Houston, Miami and other cities face a shortage of health workers to fight the coronavirus

While many hospitals have devised ways to stretch their material resources-converting the surgical ward into a specialized covid unit and recycling masks and gowns-stretching the human workers needed to make the system work. Is much more difficult.

“In the end, the capacity for critical care is space, staff, and the balance between staff. Mahshid Abir, principal physician policy researcher at RAND Corporation and director of the Acute Care Unit at the University of Michigan (ACRU). “I need all three… I can’t use a ventilator, but a respiratory therapist can’t.”

“What this is about to do will kill not only the avid patient, but everyone else in the hospital,” she warned.

The ever-growing situation reflects a full hospital in a large swath of the country. There are over 9,400 in Florida. There are thousands of hospitalizations in at least 13 other states, according to data compiled by the Washington Post.

Facilities in several states, including Texas, South Carolina, and Indiana, have reported shortages of such workers in recent weeks.

On Thursday, Louisiana governor John Bell Edwards (D) said he had called on the federal government to send 700 health workers to support the besieged hospital.

“For some strange reason… don’t worry about covid-19, but if you have a car accident, a heart attack or a stroke, or your mother or grandmother has that stroke, you don’t care about the hospital capacity. Must be Edwards said at a press conference.

In Florida, 39 hospitals have called for state help from respiratory therapists, nurses, and nursing assistants. In South Carolina, the National Guard has dispatched 40 medical professionals to 5 hospitals in response to an increasing number of incidents.

According to planning documents, many healthcare facilities predict that staffing issues will be exacerbated. Texas has been hit hardest, with South Carolina imminent. The needs vary from pharmacists to doctors.

Hotspots are spread throughout the country, from Miami and Atlanta to Southern California to the Rio Grande Valley, and the demand for assistance is as widespread as pain.

“We now have essentially three New York with these three major states in nature,” said White House Corona Antivirus Coordinator Deborah Barks on NBC’s “Today” show. Said on Friday during.

However, experts say that today’s spread needs a different mindset than what it was a few months ago in New York. While some doctors can share their expertise online and nurses team up to relieve pressure, overall tensions are on the rise.

“I missed the boat,” said Serena Bump, leader of multiple nursing organizations in Texas and regional director of nursing at Austin Round Rock in Baylor Scott and White Health.

Bumps blames the lack of coordination between state and state officials. “I feel like this is free for everyone,” she said, “each organization is simply left to its own device trying to figure this out.”

In the event of a disaster, hospitals and local health systems usually get help from nearby communities. But its standard emergency protocol, which comes into effect after hurricanes and tornadoes, “is based on the concept of concentrated influence,” said Christopher Nelson, a senior political scientist at RAND Corporation and professor at the next university. Says. Purdy Land Graduate School.

That’s how Texas has worked in the past, says Jennifer Vanda, Vice President of Advocacy and Public Policy at the Texas Hospital Association, for a temporary influx of support after Hurricane Harvey raided Houston three years ago. I recalled.

When healthcare workers headed to the blockbuster New York, it was how the outbreak reacted early.

However, the persistent and widespread nature of pandemics renders that approach infeasible. “The challenge now is,” Vanda said, “are we taxing the system nationwide?”

Teresa Q. Trang, an emergency doctor and associate professor of emergency medicine at Baylor College of Medicine at the University of Houston, began to feel cramped in June. Only a few weeks ago, she was texting her friends about how uncomfortable it was to see a lot of people enjoying themselves outdoors without masks on Memorial Day weekends.

Her fear was that she couldn’t accept critical patients because she called from her ER one after another and her hospital ran out of ICU space, but finding a hospital that could accept them. It became clear when I couldn’t.

Under normal circumstances, the transfer of such a patient, “a place where you’re afraid to look away or blink”, as Tran explains, is as Tran explains: It is done promptly to ensure the close monitoring provided.

These important patients begin to stall at the ER and develop the capacity of nurses and doctors. “Many people come in and need immediate attention,” said Trang, pointing out that emergency medical staff are always competing for time. “Time is the brain, time is the heart.”

By mid-July, an influx of “exploding” staff had provided mitigation, Trang said. However, this was short-lived as the crisis spread rapidly from one region to the next, and responding to emergencies did not allow us to increase our staff to deal with the increasing infectious diseases.

An ER doctor in Rio Grande Valley says that all three major trauma hospitals in the region have long since disappeared from their ability to absorb new ICU patients.

“We were full for several weeks,” said a doctor who spoke of anonymity, fearing retaliation for talking about the condition.

