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Lori Moon has spent substantial time in professional and emergency management training over the past thirty years. Countless hours spent in tornado, earthquake, flood, fire, and active shooter drills. A pandemic, however, never topped the list of scenarios. It was always a possibility and plans were made.

Moon is the Systems Director of Governmental Relations. A wordy title that she says covers compliance, privacy, risk management, and emergency preparedness. She’s worked with Terre Haute-based Union Health since 1989 when she started as a student nurse. In 2015 she took over responsibility for incident command.

Over the last several years, Vantage Point has helped Moon and others in the District 7 Healthcare Coalition train for a variety of scenarios. Troy Jester, President of Vantage Point Consulting shared that Union Health has invested time and resources in their preparedness efforts over many years. VPC has performed exercise tests and training courses for the Union leaders.

“Union leaders are always engaged and willing to learn and they take the exercise scenarios seriously and activate plans like it is the real thing”, Jester adds. The courses and exercises focus on an “all-hazards” approach to allow the client to utilize the skills and knowledge on any type of emergency — including a pandemic.

ICC team members on the last day of the Center's activation
ICC team members on the last day of the Center’s activation

“My goal,” Moon says, “Was to have three to four positions deep in incident command, so we had a lot of flexibility.” The pandemic changed that. “With COVID, this was such a patient-centered emergency and so focused on infectious disease, my model wouldn’t work. It couldn’t work because the non-clinical help couldn’t help.”

Instead, Union Health stuck with eight or nine people in incident command for stability and consistency. Meanwhile, clinicians maintained distance and worked under infectious disease control plans with patients to control the virus. “We did that from March 9 to May 30 for 14 hours a day, Monday-Sunday. It was hard,” she says.

Considerable attention in incident planning is devoted to just thinking about what might happen so that it doesn’t scare or panic the people involved. “We had our roles down, and we knew what we needed to do,” she says. “We were comfortable with our roles. We could be flexible and not be scared to go ahead with incident command.” And that’s where the training paid off. “We didn’t do anything unique,” says Moon. “We did what we had trained to do.”

There were plenty of differences, most of which she notes are net positives and have been good or worked exceedingly well given the pandemic’s drawn-out nature. “If this were a tornado, I don’t think we would have reached out to spend as much time with our EMA, with our Task Force 7, or public health department,” says Moon. “They’re always there, and we can call them if we need them, along with the State [Health Department]. We never had to use them before, but we’ve always had them in our communications plans.” Knowing how to use her connections, resources, and delegate tasks to dedicated team members from other exercises and plans worked as designed.

Moon’s experience and confidence are evident when you talk to her. As a result, nothing proved surprising to her or her team. Union Health expected to be short on PPE, as all hospitals and medical facilities were. They also expected challenges in patient care and other supply constraints in the short term and budgeting problems in the long term, just like most every hospital. “But we didn’t surge like we thought we would,” says Moon.

She notes in April, “Our census and COVID cases were high, but much of our capacity savings came from canceling elective surgeries and visits.” Patient loads are now back to normal for non-COVID cases. However, COVID-19 cases continue to rise in the region, as they do for much of Indiana and the nation.

During the spring, the hospital’s emergency room was relatively quiet. Non-emergent, non-COVID patients didn’t come, as was the case at most hospitals. One danger, however, was staff stress. Moon and other Incident Command staff watched others carefully for burnout. Frustration with conservation efforts of their supply stockpile, reusing PPE, and long days took a toll.

Meanwhile, in her other role as District 7 Healthcare Coalition Chair, requests for additional PPE and supplies mounted. Moon had the disheartening task of telling people it wasn’t coming. “I couldn’t help anyone because I was too involved with my own hospital. And we didn’t have any, either.”

New surges in COVID-19 cases mean ICU beds are filling up again, a new kind of flexibility is going to be required for incident command and healthcare leaders to grapple with. Despite the distinct early challenges and long hours, Moon and other incident commanders have had experiences giving them a silver lining: “The most rewarding thing of this whole time is how we’ve come together as a team. We made things work,” says Moon.

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