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Coronavirus preparation: What it's like at an alternate care site in Delaware

DelawareOnline.com (Wilmington, DE) logo DelawareOnline.com (Wilmington, DE) 2020-04-08 Isabel Hughes, Delaware News Journal
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Standing near a makeshift nurses' station inside the gym at Nemours Center for Sports Medicine, Dr. Christopher Raab looked at the hospital beds before him, each one carefully spaced about 6 feet from its neighbor.

Just a week ago, the gym was filled with physical therapy equipment used by children being treated at Nemours/Alfred I. duPont Hospital for Children. 

The room has been completely transformed, taken over by 38 hospital beds and other medical equipment.

a man wearing a mask: Christopher Raab the Medical Director for the Adult Alternate Care Site at the Nemours/Alfrd I. duPont Hospital for Children. © Damian Giletto/Delaware News Journal Christopher Raab the Medical Director for the Adult Alternate Care Site at the Nemours/Alfrd I. duPont Hospital for Children.

The sports center, located on Rockland Road, is one of two adult alternate care sites in New Castle County where non-coronavirus patients would be transferred should Christiana or Saint Francis hospitals need more beds for COVID-19 patients.

a group of people in a room: The Sports Medicine Gym at the Nemours Alfred I. duPont Hospital for Children was quickly changed into an alternative care site to help hospitals deal with patients who do not have the coronavirus. © Damian Giletto/Delaware News Journal The Sports Medicine Gym at the Nemours Alfred I. duPont Hospital for Children was quickly changed into an alternative care site to help hospitals deal with patients who do not have the coronavirus.

The gym will be ready to accept patients Thursday, but will only be used if county hospitals fill up their beds and have nowhere else to put non-coronavirus patients, said Raab, the site's medical director and a pediatrician at Nemours.

"I never imagined having to set this (up)," Raab said. "Normally, this room is chock full of big, heavy equipment, and that was gone in a day. To see the physical transformation of this room is amazing."

Military and state emergency agencies began surveying potential alternate locations across Delaware last month. Possibilities included the 76ers Fieldhouse and Rehoboth convention center.

Earlier this week, the state health department announced it had chosen Nemours Center for Sports Medicine and Governor Bacon Health Center as the two New Castle County sites.

Delaware would build a mobile hospital to support overflow patients in Kent and Sussex counties if the coronavirus pandemic puts too much pressure on existing resources there, officials said Tuesday.

All alternate care sites would be used by patients who are very low acuity and who are "really just taking up beds for a long-term process such as needing long-term antibiotics," Raab said.

Patients needing more intensive care would not be moved from the hospitals they're currently in.

IN CASE OF SURGE: Mobile hospital would help deal with coronavirus surge in Kent, Sussex counties

With the number of coronavirus cases topping 900 this week in Delaware — as of Wednesday afternoon, 147 people in the state were hospitalized — the alternate care sites aren't needed yet.

But Raab said the state needs to be ready, should it see a surge in COVID-19 cases and hospitalizations.

"I'm hopeful that we're not going to have to (use the site), but my mindset has to be that we're going to use it," Raab said. "Even though right now Christiana is in good shape and Saint Francis is in good shape, I can't think we're not going to have to use it."

The Nemours site, similar to the Governor Beacon facility, is set up much like a field hospital, though a slightly more sophisticated one than Raab ran in Haiti when he volunteered there after the earthquake in 2010.

a large white bed in a room: The Sports Medicine Gym at the Nemours Alfred I. duPont Hospital for Children was quickly changed into an alternative care site. © Damian Giletto/Delaware News Journal The Sports Medicine Gym at the Nemours Alfred I. duPont Hospital for Children was quickly changed into an alternative care site.

There are no dividers between beds, and while some patients might have privacy concerns, the lack of dividers is intentional, Raab said. Nurses and physicians need a clear line of sight to view all patients at once.

"One thing that we don't have here are call bells," Raab said. "In normal hospital rooms, if you need to call the nurse, you hit the button.

"This is a very low-tech solution to that problem. If the person in the bed in the corner needs help, they can raise their hand and we can see them."

There's not a total lack of privacy though, Raab said.

If a patient can't get to the bathroom and needs to use a commode instead, or if he or she needs a sponge bath, the nurses have dividers they can put up.

"We will try to ensure their privacy as best we can," Raab said.

a desk with a computer on a table: The Sports Medicine Gym at the Nemours Alfred I. duPont Hospital for Children was quickly changed into an alternative care site. © Damian Giletto/Delaware News Journal The Sports Medicine Gym at the Nemours Alfred I. duPont Hospital for Children was quickly changed into an alternative care site.

Raab said they are also taking significant measures to prevent coronavirus from reaching the gym, because it would go through it "like wildfire."

To be eligible for transfer to the site, a patent would have to have a negative coronavirus test. If they began to have COVID-19 symptoms while at the gym, nurses would immediately isolate them and transfer them out as quickly as possible.

No visitors are allowed at the site for fear of coronavirus, and staff are even limiting the number of physicians allowed in from other areas of Nemours to prevent the possibility of coronavirus infection.

"We've developed a plan for (everything)," Raab said.

Sharon Udy-Janczuk, nursing director for the site and director of nursing at Nemours, said those plans have been put into action through simulations over the last several days.

a group of people sitting at a desk: Nurses and national guard nurses conduct online training at the Adult Alternate Care Site at the Nemours/Alfred I. duPont Hospital for Children. © Damian Giletto/Delaware News Journal Nurses and national guard nurses conduct online training at the Adult Alternate Care Site at the Nemours/Alfred I. duPont Hospital for Children.

"One of the benefits of a simulation, which we recognized (Tuesday), is as you walk through the ideal process that you believe you have in your head, when you try to do it, there's always some outlying issues," Udy-Janczuk said.

With the simulations underway — Udy-Janczuk said staff would perform another Wednesday afternoon — Raab said he feels confident the site is ready for use.

"When push comes to shove, the medical community always rises up," Raab said. "You do whatever you have to do to help the people in front of you, and that's a fantastic feeling."

Send story tips or ideas to Isabel Hughes at ihughes@delawareonline.com or 302-324-2785. For all things breaking news, follow her on Twitter at @izzihughes_

This article originally appeared on Delaware News Journal: Coronavirus preparation: What it's like at an alternate care site in Delaware

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