There may be scarce healthcare resources in disastrous catastrophes like the COVID-19 disease, hence the need for re-allocation decisions. Healthcare professionals may be required to work beyond their usual range of practice, and the attention to patient care may call for shifting to foster benefits to the whole population rather than individual benefits. There is a need for strategies to avoid greater death, injury, and illness during such disaster situations by promoting more effective utilization of limited resources. Further, using an equitable, fair decision-making process regarding who needs treatment with limited availability, for instance, ventilators. This paper will assess the efforts to ensure the continuation of healthcare support in healthcare organizations in New Mexico in the event of the COVID-19 pandemic.
Crisis Standards of Care
Crisis Standards of Care (CSC) is defined as a significant transformation in the normal level of care and healthcare operations a healthcare organization can deliver necessitated by a pervasive, catastrophic hurricane or earthquake or pandemic influenza disaster (Hick et al., 2020). CSC strategies are the methods of mounting a response to a disaster that far surpasses a medical community’s standard medical and health capabilities and capacity. Under such circumstances, the focus of medical care shifts from individual to supporting the considerate utilization of scarce resources for optimal health results for the whole population. The health care resources are moved to patients whose treatment is likely to save lives and whose functional outcome is likely to get better with treatment. Such patients require urgent attention compared to those who are likely to die despite receiving treatment and those who are likely to survive even in the absence of treatment.
Notably, the standards of care are likely to change significantly during a disaster situation (Medical Advisory Team, 2020). Some of these changes include the short supply of supplies and equipment that need an allocation to save many lives, lack of enough trained staff, and severe backlogs and delays in hospital and emergency care. In addition, diagnostic tools may be inaccessible, forcing clinicians to make treatment decisions entirely based on clinical judgment.
Continuum of Care
There are three care levels in the Crisis of Standards Care Operations model that act as the foundation for determining possible levels of staffing and resources during a catastrophe (Medical Advisory Team, 2020). Some of the levels for determining Crisis Standards of Care planning include:
- Conventional Care: This applies when there is more demand for health care and a shortage in resources supply. The level of health care should align with daily practices in the health care organization.
- Contingency Care: This entails a situation where the demand for health care is more than the available conventional resources, but it is likely to sustain a functionally equal care level by utilizing care guidelines of augmenting, conserving, and adapting. The emergency operation plan of a healthcare facility is activated at this phase. Though clinical procedures may be substantially changed, resources normally match demand.
- Crisis Care: This applies when the need for health care exceeds the supply of resources in spite of contingency care strategies. The usual level of care cannot be sustained, and triage and allocation strategies must be executed.
Healthcare institutions were forced to rapidly augment and develop their resource conservation and medical surge plans to shift from conventional to contingency to the level of crisis to ensure an effective response to the COVID-19 pandemic (Medical Advisory Team, 2020). During this publicly declared health emergency, the objective was to stay in contingency status as much as possible and evade shifting to crisis size. Within contingency level, individual facilities can manage plans for different implementation tiers. Those tiers are different from one hospital because of different layouts, resources, and competing services offered. Each hospital should preserve a crisis command using Hospital Incident Command Structure, for instance, a planning function, to evaluate the external and internal demand and environment and shift every hospital through its different tiers. Some of the strategies of maintaining contingency capacity include:
- Cancelling elective surgeries and procedures to enhance the capacity
- Early transfer or discharge of proper patients to less-acute levels or home care
- Moving less-severe patients from curative surgical units to alternative care sites with the help of discharge planners and case managers.
- Moving behavioral health and post-acute patients from critical settings to other suitable settings
- Expanding the capacity of critical care into areas like outpatient care divisions, surgical suites, and anesthesia care divisions
- Expanding areas of patient care to include semi-private rooms and hallways
- Advancing admissions to shift patients from the emergency units to care units
- EMTALA-compliant assessment of individuals who seek care, together with EMS and other medical guidelines to ascertain the most suitable care setting, such as a developed alternate care unit for less severe patients.
