PRMC and COVID-19
On Dec. 31, 2019, cases of pneumonia were coming to light in clusters in Wuhan, China. Those cases would later be identified as a novel coronavirus. By mid-March the virus had proven it’s rapid ability to spread and severe effects to be truly alarming, and in just a few short months had become the focus of the entire world’s attention. That would begin the world’s most relevant pandemic, COVID-19.
COVID-19 first reached the United States in the state of Washington on Jan. 21, according to the Center for Disease Control and Prevention (CDC). Texas cases arrived in a few different circumstances including a group of travelers from China and the now infamous Diamond Princess Cruise Ship who were both immediately quarantined. It wasn’t until March 4 that the CDC found an unrelated COVID-19 positive patient in Texas. The patient had recently traveled to China. Texas Department of State Health Services (DSHS) didn’t announce the first case of the virus until March 4, 2020.
As COVID-19 began to spread throughout Texas and other states, Pampa began preparing. In order to coordinate efforts with the executive order that declared a state of public health disaster for the entire State of Texas, a local COVID-19 Task-force was formed in early March. The task-force consisted of Gray County and City of Pampa representatives of all kinds. Plans to protect Pampa and the surrounding areas as well as keeping them informed were made and executed swiftly.
Pampa Regional Medical Center also started preparing to slow the spread and fight the curve of COVID-19 cases that could then potentially reach Gray County. With the state of disaster issued within the state, PRMC initiated an Emergency Operations Center in early April which was manned by a committee of hospital leadership. All the decisions and policies made regarding prevention and readiness were made within the committee and in accordance with local, state and national guidance.
“If you look at our initial surge plan about where we would put patients and stuff like that, when we started really walking through the process, we realized that’s not going to work with these guidelines. We were thinking we had all these monitors in PACU and we could use that as an overflow down there instead of the ECU so we wouldn’t have to take those monitors out, but reality was that we couldn’t do that because they are (patients) on bipap. We need to shut the doors because they’re just open air to everyone. And that was a CDC guideline.” Said Twilla Thomas, PRMC CNO
“The team had to look at how to expand and what to do with staffing. It took about two weeks for the initial plan. We did all of this in April and nothing happened until October really. There were a lot of policy related things to deal with, staffing, infection control, medication management, with a potential surge. One patient caused all of this to go into effect, that first patient had to have the right staff and the right equipment and the right meds in the right place, just one patient.” Said Edwin Leon, PRMC CEO
Inevitably, the first case of COVID-19 reached Gray County. Though the spread in its early stages in our local community seemed slow and less critical, Pampa would not see its most critical surge until October 2020. Prior to the surge, PRMC had prepared its facility and staff with precautions which were adapted and tweaked weekly, or even sometimes more frequently, as more information and education became available about the behaviors of the virus.
“Our first patient, when he came from Dumas, it looked like Ebola had just stepped foot in here. That’s what I thought of.” Said Stacey Benton, PRMC Director of MedSurg and ICU.
For many staff, it wasn’t with the first patient that COVID-19 became a harsh reality. But, with each patient that the staff masked and gowned up to treat, it became more and more real.
“We started transferring the first month of COVID-19 patients who came to the ER, even though we were waiting on tests. They had ground glass opacity on their x-ray, so we pretty much suspected they were positive.” Said Pami Box, PRMC Emergency Department Director.
Early on, with all the surges happening over night at other areas facilities, the hospital thought best to preserve as many beds and resources for our community as possible.
Precautionary measures to protect both the COVID-19 and non-COVID-19 patient populations are continually enhanced in the hospital.
“We pulled all of the equipment out of rooms and stripped them down to be bare. Locked the unnecessary entrance doors and redirected the patent flow.” Said Box
As facilities began to fill and cases in the Panhandle communities continued to climb, the hospital continued reviewing readiness plans and guidelines. Adapting meant caring for more patients and saving more lives. The hospital even opened a unit that had been closed for the last eight years to accommodate more patients.