“The truth is that most of our work in the emergency department is ICU work,” he said. “Some of our patients are here, we hold them for a few days.” And each of the critically ill patients needs a nurse with them.

When ICU space is opened (probably 2, 3, or 4 beds), there’s never any relief, he said. Because 20 new patients arrive in the time it takes to dismiss them.

With the help his hospital received — masks and gowns were procured, staff doubled externally with emergency nurses and other health workers in the last few weeks — but still not enough ..

Local nurses are exhausted. Some have ended. Even the first-aid nurses who helped in New York in the spring were afraid of the magnitude of the disaster in southern Texas, he said.

“If no one came to us and we got the ammunition we needed to fight this, we couldn’t win,” the doctor said.

One of the root causes of U.S. problems is that the emergency department and the ICU often operate at or near the limits of capacity, and they are at risk before they occur and before they are in danger. Are at risk,

Texas, along with 32 other states, License compact, Enables nurses to practice across state boundaries, but is becoming increasingly difficult to recruit from other parts of the country.

Healthcare facilities in Texas can be staffed by the Department of State’s Department of Health to cover a significant two-week deficiency. However, the two weeks that take most of the time to respond to most disasters rarely enroll in a pandemic, so the facility must request an extension or create a new application.

South Carolina issued an order last week that allows nursing graduates who have not yet completed a certification exam to begin working under supervision. Prisma Health, the state’s largest hospital system, said this week that the number of patients admitted to the hospital has more than tripled over the past three weeks, approaching 300 new patients per day.

“As capacity increases, so does the need for additional staff,” said Scott Sasser, Prisma Health’s Covid-19 Response Commander, Scott Sasser. To date, Prisma has moved nurses from one region to another, called back nurses, hired doctors, and hired nurses temporarily, Sasser said.

Bumpus has gathered requests from nurses across the country and from nurses far away to the UK to find out how they can help. But Bumps says there is no easy answer.

“I had to dig myself and use my connections,” she said. Initially, she said, interested nurses were asked to register through the Texas Disaster Volunteer Registration. But the system didn’t seem to be used.

She later learned that “accidentally…literally by social media” the state contracted with a private agency to find a nurse. She therefore forwards the caller to these agencies.

According to John Henderson, CEO of the Texas Rural and Community Hospital Organization, even initially free rural areas of Texas have been destroyed by the virus.

“Unless the situation starts to improve in a short time, there is a shortage of staff,” he admitted. “In admitting that even states can’t continue,” Henderson said of moving people to fill critical staffing gaps.

Judge Eloybera asked people to stay home on Star County’s Facebook page and said, “Unfortunately, the resources at Star County Memorial Hospital are limited, so a doctor must make a decision. Who should treat? Who will go home and die?”

Stevens Gularte, CEO of Chambers Health in Anahuac, Texas, 45 miles from Houston, assists staff in a 14-bed hospital after a Houston facility begins to call for assistance in caring for patients who no longer need intensive care. The care I had to bring 10 nurses to do was not ready to go home.

“Usually we refer to them,” Gularte said. “Now they are referring to us.”

Rather than dispatching staff to other states, Donald M. Iary, director of emergency medicine at the University of Pittsburgh Medical Center, said that his hospital would effectively support other states, especially lung and intensive care physicians. He said he was helping.

“Covid has helped us to think about health care,” Yealy said, offering a lesson than a pandemic.

However, telehealth has little effect in relieving the fatigue and fear associated with working at the forefront of long-term pandemics. Wearing and undressing masks, gowns and gloves can be time consuming. Nurses are worried about taking the virus home.

Michael Sweat, Director of Global Health Center at the Medical University of South Carolina, said:

Coronavirus is a deputy manager of nursing practice that helps provide the usual staffing challenges in Harris Health, Houston, with ancillary workers to the system’s two public hospitals and 46 outpatient clinics. Changed into Pamela Russell’s daily life or death struggle.

Currently, 162 staff (including more than 50 nurses) are quarantined because they have been tested positive or are awaiting results. She said many others needed a flexible schedule to accommodate childcare. Some people are unable to work in the coronavirus ward because of their medical condition. Several contracted nurses suddenly left after their department soon learned to take covid-positive patients.

Russell seeks resources for state and international non-profit project aspirations. She is motivated, encouraged to send food to restaurants, and supports the CEO of the hospital cheerleading round.

“It’s hard to say how long this can be done. Russell, who admired the dedication of the nurses, said: “As I said, it’s a calling. But I don’t think it’s sustainable .”

Jacqueline Dupree and Lena H. Sun contributed to this report.