Standards of Care in New Mexico during a Healthcare Crisis
The COVID-19 crisis created unexpected medical conditions that severely handicapped health care professionals in nearly all types of care they offer; thus, the providers must shift their usual viewpoint to a crisis viewpoint (Medical Advisory Team, 2020). Usually, healthcare providers have a legal and ethical obligation to do everything that serves the interests of all patients. Still, during a crisis, providers have a legal and ethical obligation to consider the interests of all people in the state rather than that of individual patients. The alternative of implementing this viewpoint and the care standard that accompanies it is providing the best care to certain New Mexican people and not providing health care to some. Such would cause an ethical disaster since New Mexican would be forced to shut the doors of its healthcare facilities to people who desperately require medical care.
Healthcare providers in all fields, including healthcare agencies and facilities, must deploy various methods and tactics to treat and manage not non-COVID-19 and COVID-19 patients under the growing circumstances of a health care surge response that is different from the usual, pre-pandemic care standards (Medical Advisory Team, 2020). The usage of surge capacity methods and tactics will differ across small and large health systems, among populations, over time, and alongside the range of continuum to crisis care levels.
One of the main challenges in handling the COVID-19 response is the supply of staff and the level of skill in the available staff. Hospitals faced a dramatic rise in the number of patients, and most patients needed ventilatory aid, among other expert care. Effective management of the pandemic required more health care professionals to offer surge-level health care for COVID-19 patients in the whole state (Medical Advisory Team, 2020). Various strategies can help expand the workforce for effective management of the pandemic, for instance,
- The Medical Advisory Team should find the available health care workers who currently do not provide health care services in New Mexico hospitals. These health care professionals can support or mentor a group of health care members with less experience.
- New Mexico Medical Reserve Corps has vast experience organizing volunteers in confirmed emergencies. By so doing, they can act as a backbone for employment and confirming licenses, and conducting background checks for recognized individuals.
- Emergency Licensure: The medical board and pharmacy board in New Mexico, among other licensing agencies, have provisions for emergency licensure. The medical advisory team can identify ways through which healthcare providers licensed outside the state can be licensed by the right board to ensure they practice within the state.
- Redeployment: In the course of contingency care, when there is only the provision of vital services, medical professionals in non-crucial services can be diverted to areas that are likely to experience a medical surge. This short window provides an opportunity to offer prompt preparation to ensure this staff is ready to undertake new clinical responsibilities and duties. Hospitals can re-deploy procedural room and operating room workers into transport roles, intensive care units, and emergency rooms and start developing competence to handle surges in the allocated areas.
- Expanded scope of practice: The state can apply all the pertinent ranges of public safety and health care practices present in personal professional licensing guidelines and the public health emergency response activities.
- Other sources of expanding workforce: Health care providers with lapsed licenses, licensed higher education staff and faculty, school nurses, health care professionals without jobs, private sector providers without jobs, and Medical Reserve Corps volunteers are among the targeted categories that can provide more health care workers. Also, retired healthcare workers may provide triage and consultation though at-risk populations should offer this via telehealth.
People who obtained their health care education outside the US may be used but should not be considered a way of obtaining licensure. The participation of such professionals should be reviewed on the basis of each case. Clinical professionals in administrative posts should go back to clinical care as many as possible. Professionals should practice on the basis of their license; for instance, respiratory therapists should focus on handling ventilators and eliminating the majority of other responsibilities (Medical Advisory Team, 2020). On the other hand, nursing staff should focus on IV medication assessment and administration while deferring basic feeding personal care, among others, to family members, vetted volunteers, or health care assistants, if existent. Flexible patient and staffing models may be necessary to allocate important personnel to urgent patient needs. Healthcare workers may be required to work in areas not directly related to their profession. For instance, PTs and OTs may be required to perform as extenders of the healthcare team. Further, continuing health care students may be asked to join the medical profession to help provide an immediate response to the pandemic surges.
Responding to a pandemic can be fostered by effectively communicating with the public and pertinent stakeholders. Effective communication reduces ambiguity and improves understanding, and in most cases, people accept to follow the provided guidelines (Mintrom & O’Connor, 2020). In the long-term, effective communication can help maintain compliance, assure the public, and fight misinformation. Also, it promotes trust between governments and their citizens. Notably, preserving good governance entails transparency, which helps cultivate trust in institutions and leaders and promote the successful implementation of policies during pre-pandemic and pandemic times.
