Impact of FEMA on Rapid Response System During the COVID-19 Surge

Abstract

RATIONALE The first confirmed case of COVID-19 in New York was on March 1, 2020.(1) A nationwide emergency declared on March 13 made New York immediately eligible for FEMA public assistance.(2) At the peak of this pandemic, over 50,094 FEMA employees, Public Health Service Commissioned Corps officers from HHS and the National Guard were deployed across the US(2) to care for suspected or confirmed COVID-19 cases, including 10,437 NYC H+H cases, many of which required ICU level care. Elmhurst Hospital Center (EHC) experienced an unprecedented surge, resulting in resource strain. At EHC 2,409 patients (1501, COVID-19 positive) were newly admitted between March 1st to May 29, 2020, drastically surpassing hospital capacity. Herein, we compare patient outcomes before and after assistance. METHODS A retrospective review of cardiopulmonary resuscitation code team data was carried out for admitted adults requiring code response team between March 11 to May 25. A total of 145 cases were analyzed with respect to different grades of FEMA assistance to determine impacts of ancillary staff to patient ratios on survival. RESULTS Prior to FEMA support (3/11-3/25), code survival was 47% (8/17) and survival to discharge was 0% (0/17). The first wave of FEMA support (3/26-4/8) brought 221 Critical Care providers. Code survival was 39% (24/62) and survival to discharge was 5% (3/62). The second wave (4/9-4/23) included both 86 providers and volunteers, after which code survival was 56% (28/50) and survival to discharge was 2% (1/50). A third wave of 79 additional providers (4/24-5/10) resulted in decreased number of codes, code survival to 38% (3/8) and improved survival to discharge 38% (3/8). During the subsequent weeks while FEMA support staff remained at EHC (5/11-5/25), code survival was 50% (4/8), and the improved survival to discharge of 38% (3/8) was maintained. Overall, while the probability of code survival remained relatively constant (38-56%), survival to discharge showed significant and sustained improvement with additional provider support. CONCLUSION Given the exponential rise in COVID-19 admissions, hospitals are likely to become overwhelmed and medical practice is forced to adapt.(3) Swift action from FEMA and optimal ancillary staff deployment was critical to improving survival to discharge in critically ill patients requiring cardiopulmonary resuscitation.(4) Flexibility in step-up planning with timely high acuity capacity and appropriately trained provider staffing is vital to ensuring proper care during a pandemic surge.