Ensuring the safety of Wright-Patterson Medical Center, CST operations were staged in the center’s parking lot, and a drive-through testing process was developed. With the support of the 88th Logistics Readiness Squadron and 88th Civil Engineering Squadron, the Medical Logistics Flight coordinated the creation of two temporary structures, providing the team with heat, shelter and electricity.
The Medical Information Systems Flight worked with the 88th Communication Squadron to run fiberoptic cable to the site, allowing the team to perform DEERS checks, submit lab orders, print specimen labels, rapidly input prescriptions and document medical records, all from the parking lot.
Following the recommendations made by the Centers for Disease Control and Prevention, the team began screening all patients, visitors and staff before they entered the medical facility. Enabling this new level of safety for beneficiaries and staff members, the group leadership, MCC, manpower and clinical teams developed entry control screening teams. The ECP teams’ mission was to evaluate all personnel entering the facility for fever, coronavirus symptoms and out-of-state travel as they pose a risk for COVID-19 infection.
The data-driven design of this process resulted in immediate success. On the first day, the ECP teams screened nearly 1,600 staff members and hundreds of patients entering the facility with an average wait time of five minutes. Building on a culture of continuous improvement, the ECP teams have continued to update the screening process each week and streamlined their operations by enhancing the accuracy of temperature capturing, improving the screening questionnaire and eliminating the wait time for both team members and patients.
During the earliest stages of pandemic response, the 88 MDG Pharmacy team implemented an innovative drive-through service at its satellite Kittyhawk Pharmacy location to preserve accessibility for all beneficiaries while ensuring customer and staff safety. To satisfy the substantially increased demand – approximately 2,000 prescriptions daily – the Pharmacy team transitioned to curbside service in which an Airman greets a patient in their vehicle, obtains identifying information and then relays the information to the internal pharmacy technician, using a ticketing system. A second Airman then picks up the medication and delivers it to the patient by referring to the vehicle description noted on the ticket.
This inventive pharmacy process would not be possible without volunteer Airmen from units across the 88th Air Base Wing. These volunteers comprise the bulk of the Airmen delivering medications to patients, enabling the pharmacy staff to process nearly 9,000 prescriptions every week.
COVID-19 preparation course created
The Simulation Center team quickly realized clinical staff needed knowledge and skills in their arsenal to effectively combat the coronavirus. After much research, the team was able to develop a detailed COVID-19 preparation course packed with practical knowledge on managing pandemic response within a healthcare facility.
The course has been offered to all personnel as a general knowledge training platform to address personal protective equipment (PPE) and infection control practices. Within 30 days, the team conducted 32 classes, training 209 personnel.
The 2-hour curriculum includes both a classroom education and a work center orientation. The instruction covers proper PPE donning and doffing procedures, appropriate techniques for specimen collection and a demonstrational tour of operational practices. This training was rapidly developed in one week with the assistance of the Simulation Center staff.
At the end of April, the team had conducted 11 classes and trained 51 healthcare workers. Additionally, they were able to have 37 AMSA Phase II students observe this unique testing site process as part of their training.
Laboratory research communicated
At the first news of a potentially communicable respiratory virus, the Laboratory team also immediately sprang into action. 88 MDG Microbiology Chief Capt. Stephen LeSage began researching the disease and briefed staff on the suspected pathogen.
Along with Microbiology Technical Supervisor, Jessica Johnson, LeSage coordinated with the CDC, the 711th Human Performance Wing’s Epidemiology Laboratory and the Ohio Department of Health to secure access to testing and establish a communication network for the most up-to-date situation status.
The laboratory management team then scrutinized the 88th Air Base Wing Disease Containment Plan with the Public Health Flight to ensure the lab team was appropriately postured for an imminent pandemic. Laboratory Medical Director Lt. Col. (Dr.) Arthur Clarkson coordinated with the physician teams and quickly modified test menus with expanded arterial blood gas capabilities and the additional disease monitoring analyses required to treat an influx of ventilated patients.
As the primary Department of Defense COVID-19 testing site, the 711th Epidemiology Laboratory, the sister laboratory to the 88th Medical Group, has also up-scaled its operations. Assisting their team to meet the increased demand, the 88 MDG Laboratory team augmented the staffing support necessary to maintain a continuous flow of specimen processing. The 88 MDG Chief of Core Laboratory Capt. Daniel Wilson collaborated with the Pharmacy team to manufacture viral transport media in-house, averting a critical shortage for several local medical facilities.
