Page 139 - 2020 JSOM Winter

47-bed Riverview Unit (Riverview), and RVT provided imme- and post-mortem care, the ward further highlighted the SOF
diate relief by building, staffing, and operating a field hospital medic’s ability to adapt and respond in the most delicate of
at NYP/Columbia University Irving Medical Center, a 738-bed human domains.
facility located in Upper Manhattan, and one of seven hospi-
tals in the NYP system. Mission-critical to facilitating the transition of RVT as a re-
source for inpatient care were the bonds forged between RVT
Located in a converted conference space within the hospital, clinical leads and the NYP nursing administrators. Our proven
Riverview consisted of an open 25-bed COVID-19 ward, success in meeting and exceeding initial objectives established
with a 10-bed pass-through unit, and two six-bed enclosed our reputation as a dynamic medical workforce. As a result of
units. One enclosed unit served as a procedure and crash this success, senior hospital executives were able to adapt their
bay, while the other transitioned into a palliative care area. COVID-19 recovery staffing deployment, using the RVT team
A 47-bed ward, Riverview was built, stocked, and received as clinical needs changed.
patients within 96 hours of inception. RVT providers donned
N95 masks, gowns, gloves, face shields, and surgical caps Process
while treating patients. No RVT team member contracted
COVID-19 or tested positive over the seven weeks we actively Constructed and mission-ready in well under a week, RVT’s
treated patients. success speaks to the power of partnership between military
and civilian healthcare providers. From its inception, and
Riverview was outfitted with H-type portable oxygen cyl- throughout the seven-week duration, our team exercised ex-
inders, bedside monitors, blood glucose meters, IV pumps, traordinary self-reliance to pilot our performance and achieve
bedside blood gas analyzers, bedside ultrasound, EKG, two proof of concept. Initial construction, the urgency to fill beds,
stocked pharmacies, a code cart, and a clean supply closet. and the expectation to solve complex challenges demanded
Immediate access to hospital diagnostics, coupled with the ca- rapid innovation to quickly develop critical infrastructure.
pacity to run the floor as a stand-alone unit, satisfied the de- RVT Site Lead Joe Barajas, PJ, NRP, oversaw communi-
mand for an additional high-functioning inpatient unit within cations, talent acquisition, administration, and logistics in
the hospital. The rapid interpretation of radiology imaging support of the day and night shift leads who managed their
and laboratory samples, as well as integration with physical crews during 13-hour shifts. Clinical Lead Jason Valenzuela,
and occupational therapy (PT/OT) in an open-ward format, SOCM-ATP, a Special Operations combat medic, Operations
allowed our RVT clinicians to implement immediate modifi- Lead Chaney Harrison, PJ, and RVT Medical Director Emily
cations to patient treatment regimens. Deeply held SOF medic E. Johnston, MD, an emergency medicine physician, managed
standards of integrity and innovation once again produced an their requisite responsibilities in close coordination with the
outcome of exceptional total patient care. RVT administration team.

This unit was initially staffed by a nine-person detachment A tolerance for variation in method while maintaining out-
from the Ryan Larkin Field Hospital, near the NYP Allen comes based on high standards was essential to our team’s
Hospital, New York, NY several miles away. The founding achievements. Frequently confronted with unprecedented and
group leveraged professional and informal networks to swiftly urgent difficulties, RVT’s dynamic operation produced imme-
assemble an operating team of approximately 40 healthcare diate and lasting solutions. Mission-driven communication
professionals with backgrounds in austere medicine and di- was paramount in establishing relationship strongholds be-
saster response. Most teammates did not know each other tween SOF medics and civilian counterparts.
prior to formation of the team and had arrived individually
in New York in response to public pleas for healthcare pro- People
viders. The objective of the RVT was to provide treatment for
floor-stable, persistently hypoxic COVID-19 patients, with a Under the direct supervision of NYP/Columbia Chief Oper-
goal of decanting improvised ICUs and overwhelmed units ation Officer Laureen Hill, MD, MBA, Julia Iyasere, MD,
throughout the hospital. RVT utilized a diverse spectrum of MBA, and Director of Nursing Lucille Austria, MSN, MBA,
crisis management protocols and deployment stand-up prac- RN, Riverview progressed into a functioning medical/surgical
tices to rapidly develop efficient processes for patient man- COVID-19 rehabilitation unit, fostering a clinical environ-
agement, administrative operations, communications, and ment entirely focused on high-quality total patient care.
logistics.
During its tenure, RVT was comprised of 58 individuals ex-
Through interdisciplinary cooperation with palliative med- panding from the initial nine to an operational max of 41,
icine, faith leaders and social work advocates, our team es- reducing by natural attrition to 26 in the final week. Team
tablished a palliative care ward 24 hours after the need was member composition was 65% military/former military, with
identified. Providing advanced comfort care, family advocacy 60% still actively serving in the Guard or Reserve (Figure 2).

FIGURE 2 RVT clinical team.
RVT Clinician Background
License Doctor PA CRNA/NP RN SOF Paramedic Ops TOTAL
Military 2 3 0 4 25 2 1 37
Civilian 6 2 3 3 0 4 2 20
Note: 1 Mil PA and 1 Mil RN are also PJs, but not counted in SOF chart.
PA = physician assistant, CRNA = certified registered nurse anesthetist, NP = nurse practitioner, RN = registered nurse, SOF = Special Operations
Forces, Ops = operations.

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