Coronavirus Choreography: Scripps La Jolla ‘resuscitation director’ describes hospital protocol at this time

As coronavirus cases mount, healthcare providers in La Jolla are confronting the battle with discipline and compassion.

Said Dr. Shawn Evans, resuscitation director of the emergency department at Scripps Memorial Hospital: “We will do what it takes to get San Diego through this.”

Reflecting on more than 25 years’ experience, Evans spoke with La Jolla Light about the current front-line workers and what it takes to get COVID-19 patients through the virus.

“It’s a grueling, and mentally exhausting process to take care of the sickest of the sick,” Evans explained. “Patients who come in with respiratory distress are all presumed to have COVID-19, and the protection process takes quite a bit of time.”

Evans noted a typical shift in the emergency room has been reduced to about nine hours, “because taking care of the potential COVID-19 patients is a lot more work — just in the orchestration of staying safe. The choreography of suiting up for sick patients can take 5-10 minutes to get your gear on, and another 5-10 minutes to take it off.”

Because of the extra challenges, it’s important healthcare workers maintain focus.

“The three nemeses of being protected are fatigue, haste and complacency,” Evans stressed. “It’s a good dance, but when you become hastened, that’s when you forget your gloves or someone puts themselves at risk. Preparation is so important ... that’s why we’re going to shorter (work) days; we don’t want that choreography to become stale because of fatigue.”

Evans reported Scripps ER has seen “an overall reduction in patients, with people less active, less opportunity for harm. However, what’s made up for that time is the time we’re now spending with the viral patient,” which he estimated to be half the incoming population.

“When someone comes in with possible COVID-19 symptoms, they are immediately placed in a mask and separated from the healthy population, so they’re isolated from their family,” he explained.

This isolation, Evans noted, is instantly acknowledged by the healthcare providers.

“The first thing we recognize is that these folks are alone, they don’t have family present. We make every effort to get the family on the phone, so we can all talk together.”

After isolation, Evans continued: “We need patients to understand what will happen. We will be hyper-vigilant for any changes that might occur, and for those who do get sicker, we want them to understand none of this is something we can’t get them through.”

The ER staff’s work to allay anxiety and reassure patients “goes a long way in keeping them calm, which helps us feel more gratified,” he said.

The hospital’s policies regarding coronavirus patients are unified throughout the five local Scripps hospitals, which include two in La Jolla. A command center has been set up for the Scripps network, with another center at each location that disseminates centralized policy, which considers legislation, protocols and drug and equipment notifications, Evans claimed.

“The entire system behaves as one synchronized piece,” he said. “It’s consistent, and ultimately, we know we’re protecting staff and families if we’re all operating the same services — from testing and isolation of the ill to the strict no-visitor policy.”

Evans acknowledges the no-visitor policy causes distress.

“It’s similarly anguishing for the staff,” he shared. “We want family to be there, but we have to ensure their safety as well. The safest place for them is outside the hospital at this time. Families have been marvelous about accepting this, and are encouraged to get in touch with members inside the hospital via Skype or any portal that engages them face-to-face. We know that’s so important.

“Coronavirus is not just another virus. The difference between the common flu and this particular virus is profound. COVID-19 seems to have the master keys to the immune system for a broader audience; it overwhelms people at any age — even those in good health — and it can command aggressive life support.

“This virus can adversely affect even the most robust, and ultimately, its impact on healthcare providers has been unprecedented. We really have to approach it with a different posture.”

Due to the virulent nature of the virus, Evans said the toll on the family lives of healthcare workers is huge.

“All of us are going home, decontaminating in the safest manner possible in the garage, with everything including shoes going into the washing machine every day,” he explained. “We greet our families from six feet back. If we have any symptoms, we absolutely isolate for 14 days and avoid work. What’s different now is that our families understand they have to stay back; we can’t be in close quarters with our young kids or older counterparts. There’s more of a burden at this time with our families.”

Nonetheless, Evans revealed he is proud of what he and his staff do. “We are all bound together, and I don’t know of any staff member who’s gone home because of a stressful event or because they couldn’t do it. The resuscitation teams and staff have performed glowingly. We are so supported by our EMS teams, our medical staff, everyone.

“Though it’s an exhaustive effort, we’ve not hit an overwhelming point. If we did, we have everything in place to manage a surge at this time. If we were running short on masks, ventilators or drug therapy, we have the ability to work through our command centers to get immediate supplies. There’s a lot of solace to the bedside provider to know we’ve got the appropriate communication chain in place as we stand on the front lines.”

Evans commended the community for its support during the crisis. “The biggest difference in our city right now, compared with others, is the collective social distancing and home isolation,” he shared. “It’s kept our emergency departments open and our ICUs available for people who are infected. This profound community support bolsters emergency room staff ... This hasn’t been easy for anybody, but everybody has shown up. It’s not about being comfortable. It’s about going to work and knowing where you stand in the choreography so you never let the public down.”