Managing a Disaster, Preparing for a Surge
As the disaster management program manager at LAC+USC Medical Center, USC Suzanne Dworak-Peck School of Social Work nursing alumna Kellyn Pak is ensuring health care workers receive the resources they need.
There were days in March and early April that Kellyn Pak felt like she was playing the role of online retailer Amazon. Pak, who earned her Bachelor of Science in Nursing from USC in 2002, is the nurse manager of the Disaster Resource Center at LAC+USC Medical Center.
In this position, Pak is responsible for developing plans, relationships and procedures to enhance the medical center’s capacity to withstand surges in patients during a disaster event. Now, those emergency plans are being adapted to the COVID-19 crisis and put into practice.
A key part of her role is receiving and distributing personal protective equipment (PPE)—the masks, face shields, gowns and other items that health care providers rely on every day to protect themselves from the viruses shed by patients, largely through coughs and sneezes. Just weeks into the COVID-19 health emergency, supplies of protective gear in Los Angeles County, as a whole, are already low. The county’s emergency stockpile is exhausted.
The personal protective equipment comes to the Disaster Resource Center for Region 6, where Pak works as part of a team of three, from many different sources including the state and federal reserves. The shipments come in on huge pallets and then must be dispersed to the ten hospitals and multiple ambulance agencies, fire departments, skilled nursing facilities and clinics within the downtown Los Angeles area served by Region 6.
For the last three weeks, many of her days have begun with a daily briefing from the Los Angeles County Emergency Medical Services Agency, which serves as an update on the status of the expected surge of patients, an identification of needs for patient care expansion and discussion of which plans and logistics are going to be operationalized. During March 2020, the dispersion of personal protective equipment was a priority.
Therein lies the Amazon comparison.
“We’ve never distributed PPE at this level before,” Pak said. The sheer volume of equipment coming in from all different sources brings a need for logistics throughout the entire Los Angeles County healthcare sector at a massive, Amazon-like scale. Coordinating the right size of trucks to make pick-ups and deliveries, finding space to warehouse the large shipments, and determining if expired products can still be used has challenged everyone in the network.
In addition to disseminating shipments of personal protective equipment within her region, she and her team have helped increase local surge capacity. At LAC+USC, this has meant putting disaster tents into place to increase the number of patients it can potentially serve. Throughout the county, it means an updated accounting of bed capacity and ventilator needs, and planning patient transfers to alternative care sites such as the U.S. Navy hospital ship Mercy, medical field shelters and soon to the specialized COVID-19 treatment center being opened at the former St. Vincent Medical Center.
The experience has brought the emergency planning work of Pak and her colleagues to the forefront and also required that they adapt quickly in real time as more is learned about the virus transmission and treatment.
“We’re all trying to figure this out as we go,” she said. One example of this is how the Centers for Disease Control and Prevention’s guidance for health care workers’ use of personal protective gear in this crisis continues to change based on current understanding of how coronavirus is spread.
There are two big reasons to be positive about the health care system’s response to the pandemic. First, social distancing and hygiene protocols appear to be slowing down the spread, which means healthcare providers have more time to plan and adapt. Second, years of emergency and disaster planning, combined with regular drills and tabletop exercises, have trained providers in how to handle crises of all shapes and sizes.
Even though the COVID-19 outbreak has taken the County beyond the emergencies it has tested for in the past, the slow materialization of the peak has given planners like Pak an opportunity to learn and improve disaster response.
“It’s easy to put emergency plans on paper, but it is only in execution that we uncover the logistical and communication issues that we need to address,” she said. “We’re prepared but we’re also learning a lot.”
A difficult but rewarding role
Pak acknowledges it is a tough time, requiring more and earlier hours spent working than usual. But the fact that she has been in this emergency planning role for a decade has made her more prepared than most for dealing with the scope of the pandemic.
Still, the health emergency has impacted her personally, concerned about the toll it is taking on her husband, children, parents and grandparents. She was particularly worried at the start of the pandemic when food stocks were low at grocery stores.
“I was more stressed in those early days when things were happening quickly and changing often,” she said. Now, with her husband at home from his school district job and taking care of the children, she is more at ease about her family’s ability to move through the crisis while she deals with the many pressing issues of her job.
Pak went into nursing thinking she would work at patients’ bedsides and perhaps move into education and teaching. She wants people to see her role as a nurse emergency response manager as another career path within the broad field of nursing.
“There is such a need for nurses in this type of role,” Pak said. “It’s just one of the many ways that nurses can have an impact.”
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