The hardest part for two Army nurses on 12-hour shifts at an overwhelmed hospital in Michigan has been dealing with what they describe as "gridlock" in the intensive care unit.
"It's been rough," said 1st Lt. Sarah Semple. She's had to watch as her patients struggle with the effects of COVID-19 while there's been no room in the ICU at Spectrum Health Blodgett Hospital in East Grand Rapids.
"You have to decide, and it's hard when the ICU is full and there's no place to go," said 1st Lt. Meredith Dorman, who works alongside Semple at Blodgett. "You have to balance that out. Can they stay on the floor? It's kind of a balance weighing out the criticalness of each patient."
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Semple, 25, normally assigned to Madigan Army Medical Center at Joint Base Lewis-McChord in Washington state, and Dorman, 26, from Martin Army Community Hospital at Fort Benning, Georgia, are part of one of the military medical teams the Army, Navy and Air Force have deployed to states reeling from the coronavirus to help local hospitals grapple with a spike in cases.
Both described the difficult choices medical professionals are facing while trying to provide care to as many patients as possible.
"That game is above our paygrade," Semple said. "It's the bed managers or the doctors deciding should they get that spot, that one spot in the ICU.
"It's very frustrating as a nurse," she said. "You know, you want to advocate for that patient, for them to get the best care, but it's just not there."
At the request of the Federal Emergency Management Agency, U.S. Northern Command last August began deploying Army, Navy and Air Force military medical teams (MMTs) of doctors, nurses, respiratory therapists and medics to hospitals struggling with the delta variant of the coronavirus, and the response has steadily ramped up as the omicron variant began taking hold in November.
Initially, about 200 military medical personnel were sent in August to assist overburdened hospitals in Alabama, Mississippi and Louisiana, according to a release from U.S. Army North, which is coordinating the deployments under Northern Command.
The deployments have increased as COVID case counts have spiked across the nation; in December, the White House announced that an additional 1,000 military medical personnel would be sent to local civilian hospitals in January and February.
The two Army nurses spoke to Military.com on a Zoom call last week, joined by Dr. Joshua Kooistra, senior vice president and chief medical officer of the not-for-profit Spectrum Health System, which operates 14 hospitals in Michigan.
Kooistra described a health care crisis across the state that mirrors problems nationwide brought on by the omicron variant, which has forced hospitals to cancel or postpone non-emergency surgeries, transfer patients from overcrowded facilities, and scramble to relieve overburdened staff by turning to the military.
Through January, there were six military medical teams operating in Michigan, the most in the nation. Three of those teams have now been withdrawn as the crisis has eased in parts of the state, according to Army North.
Kooistra said Spectrum hospitals have expanded their ICUs to cover 140% of their normal capacity, but "certainly staff turnover has been a challenge throughout the pandemic."
"I think it's a combination of staff burnout" and nurses leaving to take temporary positions at other hospitals, often at higher pay, Kooistra said, describing pressure that has built up on hospitals after the latest surge struck in November. "Right around Thanksgiving, it was looking extremely bleak."
The military medical teams began arriving in early December, "and it was exactly the kind of gift we needed at the right time," he added.
Omicron infections have produced severe symptoms less frequently than some earlier variants like delta, but the surge in cases overall has been higher than any prior wave of the pandemic.
Hospitals are facing a rush of admissions, but the ICU crush hasn't been as bad, according to Kooistra. The biggest difficulty has been hospital workers getting COVID-19 and being forced to stay home.
"So at any given time point in time, we have hundreds of staff members that are unable to care for our community, and that's presenting the challenge that we're in right now," Kooistra said.
On Thursday, Army North announced that within two weeks an additional 220 personnel organized in 14 teams would be sent to six states. That deployment will complete the commitment made by the White House in December to send 1,000 military personnel to support civilian health care workers.
Although the omicron surge appears to be tapering off, "Communities and healthcare facilities in certain areas remain heavily burdened by coronavirus-induced hospitalizations," Lt. Gen. John R. Evans Jr., the Army North commander, said in a release.
Since August, the military has activated, or previously activated, a total of about 1,400 medical personnel and deployed them to 29 states and the Navajo nation.
