EDEN — The eyes are a strong communicator when half the face is obscured.
If I had to read the eyes peeking above surgical masks of those gathered in the main conference room at UNC Rockingham, I’d describe them as focused, serious and concerned.
It’s 9:30 a.m. and Brian Armstrong, the hospital’s interim director of emergency services, is kicking off the daily report in Incident Command.
This is unfamiliar ground for the 108-bed hospital. Like other hospitals around the country, its staff is gearing up for a new enemy.
The conference room has become a war room. The enemy? COVID-19. And people who once had mainstream titles like director of lab services, surgery technician and nurse are now referred to as incident commanders, section chiefs and branch directors.
It’s become a ritual at the small rural hospital in Eden since March 16.
Only a few people are in the room; others are phoning from the safer isolation of their offices or reporting remotely while they work from home.
If a surge in coronavirus cases hits the Eden community or perhaps other locations in Rockingham County, this Incident Command center will be staffed 24/7, providing the most up-to-date information and resources to those on the front lines.
In a matter of weeks, health care has entered the realm of emergency management with no clear end in sight.
Though the staff trains rigorously for fires, tornadoes, active shooter drills and infant abductions, a pandemic is new. The training manuals don’t have a COVID-19 chapter.
But UNC Rockingham has Armstrong, who is a recent addition to the staff. A resident of Texas, Armstrong works for a health care staffing agency that specializes in operational efficiencies. In early February, when it felt like there was an ocean between the U.S. and the coronavirus, he came to UNC Rockingham to optimize operations in the emergency room, while a search for a permanent director was conducted.
Call it serendipity or right place at the right time, but the registered nurse who holds a master’s degree in business is exactly the person the hospital needed. It only took a quick glance at his resume for Steve Eblin, the interim president and CEO of UNC Rockingham, to know that Armstrong was the right person to lead the hospital’s preparedness and response to the virus.
Armstrong knows his way around disasters. He’s provided emergency response for six hurricanes. He’s been a Navy Corpsman, a paramedic, a firefighter and an airborne scout in Iraq during the war. He’s done a stint with the Department of Defense, taught marine firefighting and survival and was an instructor in fire and emergency training at Louisiana State University.
Now, he’ll be adding this pandemic to his resume.
By early March, before the first COVID-19 case was confirmed in North Carolina, Armstrong was working with leaders to compile an Incident Command team.
“We’re taking this very seriously, adjusting our operations to be in a good place to manage the types of patients we may get,” said Armstrong, who knew state agencies and hospitals would organize Incident Command centers, and wanted UNC Rockingham to be ready.
Armstrong led the staff through a quick review of the Federal Emergency Management Agency’s Hospital Incident Command system. As a requirement, many staff members had passed an online course in the procedures, but Armstrong’s refresher came with the real-life experience. He knows what garbage smells like when waste management systems are down, how important procurement of supplies can be when customary sources are shut down and the resilience of the human spirit in the midst of loss and fear.
And he knows the efficiencies realized when all across the state and the nation, everyone is using the same system and the same command structure to tackle the same problem.
On March 16, Incident Command was established.
After a few weeks, Armstrong, who once prompted the rotating incident commanders through the report, is able to watch from the sidelines.
On a recent day, Chip Miller, manager of physical therapy, served as Incident Commander. The colors red, green and yellow stipulate the status of operations.
For now, the review is very basic. Miller goes through the drill:
Personal Protective Equipment or PPE — one of those medical acronyms that’s become a daily household word — is yellow. But it won’t stay that way. After weeks of searching, a source was located and a supply of masks should arrive soon. Every employee is now required to wear one to protect patients and themselves.
Staffing is green, which means adequate.
Food supply is green.
Facilities is green.
It’s very basic at this point, but that’s not likely to be the case moving forward. We just haven’t seen the onslaught, yet.
In other places, daily reports include available ventilators and body counts.
Thankfully, it hasn’t happened here — yet.
Because of that, every now and then, you can see the eyebrows soften, the outer skin around the eyes lift and the pupils brighten. Though it’s hidden behind a mask, you know it’s there. A smile. A reason to hope.