Page 140 - 2020 JSOM Winter

While most of our physicians and PAs were nonmilitary, Conclusion
nearly all had significant experience in emergency and austere
medicine, which provided similarity in culture and communi- By emergency decree, SOF medics were permitted to work
cation between clinicians and SOF medics. This cultural con- within their full scope of practice during the novel corona-
sistency was echoed throughout our team’s staff of NPs, RNs, virus pandemic in New York. This decree enabled our joint
and paramedics. Each provider lent a diverse spectrum of clin- civilian/military COVID-19 medical team to accomplish the
ical experience to the team which included firefighting, flight/ first successful integration of an autonomous team into a US
critical care medicine, nursing organization and process, and hospital. Emily E. Johnston, MD, an emergency medicine
technical skills in airway and wound management. Civilian physician, former emergency medical technician (EMT), and
RNs critically enabled our SOF medics to rapidly acclimatize civilian contractor for the Army, who has instructed, trained
to the unfamiliar tasks and demands of the traditional hospital alongside, and worked clinically with SOF medics, made the
environment. following observation:

While I already understood, and respected, the depth and
Riverview Terrace Phase 2 breadth of SOF medic training and experience, I was still
Four weeks after Riverview opened, there was a marked change consistently taken aback by their ability to adapt and
in the patient census. A declining number of floor patients was perform. Our patients were fragile; entering, exiting, or
countered by a rising number of post–ventilator tracheostomy inhabiting the uncertain realm of critical illness, their clin-
patients recovering from extended ICU stays. As RVT clinical ical needs falling far from the traditional experience of my
and operational leaders, we actively pursued new opportuni- SOF medic teammates. With their uncanny situational
ties within the hospital. Staying true to the SOF medic tenets awareness, dynamic problem solving, focused motivation
of autonomous leadership and objective orientation, and with for total patient care, and unparalleled compassion, they
the support of NYP administration, we brokered a new rela- stood out as an unrecognized, and unutilized resource for
tionship with nursing administrators that enabled RVT’s inte- our civilian healthcare system. As the medical director
gration into three floors of the hospital. of RVT, months of observation made it clear to me that
we need to create a role in civilian health care for SOF
During phase 2, RVT staff were inserted into a myriad of clin- medics. This is a resource that should not just be utilized
ical roles to address the hospital’s pressing needs, including in emergencies. Particularly when working as an auton-
augmenting the Rapid Response Team, which covered code omous team, their clinical capacity goes far beyond that
calls throughout the hospital for the entire patient population. of a paramedic, and differs from that of an RN or PA.
Our healthcare system has been missing out by saddling
RVT nurses, paramedics, and SOF medics took ownership of a SOF medics with the requirement to further educate and
six-bed unit dedicated to step-down COVID-19 patients, free- fit into a currently established occupational niche. Devel-
ing up NYP nursing staff. Continuing the RVT mission of total oping a novel healthcare role for these providers will not
patient care, we worked collaboratively and delivered timely, only significantly enhance our healthcare system but will
optimal treatment with an emphasis on PT/OT, tracheostomy, also provide a powerful transition opportunity for veter-
and wound management. ans who have trained, served, and sacrificed.
In collaboration with NYP nursing staff, our RVT team man- From inception to end, our RVT team was a cohesive unit built
aged the care for one of the first COVID-19 tracheostomy around total patient care. The emphasis on open communica-
wards in the nation. In this previously post-operative ortho- tion and healthy relationships among all providers was key to
pedic and otolaryngology unit, our SOF medics played a crit- our success. Over 7 weeks, RVT documented nearly 21,000
ical role in providing tracheostomy management, in-service patient contacts. Flexibility and creative problem solving under
training for NYP peers, and acting as primary personnel for pressure proved monumental in consistently providing quality
tracheostomy care. Our team effectively served as emergency patient care and fostering relationships with NYP staff. At its
respiratory therapists responding to tracheostomy-related hy- core, the clinical success of RVT relates to the exceptional nature
poxic events, and proactively relieved the overburdened NYP and the elite caliber of performance, synonymous to that a SOF
wound care team by frequently debriding complicated decu- medic. The result was an unprecedented proof of concept born
bitus ulcers. of the expertise, grit, and commitment put forth by our team.

138 | JSOM Volume 20, Edition 4 / Winter 2020