“If you look at the first plan we put in place when we started seeing how we would receive and expand our surge capacity to help other facilities, we had something totally different then how we ended up.” said Thomas.” We also had the support of our (corporate) system, we exchanged information all though our system on weekly calls. We heard what was going on in other areas. Our corporate COVID Taskforce drove our pharmacy policies and we stayed on their guidelines because they had a team constantly doing research. So those were all research based and evidence based, and we developed our protocols from our corporate covid taskforce.” Said Thomas
That is an advantage Pampa has compared to other rural hospitals, in that it is part of a system of hospitals all over the country. Rural hospitals were struggling because they couldn’t buy all the necessary equipment needed.
“We could request warmers and parts for high flows and vents and pumps, and we got all of that from sister hospitals.” Said Leon “We have the backing of a major company, and with being part of such a large system we had buying power that other facilities didn’t have. It’s a big deal. We were even able to help others in our area by loaning equipment sometimes.”
It wasn’t until October that the hospital began to surge with COVID-19 cases.
“When we intubated three patients in one night and we were running all night with five respiratory therapists, and that’s not counting all the bipaps we were putting on and everything else that night, that’s when I was like, this just got real.” Said Chalenia Freeman, Director of Respiratory and Therapy.
Supplies throughout the pandemic have been in high demand not only for the public, but for hospitals as well.
“Once we really started surging, we didn’t feel like we were going to run out of supplies. We looked in ICU and they had stacks and stacks of IV pumps per patient, but we were always able to have plenty. Early on we worried about N95 masks to protect staff, but we were able to get a large supply. And then we were able to get the respirators that last for months as well, so we had what we needed.” Said staff
“We even had sister hospitals could send respiratory supplies like ventilator circuits all the way from Alabama. We were able to help and support as well as receive support from other facilities.” Said Freeman
The Panhandle Regional Advisory Council, one of 22 RACs throughout the state of Texas, was formed to provide aide throughout the state for Trauma events. With their coordination of FEMA benefits to the area, as a member of the RAC, the hospital was able receive aide in many forms as COVID-19 volume grew in the area. Throughout the surge, the RAC was able to provide additional supplies which were used plentifully and in great demand all over the country, such as sanitation wipes, antibacterial soap and hand sanitizer. Other critical supplies such as surgical gowns, face shields, isolation gowns, masks, gloves and N95 masks were also made readily available. The RAC proved to be a great resource for PRMC and other facilities in the area. As the hospital census of more critical COVID-19 patients grew, PRMC was also supplied with an additional 25 IV pumps, five comfort flos, five bipaps, and 15 ventilators. With the equipment belonging to the hospital and outside support, PRMC has been prepared.
Texas Tech in Amarillo also stepped up during the pandemic.
“It was neat to see a bunch of engineering students at Tech jump in to see how they could help the medical field and these students ended up really pioneering ideas.” Said Thomas.
But it wasn’t just supplies that worried the healthcare community. Beds and doctors were on high demand. When another facility faced the issue of losing patients because they had nowhere to transfer a surgical case, Pampa Regional stepped up.
“Hearing about that young guy who needed help he couldn’t get, that solidified what we needed to do. Even though it was going to cost us an exponential amount of money, we couldn’t afford not to bring a surgeon in to the area.” Said Thomas
Within the first week of the surgeon’s arrival, the hospital was able to accept six surgical transfers in the facility.
COVID-19 affected not only those positive patients, but all patients. Hospitals didn’t just run out of beds and staff for COVID-19 patients, but for all patients.
“Usually, rural hospitals don’t look for other rural hospitals for support, they look to the bigger cities. But, when they started calling around and no one was accepting for them, we were able to provide support. And they came from a long way.” Said Leon
Overall, the hospital was able to accept 26 patients within the three-month surge for other facilities. Some staying 20 or more days sometimes.
“We went from 25 vent days a month due to early COVID-19 cases to 200 vent days a month. And 100 ABG’s to over 400 ABG’s a month” said Freeman.
