‘It’s like multiple flu seasons simultaneously’

Medical Center working hard to prepare for COVID-19 winter
Deb Hill
News-Argus Managing Editor
Friday, October 23, 2020
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Annie Davis (left), acute care/OB manager at CMMC and Registered Nurse Marsha Zibell check patient records Thursday morning. Davis serves on the hospital’s Incident Command team, which has created a plan in case the facility sees a surge in COVID-19 patients.
Photo by Deb Hill

This week saw the number of COVID-19 cases spiking to the highest level yet, with over 900 new cases a day reported across the state, just as winter weather settles in. Add the traditional flu season on top of that, and medical professionals around the state are worried about whether the state has the resources that will be needed. This is especially true for hospitals, with several already being at maximum capacity.
With that in mind, a group of Central Montana Medical Center staff meets daily to discuss the local situation and to plan for what might be coming. This group, the Incident Command team, includes 16 of the hospital’s medical experts and department directors, including CEO and Incident Commander Cody Langbehn. On Thursday, Langbehn shared their plans with the News-Argus.
“I know some people say it [COVID] is just the flu so why make a big deal about it, but what we have is a highly infectious disease running through the country, at the same time as we are going into the traditional flu season. It’s like having multiple flu seasons all at the same time. It’s creating atypical needs, and we must be able to respond to the surges in patient load,” Langbehn said.

According to Langbehn, CMMC averages nine to 10 patients per day throughout the year.
“We have the resources in place to handle that volume,” Langbehn said.
But the COVID-19 pandemic is coming on top of that average. This past week the hospital, which is set up to reasonably handle up to four COVID-19 patients, already had three.
“Not only is the number of patients higher, but the work related to those cases is higher. A COVID patient needs a lot more resources than a typical patient,” Langbehn said. “We have to figure out how to respond with necessary staffing and equipment.”

Staffing shortages, surging numbers a concern
One of the biggest challenges for small, rural hospitals, including CMMC, is staffing.
“The labor market in Central Montana is extremely ugly,” Langbehn said. “We struggle to fill positions, such as nursing, environmental health or kitchen workers. We’ve had people apply who turned us down when they couldn’t find housing. With COVID, we also may have staff out due to being in quarantine.”
Langbehn said CMMC is working aggressively to fill positions, but so are all the other rural hospitals.
“We are competing with everyone else, nationwide, for the same resources,” Langbehn said. “That’s what keeps me up at night. If we get exponential growth [of COVID cases], if we go from three to six, we are going to be in a situation that impacts our ability to provide care. It doesn’t matter how many beds we have if we can’t staff them.”
Those are just some of the difficult issues CMMC’s Incident Command team is discussing while creating their “surge” plan.

Worst-case scenario
The Incident Command team’s planning has identified how CMMC will respond in the event the number of COVID patients rises above the current level.
“We can care for at most four COVID patients in isolation rooms with negative air pressure,” said Annie Davis, acute care/OB manager and the person in charge of staging for the Incident Command team. “If we have someone whose COVID case is very bad, if they need to be on a ventilator, we can get them to other hospitals. Billings and Great Falls are typically our first transfer locations.”
Unfortunately, with COVID cases spiking simultaneously across the state, hospitals in other communities are already at maximum capacity. Both Benefis in Great Falls and St. Peters Health in Helena reported more than 90% of their beds were occupied this week. Billings Clinic and St. James Healthcare reported between 70 and 90% occupation.
What does that mean for Central Montanans? Patients may need to be transferred to hospitals much further away, such as Salt Lake City.

CMMC can treat most patients locally
Emergency Room Manager and Incident Command Planning Section Chief Cindy Birdwell said CMMC has been able to get a supply of COVID-19 treatment drugs, including the anti-viral drug Remdesivir and the steroid Dexamethasone, both of which may help patients with serious COVID-19 symptoms.
“We are blessed to have some treatment options, and we seem to be able to get what we need,” Birdwell said, adding, “but you have to be pretty sick to get these drugs.”
Birdwell said those coming to the ER with COVID-19 symptoms are asked to call ahead.
“If a sick person, any sick person, comes into the ER, we wear PPE [Personal Protective Equipment] for everything. We act as if every patient could have it. We have become extremely diligent with hand sanitation and donning or doffing of PPE,” she explained. “COVID patients are transferred to isolation rooms, with dedicated staff. If we can’t ‘room’ them directly, we put them in a triage room.”
Birdwell emphasized CMMC has the capacity to handle the number of cases they are currently seeing. In the worst-case scenario, the Incident Command team has plans to turn an entire section of the hospital into a COVID ward, should it be needed.

You can help
While planning for the worst-case scenario continues, Langbehn said he is asking for the Central Montana community to take actions to help keep that worst-case scenario at bay.
“We are asking the community to help us out, help our ability to care for them, not just with COVID but with everything else,” Langbehn said. “We will be here, we will do our best, but we’re asking for help. There is science that supports masking and staying away from crowds; that it helps slow the spread of this disease. Is it 100% effective? No. But it helps. You can help us be able to care for Central Montanans by wearing a mask, social distancing, avoiding large public gatherings. I know it’s difficult, but we are asking people to be in it for the long haul. Some won’t get a bad case, but eventually the virus finds someone who isn’t going to do well with it. Help us by doing what we know works.”
Meanwhile, Langbehn said, the CMMC Incident Command team will continue to plan for the worst while hoping it doesn’t come to pass.

Members of the CMMC Incident Command team

Cody Langbehn, CEO, Incident Commander
Dr. Bennett, Medical and Population Health Director
Joanie Slaybaugh, Director of Human Resources, HR Liaison
Torie Poser, Director of Business Development , Labor Pool & Credentialing Leader
Abbey Wichman, Director of Compliance & Risk Management, Logistic Section Chief
Julie Reiman, Quality Improvement Coordinator-Interim CNO, Operations Section Chief
Alan Aldrich, CFO
Denise Jimmerson, Infection Control Coordinator, Safety Officer
Laurie Ray, Occupational Health Manager, Employee Health
Stephanie Prater, Marketing Coordinator, Public Information Officer
Cindy Birdwell, Emergency Room Manager, Planning Section Chief
Rick Poss, Director of Ancillary Services
Annie Davis, Acute Care/OB Manager, Staging Manager
Lisa Ash, OR Manager
Dr. Marchion, Medical- Technical Specialist
Jodie Reishus, Executive Assistant, Deputy



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