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. 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...

IV Vasoactive Medication Basics for the Non Intensivist (March 19, 2020)

Video
5/11/2020
IV Vasoactive Medication Basics for the Non Intensivist (March 19, 2020)

This video provides a refresher/introduction to the basics of inotropes and vasopressors that may be helpful in the context of treating COVID-19 patients. It is not intended to be all-encompassing.

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

Acute Respiratory Distress Syndrome Lecture (April 10, 2020)

Video
5/11/2020
Acute Respiratory Distress Syndrome Lecture (April 10, 2020)

In this lecture, the topic or Acute Respiratory Distress Syndrome is reviewed. Specific discussion on diagnosis and treatment including lung protective strategies are discussed.

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

Ventilator Basics (ACVC) (March 19, 2020)

Video
5/11/2020
Ventilator Basics (ACVC) (March 19, 2020)

Ventilator basics (one mode) for non-intensivists

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

Ventilator Basics - Part 2 (ACPC and PS) (March 25, 2020)

Video
5/11/2020
Ventilator Basics - Part 2 (ACPC and PS) (March 25, 2020)

This video is an introduction to pressure control and pressure support ventilator settings. If you have not yet viewed 'Vent Basics for Non-Intensivists (ACVC/VAC)", please watch that video first. This video is not intended to be all encompassing. It is intended to educate non-intensivists on basic vent settings and vent mechanics.

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

Sedation and Analgesia in the ICU during COVID-19 (March 31, 2020)

Video
5/11/2020
Sedation and Analgesia in the ICU during COVID-19 (March 31, 2020)

This video is intended to assist healthcare providers with the care of critically ill patients only. It is to be used as a guide ONLY for patients who have breathing tubes and are mechanically ventilated (on breathing machines). It will introduce you to sedative and analgesic medications that are used in the intensive care unit setting only. It will provide recommendations for use of sedation and analgesia in standard settings, but it will also provide recommendations for use in resource limited

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

Airway Pressure Release Ventilation (APRV) (April 17, 2020)

Video
5/11/2020
Airway Pressure Release Ventilation (APRV) (April 17, 2020)

This video will explain the basics of Airway Pressure Release Ventilation, an option for mechanical ventilation, that is helpful as an oxygen salvage therapy for patients with Acute Respiratory Distress Syndrome (ARDS).

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

Multi-Dimensional Approach To Intubation In The Setting Of COVID-19 (April 1, 2020)

Video
5/11/2020
Multi-Dimensional Approach To Intubation In The Setting Of COVID-19 (April 1, 2020)

In this video, a doctor and nurse will talk you through preparing to intubate a patient. At the end of the video we highlight some special considerations for intubation in the context of COVID.

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

Transport Vent Tutorial (ParaPAC) (March 25, 2020)

Video
5/11/2020
Transport Vent Tutorial (ParaPAC) (March 25, 2020)

Transport Vent Tutorial - ParaPAC

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

ICU Nursing Series: Assembling Pressure Tubing (March 31, 2020)

Video
5/11/2020
ICU Nursing Series: Assembling Pressure Tubing (March 31, 2020)

This video will review how to assemble pressure tubing to transduce pressures and waveforms from arterial lines and central lines. Connection to an ICU monitor with zeroing is also reviewed.

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

Ventilator Tutorial V500/PB840 Drager (April 10, 2020)

Video
5/11/2020
Ventilator Tutorial V500/PB840 Drager (April 10, 2020)

Ventilator assembly and input of settings for two common ICU ventilators.

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

Shock Basics for the Non-Intensivist (March 19, 2020)

Video
5/11/2020
Shock Basics for the Non-Intensivist (March 19, 2020)

Shock Basics for the Non-Intensivist...in the age of COVID-19.

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

Awakening Trials, Breathing Trials, and Extubation (March 27, 2020)

Video
5/11/2020
Awakening Trials, Breathing Trials, and Extubation (March 27, 2020)

This video covers safety screens and failure criteria for Spontaneous Awakening Trials (SATs) and Spontaneous Breathing Trials (SBTs). These together form the ABCs of daily care of ICU patients on vents (Airway and Breathing Coordination). Additionally, it covers the criteria that should be met prior to attempting extubation.

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

Sepsis In The Age of COVID-19 (April 10, 2020)

Video
5/11/2020
Sepsis In The Age of COVID-19 (April 10, 2020)

This video will review diagnosis and management of sepsis with some clarifications/alterations that apply during the COVID pandemic. This video is not all inclusive. It is meant as a refresher for non-intensivists.

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

Acid Base for the Non-intensivist (March 21, 2020)

Video
5/11/2020
Acid Base for the Non-intensivist (March 21, 2020)

This video will teach you the etiologies for the various acid-base disorders as well as teach you how to interpret an ABG with a focus on metabolic acidosis and mixed disorders. This will teach you little to nothing about buffering, organic chemistry, biochemistry, etc. This is for practical application at the bedside.

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine

BAMCheroes appreciation

Video
4/29/2020
BAMCheroes appreciation

Our community has been a great source of support! Check out some of the positive feedback Brooke Army Medical Center has received for our incredible healthcare professionals.

Recommended Content:

Coronavirus | Coronavirus and the COVID-19 Vaccine
<< < 1 2 3 4 5  ... > >> 
Showing results 61 - 75 Page 5 of 6
Refine your search
Last Updated: May 17, 2021

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.