Caring for Patients at a COVID-19 Field Hospital

Case 1

A 39-year-old man was transferred to the BCCFH on his 9th day of symptoms following a 3-day hospital admission for COVID-19. On BCCFH day 1, he developed an oxygen requirement of 2 L/min and a fever of 39.9 ^oC. Testing revealed worsening hyponatremia and new proteinuria, and a chest radiograph showed increased bilateral interstitial infiltrates. Cefdinir and fluid restriction were initiated. On BCCFH day 2, the patient developed hypotension (88/55 mm Hg), tachycardia (180 bpm), an oxygen requirement of 3 L/min, and a brief syncopal episode while sitting in bed. The charge physician and nurse were directed to the bedside. They instructed staff to bring a stretcher and intravenous (IV) supplies. Unable to locate these supplies in the triage bay, the staff found them in various locations. An IV line was inserted, and fluids administered, after which vital signs improved. Emergency medical services (EMS), which were on standby outside the field hospital, were alerted via radio; they donned personal protective equipment (PPE) and arrived at the triage bay. They were redirected to patient bedside, whence they transported the patient to the hospital.

Case 2

A 64-year-old man with a history of homelessness, myocardial infarctions, cerebrovascular accident, and paroxysmal atrial fibrillation was transferred to the BCCFH on his 6th day of symptoms after a 2-day hospitalization with COVID-19 respiratory illness. On BCCFH day 1, he had a temperature of 39.3 ^oC and atypical chest pain. A laboratory workup was unrevealing. On BCCFH day 2, he had asymptomatic hypotension and a heart rate of 60-85 bpm while receiving his usual metoprolol dose. On BCCFH day 3, he reported dizziness and was found to be hypotensive (83/41 mm Hg) and febrile (38.6 ^oC). The rapid response team (RRT) was called over radio, and they quickly assessed the patient and transported him to the triage bay. EMS, signaled through the RRT radio announcement, arrived at the triage bay and transported the patient to a traditional hospital.

The BCCFH, which opened in April 2020, is a 252-bed facility that’s spread over a single exhibit hall floor and cares for stable adult COVID-19 patients from any hospital or emergency department in Maryland (Appendix A). The site offers basic laboratory tests, radiography, a limited on-site pharmacy, and spot vital sign monitoring without telemetry. Both EMS and a certified registered nurse anesthetist are on standby in the nonclinical area and must don PPE before entering the patient care area when called. The appendices show the patient beds (Appendix B) and triage area (Appendix C) used for patient evaluation and resuscitation. Unlike conventional hospitals, the BCCFH has limited consultant access, and there are frequent changes in clinical teams. In addition to clinicians, our site has physical therapists, occupational therapists, and social work teams to assist in patient care and discharge planning. As of this writing, we have cared for 543 patients, sent to us from one-third of Maryland’s hospitals. Use during the first wave of COVID was variable, with some hospitals sending us just a few patients. One Baltimore hospital sent us 8% of its COVID-19 patients. Because the patients have an average 5-day stay, the BCCFH has offloaded 2,600 bed-days of care from acute hospitals.