally affected during the pandemic and benefited from information the toolkit provided to the staff, taking care of her husband and using the means of communication the tablets provided. Her husband was admitted to Grant's ICU with cardiac issues during the pandemic.

"When I brought him to the emergency room I wasn't prepared for him to be admitted, I thought that he would get some medications, stabilize, and return home," she said.

Instead, he was admitted from the emergency room to the intensive care unit and the only means for them to communicate was through the tablets provided by the pilot program.

"The nurse taking care of my husband learned that I was one of the team leads for the project," Migliore added. "She told me how grateful the staff was for the tablets and how helpful they were for patients and staff during the visitor restrictions."

The toolkit is now available to all DHA medical professionals on the organization's internal website.

According to Migliore, the pilot is concluding soon and the results and lessons learned will be published and made available to military hospitals and clinics, incorporating the COVID-19 Palliative Care Toolkit into inpatient practices.

"We worked out some significant challenges despite constantly deploying staff and issues with inpatient internet capability," she said. "We incorporated feedback from the field to refine the contents for a simple yet relevant and practical resource."

The short-term goal of the pilot was to provide immediate palliative care resources to medical staff based on evidence and vetted by palliative care subject-matter experts for immediate use during the pandemic. The long-range objective is to develop centralized, standardized resources for palliative care use throughout the Military Health System.

"The enterprise would benefit from standard order sets, protocols, and simulation training for staff/patient communication for goals of care during high-stress crisis situations," Migliore said. "Ultimately, the impact (of palliative care) is improved quality of life, decreased suffering, and satisfied patients and families."

You also may be interested in...

Got Your 6 - Jan. 3, 2022

Video
1/4/2022
Got Your 6 -  Jan. 3, 2022

‘Got Your 6’ is TRICARE’s COVID vaccine video series that delivers important information and updates, on days that end in ‘6.’ It includes the latest information about DOD vaccine distribution, the TRICARE health benefit, and vaccine availability. Got a question about ‘Got Your 6’? Send an email to dha.ncr.comm.mbx.dha-internal-communications@mail.mil Find your local military provider at tricare.mil/MTF, or go to tricare.mil/vaccineappointments and schedule yours today!

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus | COVID-19 Vaccine Efforts | Getting the COVID-19 Vaccine

This is my Why

Article Around MHS
12/30/2021
Air Force Senior Airman Marcus Bullock poses for a photo after receiving his COVID-19 vaccination

Air Force Senior Airman Marcus Bullock stated his reason for getting the vaccine was to help his mother and son be able to have a play date again.

Recommended Content:

COVID-19 Vaccine Efforts | Coronavirus

Development of WRAIR’s Pan-Coronavirus Vaccine Shows Promise

Article
12/28/2021
A vial of spike ferritin nanoparticle WRAIR's COVID-19 vaccine

Series of preclinical studies supports the Army’s pan-coronavirus vaccine development strategy

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus | COVID-19 Vaccine Efforts

Immunization Experts are Central to COVID-19 Vaccine Program

Article
12/20/2021
Medical director at Fort Riley, Kansas receives a COVID-19 vaccination In his left arm from a tech in personal protective equipment.

Immunization Health Division at forefront of COVID-19 vaccinations.

Recommended Content:

Coronavirus | COVID-19 Vaccine Efforts | Coronavirus and the COVID-19 Vaccine

Military Health System Marks 1-Year Anniversary for COVID Vaccinations

Article
12/14/2021
FEmale Marine gets COVID 19 vaccination in left  arm at Camp LeJeune in December 2020

More than 6.4 million COVID-19 vaccine doses have been administered a year after first shots within MHS.

Recommended Content:

Coronavirus | COVID-19 Vaccine Efforts | Getting the COVID-19 Vaccine | Coronavirus and the COVID-19 Vaccine

So others may breathe - Navy Medicine Respiratory Therapist cares for COVID casualties

Article Around MHS
12/13/2021
Military Health personnel posing for a picture

Navy Hospital Corpsman 2nd Class Tessa Hazard, a respiratory therapist, recently deployed to Alabama as a member of a COVID-19 response team.

Recommended Content:

Coronavirus

Army Public Health Center provides update on Long COVID risks

Article Around MHS
12/1/2021
COVID19 Symptoms

According to the Centers for Disease Control and Prevention, Post-COVID conditions are a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19.

Recommended Content:

Coronavirus

JTF Coyote begins pediatric COVID-19 clinics as adult booster vaccination numbers increase

Article Around MHS
11/23/2021
Military health personnel giving the COVID-19 vaccine

The Vermont National Guard now supports the state's response to the COVID-19 pandemic with vaccinations for youth in the 5 to 11 age group and booster clinics for the general adult population.

Recommended Content:

COVID-19 Vaccine Efforts | Coronavirus

MHS Reaches 6 Million Doses of Vaccine Against COVID

Article
11/10/2021
Airmen of the 139th Airlift Wing, Missouri Air National Guard, receive COVID-19 immunizations as a part of the federal mandate at Rosecrans Air National Guard Base, St. Joseph, Missouri, Oct. 2, 2021. The 139th Medical Group oversees the operation. .

Military passes 6 million mark for COVID-19 shots administered across the Military Health System.

Recommended Content:

Health Readiness | Coronavirus | COVID-19 Vaccine Efforts | Getting the COVID-19 Vaccine | COVID-19 Information for Military Treatment Facility Directors

COVID 19 Vaccine Is Now Available for Children 5 to 11

Article
11/9/2021
5-year-old girl in mask reads a book by herself

COVID-19 vaccines for 5-11 year olds are ready now through MHS

Recommended Content:

Coronavirus | COVID-19 Vaccine Efforts | Getting the COVID-19 Vaccine

Vax Facts for Children

Infographic
11/4/2021
Vax Facts for Children

Should Young Children Get the COVID-19 Vaccine? Yes. The CDC recommends that children ages 5-11 receive the Pfizer-BioNTech COVID-19 pediatric vaccine.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Vaccines for Children

Vaccine for Children TLDR

Infographic
11/4/2021
Vaccine for Children TLDR

Vaccination is our best defense against the spread of COVID-19.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Vaccines for Children

DHA-Policy Memorandum 21-004: Coronavirus Disease 2019 Vaccination Attestation, Screening Testing, and Vaccination Verification

Policy

This memorandum provides guidance on the implementation of vaccination, attestation, and testing requirements in accordance with the References listed in Attachment 1 to reduce the transmission of the virus that causes COVID-19.

Pregnancy Health Alert: COVID-19 Vaccine is Strongly Recommended

Article
10/20/2021
Pregnant women gets the COVID-19 vaccine

Get vaccinated for COVID-19 if you’re pregnant or trying, DOD and CDC and advise.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Women's Health

More Than 95% of Active Duty Have Received COVID-19 Vaccine

Article
10/15/2021
Female hospital corpsman gives a COVID-19 vaccine injection to a sailor in her left arm

Service members continue to line up for COVID-19 vaccinations.

Recommended Content:

COVID-19 Vaccine Efforts | Coronavirus | COVID-19 Information for Military Treatment Facility Directors
<< < 1 2 3 4 5  ... > >> 
Showing results 46 - 60 Page 4 of 40

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.