This is from the Chief of Surgery at the Columbia U Medical Center in NYC about a week ago….
”…our inpatient population of COVID patients is a crippling rate-limiting obstacle to restarting (medical) service lines dependent on ICU capacity, such as transplantation, neurosurgery, vascular surgery, and cardiac surgery…. Please don’t conclude that the pace of restarting is all about revenue and maintaining reputation. We have a large pool of postponed patients who are directly harmed by delay because they need procedures that extend life and improve quality of life.”
“…..I will shift gears by reviewing some of our achievements. The ED (emergency dept) was the earliest point of strain in the pandemic. Patients were arriving in extremis and requiring intubation before they could be moved to an ICU. The existing ICUs quickly filled to capacity, so intubated ED patients had nowhere to go. ICU space was more than doubled by building the ORICUs (operating rooms turned into ICUs) and other pop-up ICUs, but those filled immediately, and ED patients still had no place to go. A de facto ICU settled into the ED like a tent city of lost souls. It became obvious that ED staff were stretched to their limits by patients streaming through the front door, and could not be expected to simultaneously manage an ICU full of intubated respiratory failure patients.”
“In response, a spirited coalition of the willing sprang up to fill the void, comprised of resident-attending pairs from Urology, Radiation Oncology, Orthopedics, Dermatology, Ophthalmology, ENT, and Rehab Medicine (URODOER). Note these are not people for whom ICU care is a commonplace feature of practice…..After cramming diligently with a rapidly assembled on-line ICU-care curriculum, this fearless rabble mustered into the field. The ED ICU quickly became another capably managed front line in the battle against coronavirus.”
“Three days ago it was announced that the Department of Medicine would be taking over management of the ED ICU. The URODOER subspecialty team pivoted instantly. The following email was sent by the Chair of Urology: “We are ready to go into any critical care role you need. Anywhere.” They are being added today to the ORICU coverage schedule.”