Everyone stepped in during the surge, often shape shifting into something they likely never saw themselves doing when they came to the hospital in an office based or non-clinical role.
“Our own facilities department went and got plastic and made us gowns when we were running low, sharps containers when those were hard to get, and the curtains on the doors that let us visualize our patients in case they crawled out of bed.” Said Box They transitioned into EVS help, runners for the lab and even with more delicate situations.”
Staff said that Pampa Medical Group physicians and nurses came down to the hospital to help with the surge of patients and help work within the hospital. LVN nurses from the clinic would be helping as techs on the COVID-19 unit, physicians weren’t afraid to take care of any and all duties. Internist, Dr. Kevin Sieck, was even seen moving carts of trash after the night shift had a particularly rough night, just because he knew it needed to be done.
“Our staff was tough, locally we didn’t have many issues with staff mental health.” Said Leon
“They actually stepped up, having one on one conversations with ICU staff, they weren’t used to seeing their patients not getting better and you could see where the mortality would wear on them. And the doctors too.” Said Thomas
The stress, while there, was handled with grace by the staff, even in the most difficult moments.
“The stress on the nurses of dealing with the families and not having them there for their loved ones and the burden of that was rough. Being the one who took the beating when families needed to vent on the phone because they were scared and angry was weighing on them. The nurse really had to own the whole death process as well without the ability to have family there.” Said Benton
There were a few good things to come from the pandemic. One being the swift transition to tele-health. Programs such as having access to other intensivists, speech therapy from home, doctors visits without leaving the house will be around for a long time. Tele-health programs will grow and continue giving access to more healthcare in the future.
The biggest force felt at PRMC during the most difficult months of the COVID-19 surge was the support of the community. Community members, churches, businesses, school groups, other health facilities and families came together in an effort to support the hospital and its staff. Their show of support through kind notes, meals and sweets was received with the loving intent they were sent. Pampa ISD met one evening and greeted the shift change with cocoa and words of encouragement. A local church youth group decorated the sidewalks all the way around the facility with scripture and quotes and pictures to lift the spirits of all those headed in and out of the hospital. On a few different occasions, prayers were lifted from people of the community who gathered together in the parking lot. Employees and patients heard them as lights flashed and vehicles by the dozen traded in and out to pray. This is the support the hospital truly thrives on and the reason for which it exists.
It’s important to have this support to the hospital, and to continue to use rural and small hospitals. Because even if you need them for a short time, you want them to still be there when you do.” Said Benton.
According to Beckers, 47 hospitals went bankrupt and closed due to COVID-19 in 2020. COVID-19 had a drastic impact on hospitals, particularly rural ones, financially. With the cost of supplies, staffing and other issues, many did not survive 2020.
“We are your neighbors, our kids are friends with your kids, and our staff is personally invested in your health. I like to see new graduate nurses come home to work in local hospitals. That’s family taking care of family which is so important in rural America.” Said Thomas. Our facility has been maintained, our equipment has been upgraded to the best there is, resources have been put into this facility to provide our community with healthcare. “
Pampa Regional began expanding services and programs such as ICU specialists, Pulmonology, Surgical Critical Care, and Infectious Diseases and has plans to continue this growth into the new year.
PRMC is proud to offer a facility where the company and the staff create a culture where patients are not just another number.
About Prime Healthcare and Prime Healthcare Foundation: Prime Healthcare is an award-winning health system operating 46 hospitals and more than 300 outpatient locations in 14 states, providing over 2.6 million patient visits annually. It is one of the nation’s leading health systems with nearly 50,000 employees and physicians dedicated to providing the highest quality healthcare. Fifteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Based in Ontario, California, Prime Healthcare is nationally recognized for award-winning quality care and has been named a Top 10 and Top 15 Health System by IBM Watson Health. Its hospitals have been named among the nation’s “100 Top Hospitals” 53 times and have received more Patient Safety Excellence Awards from Healthgrades than any other health system in the past five years. To learn more, please visit www.primehealthcare.com.