key: cord-0944581-xe4izavv
authors: Giangola, Matthew; Siskind, Sara; Faliks, Brad; Dela Cruz, Ronald; Lee, Andrew; Shebes, Matthew; Ritter, Garry; Prince, Jose; Coppa, Gene; Barrera, Rafael; Patel, Vihas
title: Applying Triage Principles of Mass Casualty Events to the SARS-Cov-2 Pandemic: From the Perspective of the Acute Care Surgeons at Long Island Jewish Medical Center in the COVID Epicenter of the United States
date: 2020-06-18
journal: Surgery
DOI: 10.1016/j.surg.2020.06.004
sha: f0287cdc09345c9a890463a7081b90c86f05acc9
doc_id: 944581
cord_uid: xe4izavv

nan

Northwell Health, a 23-hospital, not-for-profit enterprise in New York, is located at the 21 epicenter of the global COVID-19 pandemic 1, 2,3 . As an entity, Northwell Health serves a large 22 portion of New York City and Long Island. Of its two flagship tertiary care academic medical 23 centers, Long Island Jewish Hospital (LIJ) is a 583-bed teaching hospital located in Queens, NY, 24 providing care to the western area of the borough and serving one of the most diverse 25 populations in the United States. Anticipating this broad catchment area for the nation's 26 COVID-19 patients, we proactively enacted multi-modal strategies to both increase capacity 27 and provide advanced intensive care to the over 700afflicted patients admitted to our medical 28 center. Additionally, as one of the larger academic surgery departments, we made substantial 29 adaptations to assignments of trainee and coverage pf the intensive care unit (ICU 

Potential pitfalls of using the tiered approach to pandemic response is overestimating 117 the capability of the staff involved with direct patient care. We were able to be adequately 118 staffed with enough intensivists and surgeons to allow continuity over a 5-7 day shifts with 119 separate night coverage. The schedule was rotated so that we were able to maximize the 120 contiguous days in-house and days off. If there is a paucity of critical care physicians, a tight 121 and grueling schedule may lead to rapid burnout. In large part due to assiduous adherence to 122 universal precautions and the hospital's provision of adequate personal protective equipment 123 (PPE) to frontline workers, very few of our essential staff became infected and required time off 124 during their illness. Planning for coverage should a staff member fall ill is a contingency which 125 must be calculated into the schedule. Without adequate physician extenders, the tiered 126 approach may be top-heavy and increase the burden on physicians and decrease the time they 127 may spend with the critically ill. We outline the response of the surgical intensivists to the SARS-COV2 pandemic within one of the hardest hit areas of New York City. The importance of this work lies in the ability to show buy-in and cooperation of surgery and surgical subspecialties in the care of ICU patients is paramount to the success of a rapid response to a public health crisis.

New York Coronavirus Map and Case

Presenting Characteristics, Comorbidities, 177 and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the

6775 for intensive care unit (ICU) redeployment of the noncritical care surgeon