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Defending the Homeland: WRNMMC on front line of COVID-19 war

Image of soldiers and businessman in suit walking through an emergency shelter lined with beds and medical equipment Walter Reed National Military Medical Center (WRNMMC), Command Emergency Manager, Mr. Chris Gillette (center) gives a tour of the Rapid Response Shelter to WRNMMC Board of Directors during an exercise held at the hospital this week. The deployment of these units is not in response to any increase in patients or diagnoses; it is a preemptive measure to assess the ability to rapidly expand our facility in the event of a patient surge. (Photo by Harvey A. Duze) (Please note: photos were taken prior to CDC recommendation of wearing cloth face coverings.)

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While it may be challenging to precisely predict the spread of COVID-19, “what we can control is our planning, preparedness and our ability to remain ready for whatever may come our way,” said Army Col. (Dr.) Andrew Barr, director of Walter Reed National Military Medical Center (WRNMMC), during his weekly Facebook town hall April 8.

During the town hall, he explained what measures the medical center has implemented to keep beneficiaries and staff safe, and also how WRNMMC service members have deployed to help battle the novel coronavirus. 

For patient and staff safety, WRNMMC started restricted access control points March 12, decreasing the medical center’s exterior entrance points to monitor and screen people for COVID-19. Corpsmen and medics monitor the entrances, asking questions regarding each individual’s possible exposure to COVID-19 to ensure staff and patients are symptom-free before entering WRNMMC, or assisting symptomatic individuals with donning an appropriate mask and escorting them to the centralized screening area tent, located outside of the emergency department, for further evaluation, explained Army Master Sgt. Rich Ciuk, chief of both WRNMMC’s Incident Management Team Operation and the Operational Management Department.

“This is an ever-evolving process we’re working to make sure we have the best practices,” said Ciuk. “We keep force-health protection and the safety and security of everyone in mind.”

Image of soldiers leaving a building
Sailors assigned to Navy Medicine Readiness and Training Command (NMR&TC) leave Walter Reed National Military Medical Center (WRNMMC) before deploying to the Military Sealift Command hospital ship USNS Comfort (T-AH 20) in support of efforts to combat COVID19 along the East Coast of the United States of America (U.S. Navy photo by Mass Communication Specialist 2nd Class Kurtis A. Hatcher/Released).

“The ED started to get an influx of patients concerned about COVID-19, potential exposure risks, and symptoms,” Ciuk explained. “Our infectious disease team in the Department of Medicine took action on that, and set up a COVID-19 screening station outside of the ED to make sure patients did not have to come into the ED in order to be screened and or tested for COVID-19.”

The Centralized Screening Area tent, staffed by two teams of 14 staff members including enlisted, laboratory, nursing and medical disciplines, operates seven days a week, and has screened more than 2,000 beneficiaries since it began operation.

Barr added that as WRNMMC has battled COVID-19, the medical center has also expanded its telehealth and virtual health options for beneficiaries. “Patients love [telehealth and virtual health] wherever we’ve been able to institute it to meet our beneficiaries in that virtual space to take care of their health care needs, whether that be to refill prescriptions, follow-up appointments, counseling, or whatever else it may be,” said the WRNMMC director.

He added the Defense Health Agency recently authorized WRNMMC to expand telehealth and virtual health services. Staff at the medical center continue to use regular telephone consult as well, he added.

He also stressed the medical center will continue with acute, urgent, and emergent care services required by beneficiaries and active duty, in addition to required routine and readiness care in order “to get our service members back to the force quickly” as the COVID-19 battle continues.

“We have individuals who are in New York from Walter Reed Bethesda working on vastly different platforms,” Ciuk continued. These service members are a part of Joint Task Force Civil Support in New York, where the hospital ship USNS Comfort and combat support hospitals have provided aid to fight the COVID-19 pandemic.

Ciuk added WRNMMC personnel have also deployed as part of a COVID-19 response to support civil health authorities at existing facilities in New Orleans and Dallas as well as aboard the USNS Mercy in Los Angeles.

WRNMMC set up its Rapid Response Shelter tents in front of the iconic tower for the medical center’s annual training exercise in March. The RRS is an inflatable, modular-designed, self-sustaining structure with the capacity to serve as a temporary hospital with additional beds in a controlled atmosphere, external to the main hospital, explained Gillette. Medical center officials decided to continue using the RRS following completion of the exercise.

“This is not in response to any increase in patients or diagnoses; it is a preemptive measure in case we need to rapidly expand our facility in the event of a patient surge,” explained Christopher Gillette, command emergency manager, Hospital Command Center, at WRNMMC.

The HCC, staffed by WRNMMC leaders and their representatives, manages taskers, operations, logistics, human and financial resource management, and ad hoc subject matter expert workgroups to find novel solutions to organizational issues surrounding COVID-19, Barr explained.

Barr said WRNMMC has completed the first phase of its expansion plan in preparation for COVID-19. The phase included validation of current adult medical surgical and intensive care units in the hospital. Planning also includes tracking of equipment and supplies to ensure WRNMMC has what’s needed to provide care to a large influx of patients. 

“Most importantly, planning includes identifying staff who would flex into those areas where care most would be needed,” said the medical center director.

“I also want to thank our patients for their flexibility,” he continued. “We recognize the hardships and challenges they may be facing now.”

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DoD COVID-19 Practice Management Guide Version 5

Technical Document
7/30/2020

This Practice Management Guide does not supersede DoD Policy. It is based upon the best information available at the time of publication. It is designed to provide information and assist decision making. It is not intended to define a standard of care and should not be construed as one. Neither should it be interpreted as prescribing an exclusive course of management. It was developed by experts in this field. Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of this guideline is responsible for evaluating the appropriateness of applying it in the setting of any particular clinical situation. The Practice Management Guide is not intended to represent TRICARE policy. Further, inclusion of recommendations for specific testing and/or therapeutic interventions within this guide does not guarantee coverage of civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil or by contacting your regional TRICARE Managed Care Support Contractor.

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