To ensure continuous testing capabilities, Tech. Sgt. Jacob Grimes, a member of the Dental Laboratory Flight, contacted FormLabs, a 3D printing company the Dental Lab uses for fabricating dental appliances, inquiring about 3D printing nasal swabs. Grimes teamed up with Chris Crowley at FormLabs to develop a fabrication process and ensure full FDA compliance. He then expedited the procurement of supplies through Medical Logistics and worked with the Dental Infection Control NCO in Charge Staff Sgt. Virginia Campbell to develop a sterilization process that would be in compliance with the manufacturer’s instructions for use.
The Dental Laboratory has since printed a test batch to be quality checked by the Medical Laboratory Flight commander and following all quality assurance and compliance checks, the Dental Lab will be able to fabricate 486 nasal swabs daily. This will increase the COVID-19 testing supply quantity substantially and ensure operations will continue uninterrupted. A continuity binder was also created to ensure the process was historically documented for later education and review.
Blood Donor Center needs donations
The Blood Donor Center has been working diligently to spread the message that blood donations are still in high demand and essential to support both domestic and downrange military operations. They have worked directly with the medical center’s Transfusion Services medical director to solidify access to the Armed Services Blood Program’s COVID-19 convalescent plasma inventory.
Medical Logistics, including Director Lt. Hannah Reed and her team, are supporting numerous groups across the base as they off-load and transport COVID-19 specimens to the 711th Epidemiology Lab. Medical WRM contractors and other Medical Logistics personnel also assembled, validated, palletized and certified eight medical war reserve materiel assemblages for ground transportation and military airlift. This tasking was accomplished in less than 48 hours and outshipped to McGuire AFB where it was processed for military air transport overseas.
In the early stages of COVID-19 reaching the United States, the Federal Drug Administration put out an emergency investigative new drug protocol for COVID-19 convalescent plasma (CCP) for severe disease. Having already begun research, two 88th Medical Group physicians, Maj Matthew Koroscil, a pulmonary and critical care specialist, and Maj Evan Fisher, chief of Nephrology, immediately began to operationalize how CCP could treat patients with COVID-19.
They coordinated with the local Dayton medical community to expand CCP collection points and identified a donor who had recovered from COVID-19. Within two weeks of the FDA protocol being released, the first convalescent plasma donation was collected by the Community Blood Center in Dayton, and that donation has already been used to treat patients.
The 88 MDG team continued to identify needs that weren’t being met, which led to the creation of an intubation box. A plexiglas enclosure was developed to be placed over the head and shoulders of a patient, including two arm holes for unrestricted movement. The box was developed as an extra layer of protection for frontline providers caring for COVID-19 positive or suspected patients in the operating room or within inpatient units.
In less than 24 hours, the team had received approval to begin production and all necessary materials had been procured. Within 72 hours, two intubation boxes had been assembled and were ready for use in the operating room.
Working with mission partners
Being postured at the center of Air Force Materiel Command allows the Wright-Patterson Medical Center unique opportunities to work with mission partners throughout the MAJCOM. The Air Force Research Laboratory reached out to offer the use of a technology that would theoretically increase the flexibility of our medical staff assigned to COVID-19 inpatient units. The Battlefield Assisted Trauma Distributed Observation Kit, referred to as BATDOK, incorporates pulse oximetry, end tidal CO2, blood pressure, and cardiac telemetry monitoring into an Android application allowing increased mobility for the staff.
Within the Bioenvironmental Engineering Flight, Christine Knezevich, a certified industrial hygienist, recently co-authored an article, “COVID-19 and the Industrial Hygienist: FAQs on Practicing IH in a Pandemic,” which was published in “The Synergist,” a magazine by the American Industrial Hygiene Association (AIHA). Knezevich serves on the Surface Disinfection/Infection Control Subcommittee of the AIHA Healthcare Working Group. The subcommittee published the “Guidelines for the Selection and Use of Environmental Surface Disinfectants in Healthcare” in 2017 and is currently updating its manual to address COVID-19.
The 88th Medical Group has constructed its culture on a foundation of continuous improvement, centered on patient safety and vectored toward delivering the highest quality care. The desire to deliver exceptional service to beneficiaries puts them on the front line of technological advancement and allows them to engineer systems and operations that both civilian and military healthcare organizations adopt as standard practice.
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