During the COVID-19 pandemic, the government disseminated two kinds of public health information (Sagan et al., 2021). The first one was on how to prevent the infection and the second one was official communication informing the public about the current policy and situation. The government missed different communication channels to facilitate wide coverage, for instance, social media platforms to address the citizens about the crisis. Also, public broadcasting services aired constant press conferences to announce prevention measures. In the healthcare industry, technical experts and professionals explained the epidemiological situation. Further, health interviews and advice in advertisements and print media amplified the messages about public health.
Currently, social media sites like YouTube, Instagram, Twitter, and Facebook are among the main aspects of most public health campaigns (Sagan et al., 2021). Further, official websites are other ways of communicating and direct channels such as chatbots, text messaging, and hotlines. The chosen channel was supposed to be consistent with local communication cultures. Notably, effective public health communication needs high transparency, including information about uncertainty and risks and community engagement with hands-on strategies that deviate from traditional one-way communication. Thus, effective communication should contain data that people can understand and interpret to ensure they comprehend the risks and handle expectations, thus providing more support to the response activities.
Provisions for Populations with Different Social Determinants of Health
Responding to COVID-19 has been enhanced by the availability of tests for detecting the disease. Various kinds of tests have increased but are still a challenge. Medical experts in diagnostic personnel and testing from the health epidemiology department and response division collaborated to offer an evidence-based and balanced tactic to COVID-19 testing. The assessment strategy addressed the need to identify the virus or underlying issues in non-symptomatic and symptomatic persons for prevention, tracing, surveillance, and public health research.
COVID-19 testing for crucial health care providers and at-risk populations such as ethnic and racial minorities and people living in congregate facilities was prioritized. Besides testing, the state continued with the prevention strategies, for instance, enhanced infection control and screening among the skilled nurses and longstanding care facilities and providing medical shelters and quarantine facilities to mitigate the spread of the disease and worsening signs that need hospitalization. With more and more diverse communities, it is crucial to avoid excluding disadvantaged groups when providing health care during a crisis event. For instance, the disadvantaged community should not be denied access to public health messages based on their language. The information should be made available in various languages, including those minorities use. Also, health information should not be one-size-fits-all since different people have diverse needs.
The COVID-19 pandemic has been around for some time now, and New Mexico heeded the warnings and applied enough measures to reduce the viral spread among the people. Not all lessons learned are negative. According to health administrators, they were inspired by their workers. Others claim that the pandemic prompted an examination of their lives and encouraged them to live better. The health care professional learned about the essence of unity. Another observation from the pandemic is how the internet can be misleading, and thus people should stop depending too much on the internet. Health care professionals should adopt effective communication methods to provide reliable information regarding infection prevention to ensure they don’t rely on misleading information.
The healthcare industry in New Mexico played a crucial role in ensuring a continuum of care during the COVID-19 pandemic. Health care professionals tried to match staffing with health care needs and encouraged adaptation to respond to the emerging needs to match patient demand. Further, the health care organizations rapidly augmented and developed resource conservation and medical surge initiatives to change from traditional to an emergency. This helped to combat the pandemic effectively.
Hick, J. L., Hanfling, D., Wynia, M. K., & Pavia, A. T. (2020). Duty to plan: Health care, crisis standards of care, and novel coronavirus SARS-Cov-2. NAM Perspectives. https://doi.org/10.31478/202003b
Medical Advisory Team (2020). New Mexico Statewide Acute Care Medical Surge Plan for COVID-19 Pandemic Response
Mintrom, M., & O’Connor, R. (2020). The importance of policy narrative: Effective government responses to Covid-19. Policy Design and Practice, 3(3), 205-227.
Sagan, A., Webb, E., Azzopardi-Muscat, N., de la Mata, I., McKee, M., & Figueras, J. (2021). Health systems resilience during covid-19. Lessons for building back better. United Kingdom: World Health Organization, European Commission, European Observatory on Health Systems and Policies.