The relief effort thus far has not been on the scale of the military's response in early 2020, when hospital ships were sent to New York City and Los Angeles and the Army Corps of Engineers converted stadiums and other facilities to COVID centers. FEMA and state governors have instead asked Army North to help with staffing at hospitals.
One hospital in dire need was about a mile from the boardwalk and the famed amusement park at Coney Island in Brooklyn, New York, where Dr. Terence Brady, chief medical officer at the 371-bed Coney Island Hospital, said demographics have compounded efforts to battle COVID.
Over the years, the Coney Island area has become a neighborhood of retirement and assisted living communities, with more than 20 nursing homes, and the high percentage of senior citizens living near the hospital has added to the staff's burden.
Of the more than 884,000 COVID-related deaths recorded in the U.S. thus far, more than 550,000 have been aged 65 or older, according to the Centers for Disease Control and Prevention and tracking organizations.
Brady said that Coney Island Hospital was the hardest hit of the 11 facilities in the New York City Health + Hospitals Corp. system. "We wound up with all the beds filled, all the ICUs, and we had to open up a surge unit of 37 beds," Brady said in an interview Monday.
One issue exacerbating the logjam were the rules in place for nursing homes. Patients had to wait 10 days before they'd be allowed to return to nursing homes after treatment, which meant that "there was no place to move the ICU patients out to the regular floor," Brady said, but the situation has eased as hospital social workers negotiated with the nursing homes to take patients back sooner.
In addition, the latest wave of the omicron variant has taken a heavy toll on the Coney Island staff -- just as it has in Michigan -- putting a premium on having the MMT there to fill gaps.
"On one given day, we've had 120 [staff] members out," Brady said. With the shortage, there have been no vacations for the staff since COVID first hit the city in 2020.
Maj. Hollye Cottle, an Army nurse and the officer in charge of the MMT at Coney Island Hospital, said that there were more than 20 Army doctors, registered nurses, practical nurses, respiratory therapists and medics on her team.
She said they began arriving at Coney Island Hospital on Jan. 22 from a mix of bases, including Fort Riley, Kansas; and Forts Sam Houston and Hood in Texas.
"We're covering all shifts, filling in where we're needed most for the Coney Island staff," Cottle said. "We're here for 30 days and, depending on how things look, we can be extended."
Cottle arrived to what she described as "definitely a different New York than the first time I was here in 2020," when she helped staff the Javits Center on Manhattan's West Side, which had been converted to treat COVID patients.
"We would not see any vehicles" on the streets and even Times Square was devoid of traffic, "but now I'm seeing kind of the hustle and bustle," she said. "It was really good to see that there's life back in the city."
The need for their assistance has been so great that service members have been shuffling between multiple hospitals where staff members are hanging on by a thread as cases have surged, even though many parts of the country have enforced fewer restrictions and lockdowns during the latest wave, and more Americans are back out in public.
"I can definitely attest to that. We are holding some very sick COVID patients," said 1st Lt. Kate Parchinski, 28, an Air Force nurse who is based at Brooke Army Medical Center at Joint Base San Antonio, Texas.
Parchinski was part of a military team that previously deployed to Benefis Hospital in Great Falls, Montana, and then made a quick turnaround to come to WellSpan York Hospital in York, Pennsylvania. She said the team had about a 10-day break and then got word Dec. 28 for another deployment, arriving in Pennsylvania on Dec. 31.
The timing of the arrival of the Air Force MMT at York in early January "could not have been better, just because of the post-holiday surge," said Dr. Thomas Kehrl, chair of emergency medicine at the York hospital, who joined Parchinski in an interview Monday. "We were seeing huge numbers of omicron variant cases. Essentially, the dominos start falling when the ICUs get full."
Parchinski said the 20-member Air Force team knew coming in that "there's been a tremendous strain in the last two years nationwide -- dramatic increase in COVID cases, COVID hospitalizations, lot of staff coming down with it. So there was really this need for us to fill in to relieve some of that burden."
-- Richard Sisk can be reached at Richard.Sisk@Military.com.
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