The Louisiana Response to COVID-19
New Orleans has served as one of the nation’s coronavirus hot spots. TEMSA recently sat down with Porter Taylor, Acadian Ambulance’s director of operations for Eastern Louisiana, to learn more about the EMS response to the coronavirus hot spot in Louisiana.
TEMSA: The news reports from New Orleans paint a pretty grim picture. Is it as bad as it looks?
Porter Taylor: YES! The number of positive cases is growing each day. The biggest concern is that the hospitals will breech their capacity in short order if nothing is done to help them decompress.
TEMSA: How is that affecting our day-to-day operation?
Porter Taylor: The possible surge is now not as bad as predicted. We are holding our own right now. The risks are still there and the crews are taking all possible precautions.
TEMSA: Are you leaving patients at home?
Porter Taylor: Not unless we have to. In some cases, we have brought them to an alternative destination like express care. But that has been rare.
TEMSA: How real is the danger of overwhelming the hospitals?
Porter Taylor: It has slowed down tremendously in the last week.
TEMSA: Are they full now?
Porter Taylor: No, the big facilities did a tremendous job shutting down non-essential parts of their systems and turning them into COVID units and spreading the patients out into their smaller facilities.
TEMSA: How is it affecting the EDs?
Porter Taylor: They still remain busy. Wait times fluctuate.
TEMSA: From what you’ve seen, is the general public taking the threat seriously?
Porter Taylor: Absolutely. Life will be different after this in many ways. Obviously, our world is different now.
TEMSA: How is EMS different today in New Orleans?
Porter Taylor: The approach to each patient is now more cautious than ever because of this hidden enemy.
TEMSA: What are your staffing challenges and how are you handling them?
Porter Taylor: We are bringing in staff from areas that are not busy into areas that are. We are very fortunate to have a large and diverse work force that is willing to travel to help the make the mission successful.
TEMSA: How is the mission of the New Orleans EMS and private services different during this crisis? How do you complement each other?
Porter Taylor: New Orleans EMS is strictly running the 911 portion with us backing them up when needed. We are handling emergencies at the nursing homes along with all the non-emergency transports between all facilities. In addition, we are handling transports to the new MMS & PHU at the Morial Convention Center. Acadian and New Orleans EMS have a great working relationship and we complement each other by keeping the lines of communication open and process issues together as they arise.
TEMSA: Is there an increase in the number of 911 calls? Or has it been consistent with volume before the crisis?
Porter Taylor: Slightly higher. We ran the numbers last week and it was around 4 percent higher. Earlier on, the New Orleans 911 market went through the roof. It has settled down. That is really the only market that had a significant increase.
TEMSA: What has the state done to accommodate all the COVID-19 patients, and what is your role in that?
Porter Taylor: The state entered into a contract with The Morial Convention Center in downtown New Orleans with the mission to erect a 3,000-bed medical monitoring station or step down unit for all the regional hospitals. This will allow the hospital to decompress the less acute patients who are COVID-19 positive.
They also put up a 250-bed housing unit to hold all pending tests. My role on the task force was to start the process of planning and standing up with all the stakeholders.
TEMSA: Can you describe what the state set up at the state parks, what types of patients go there, and the EMS role?
Porter Taylor: The state selected three super sites. Utilizing cabins that already existed and purchased RVs to be set up at each site that allowed about a 115-bed capacity for each site.
They focused on the homeless in each region to be the main guests. EMS provided transports from the facilities to the sites.
TEMSA: What is the EMS role at the convention center and the PHU, besides bringing patients to them?
Porter Taylor: Bringing patients back to facilities when needed, Dialysis transports and an occasional trip home when discharges.
TEMSA: Do you have units standing by for them?
Porter Taylor: Yes, we are providing two dedicated units for the 911 response only inside both The Morial Convention Center and PHU.
TEMSA: Logistically, what adjustments have you made in New Orleans?
Porter Taylor: Increased awareness and tactics with our staff to help protect them. This was done by several vehicles of communication of up to date CDC guidelines for protection. We worked diligently with all suppliers and GOHSEP (Governor’s Office of Homeland Security and Emergency Preparedness) to make sure we have adequate PPE. We also closely monitored all of the hours put in by staff to make sure they are getting some down time.
TEMSA: Are EMS professionals working extra hours?
Porter Taylor: Yes, but the hours have not been too bad; we’re trying to “spread the wealth.”
TEMSA: Is Acadian staffing some of these new facilities?
Porter Taylor: We are staffing The Morial Convention Center. We have a transport coordinator, the two ALS units, and two electric med carts with drivers to move patients around.
On the observation sites, we are providing one paramedic and one EMT for the support staff.
TEMSA: How is the EMS industry handling personnel who have been exposed, possibly exposed, symptomatic, non-symptomatic, etc.?
Porter Taylor: Our medical director and HSE team have formed a protocol for immediate assessment, treatment, and isolation (if necessary) of anyone who has been exposed/exhibiting symptoms.
We are working with all agencies to keep track of patients transported and their outcomes of COVID testing. Of course, we are following all CDC guidelines for any of our staff who has symptoms.
The Morial Convention Center is for patients that have tested positive and are on the mend. The PHU is only for patients pending test results but do have symptoms but don’t need to be in the Hospital. I think that this is about to be a real issue in Texas.
We have stood up our EROC (emergency response operations center) center in Lafayette, Louisiana to work with our staff in NOLA for the incoming calls and organization of transportation to any of the monitoring/observation sites that are up and running. I know they handle logistic requests and evacuations.
We are also providing a screening process for The Morial Convention Center that was set up by BCFS and the Region 1 physician. Once the unit arrives to pick up the patient, they are verifying the screening for a second time.
TEMSA: Any other best practices you can share or that you’ve learned?
Porter Taylor: When setting up a field hospital or medical monitoring station, make sure to bring all the local experts to the table and allow them to participate in the planning and execution. Also, ensure that they are willing to do what’s right for the whole.
Local services might not be in the position to fill all the slots, but give them the first chance because they are the most familiar with the local terrain and systems.
TEMSA: Is there anything that surprised you?
Porter Taylor: How well we are all working together, especially at the The Morial Convention Center. It was a little bit of a learning curve at first, but it is clicking now. Problems will occur, and it is about how you work them out and listen to the experts. It is important to make sure the lines of communication are open at all times and never lose sight of the mission. To take care of the people that need to be taken care of. We are all in this together no matter where you are from.