Researchers outline a 5-point prep plan that could help you weather the storm.
Picture this: it’s been a long night. You’re the only radiologist in the building. And, somewhere around 3 a.m., you get the call from your emergency department (ED) that they’re sending 15 mass casualties your way for CT scans. These aren’t victims of a multi-car crash – they’re patients suspected of having COVID-19 infection.
Suddenly, your mind is racing. Scan time itself is minimal, but what about patient transport time? CT scanner disinfection time? Time to outfit both yourself and your technologists with the personal protective equipment (PPE) needed to shield yourself from possible infection?
You have to ask yourself – “Am I ready?”
Throughout the country, the COVID-19 outbreak is already in full-swing with the hardest hit areas being major municipalities, mainly New York City and the surrounding area. While the virus is present in all 50 states, not every hospital has seen its COVID-19 peak. Now is the time to prepare your radiology department for what’s coming.
In an effort to help, researchers from the University of South California published guidance in the Journal of the American College of Radiology that can lead you through proper preparation for the current mass casualty incident (MCI).
“Radiologists can play an important adjunct role in triaging and diagnosing patients during a mass casualty incident, including a COVID-19 outbreak,” wrote a team led by Lee Myers, M.D., assistant professor of clinical radiology at the Keck School of Medicine at the University of Southern California. “Even the most efficient radiology department will undergo tremendous stress when victims of a mass casualty flood the emergency department and, in turn, the radiology department.”
And, while the real-time reverse transcriptase polymerase chain reaction (RT-PCR) test is considered the gold standard for COVID-19 detection – and the American College of Radiology recommends against using CT scans to identify the disease – there could still be instances nationwide where hospitals will rely on imaging as a way to detect and triage patients.
“It is expected that there will be a significant interest in increasing the number of imaging studies ordered for suspected cases of COVID-19 from both emergency medicine departments and inpatient services,” they wrote.
Consequently, contended Myers’ team, each radiology department must have an MCI plan in place to handle the imaging influx.
Laying the right groundwork for communication will be critical to successfully managing and navigating the crisis, the team said. And, a good communication plan requires early identification of point people in each department, as well as what each area will need. If you have a standard radiology MCI plan, break it out and build on it.
Designating a radiology MCI manager who can oversee activities can keep your department running smoothly during the crisis.
“An MCI plan ‘manager’…will oversee radiology operations during a mass casualty scenario,” the authors wrote. “The radiology department MCI plan ‘manager’ will decide when radiology resources will be mobilized and the best use of these resources.”
In doing so, keep these points in mind:
Clarify the Imaging Chain
According to the team, during a viral outbreak, your imaging chain is most vulnerable with patient transport to the radiology department and with cleaning equipment. Clearly outlining when imaging should be used and how it can be accomplished will prevent any overuse.
Remember you might have to make adjustments as patient volume changes, the team advised.
Educating Your Team
One of the biggest dangers present in a viral outbreak is a lack of understanding around personal and patient protection.
“Education has an important role in decreasing transmission rates and improving patient throughput efficiency,” the team wrote. “The use of proper precautions can help protect patients and radiology staff.”
The best way to learn and prepare is by doing, and getting ready to handle a huge surge of patients in a viral outbreak is no different, the researchers wrote.
“The use of simulations can identify breakdowns and bottlenecks in the imaging chain,” they wrote. “This can also identify the minimum number of personnel needed from start to finish of the exam.”
As the virus continues to spread nationwide, it’s highly likely that more radiology departments will find themselves faced with a surge of patients, requiring them to implement an MCI protocol. Prior planning can be critical to controlling the outbreak as much as possible.
“Having an MCI plan in place for a viral outbreak will protect patients and staff and, ultimately, decrease virus transmission,” the team wrote. “The radiology department should be ready to mobilize equipment and staff to meet the needs of our patients.”