Civilian Medical Responder Perspectives to a Federal Military Medical Deployment in New York City during the COVID-19 Pandemic

This study aims to describe the civilian experience and perceptions of the patient coordination and management at the interface of the New York City (NYC) civilian and the military health systems during a large-scale public health emergency. A qualitative study design was implemented with interviews conducted using a basic descriptive approach. Purposive sampling was used to recruit participants with experience working during the first wave of COVID-19 in NYC. Inclusion criteria were civilians who worked at the Javits Center, the USNS Comfort, or NYC hospitals, who interfaced with patient transfer and military personnel during the city-wide medical response to COVID-19. Semi-structured video interviews were conducted between July 20, 2021 and March 11, 2022. Civilian responders working in the clinical and transfer operations of patients to military facilities in NYC during March and April of 2020 described initial confusion, as well as logistical (patient selection, transfer logistics, patient tracking), communication, and leadership challenges. While the military deployment was felt to be necessary to address the surge capacity in hospitals, the lack of clarity about military medical resources and frameworks for response resulted in confusion about what was being offered by the military deployment. This was balanced by the positive impression of working with military members and the resources that they brought to the response more generally. The need for future trainings and exercises were highlighted. Initial challenges with civilian-military roles and responsibilities, regional needs assessment, patient selection, and logistics were ultimately resolved through adaptation of civilian and military leadership. Improvements in patient tracking, medical records, and standard hospital admission and discharge functions for patients in military alternative care facilities were identified as areas for improvement. Civilian government, health care, and military leaders should consider these ideas when planning for future military deployments in support of a domestic medical response.

本研究旨在描述大规模公共卫生突发事件期间，纽约市（New York City，NYC）民用与军用卫生系统衔接场景下，民用人员对患者协调与管理的经历及认知。本研究采用质性研究设计，以基础描述性方法开展访谈。研究采用目的抽样法，招募曾于纽约市第一波新冠疫情暴发期间参与工作的参与者。纳入标准为：曾在贾维茨中心（Javits Center）、美国海军安慰号医疗舰（USNS Comfort）或纽约市医院工作，且在全市新冠疫情医疗应对期间参与过患者转运并与军事人员有对接的民用人员。半结构化视频访谈于2021年7月20日至2022年3月11日期间开展。2020年3月至4月期间，在纽约市参与患者转运至军事医疗机构的临床与运营工作的民用应急人员描述了初期面临的困惑，以及后勤层面（患者遴选、转运流程、患者追踪）、沟通与领导力层面的挑战。尽管军方部署被视为应对医院收治量激增的必要举措，但由于对军方医疗资源及应急响应框架缺乏清晰认知，民用方对军方部署所能提供的支援存在认知模糊。此类认知模糊，与参与者与军方人员共事及军方为整体应急响应投入各类资源所带来的积极印象形成了对冲。研究同时强调了开展后续培训与演练的迫切需求。军民角色与职责划分、区域需求评估、患者遴选及后勤保障等初期挑战，最终通过民用与军方领导层的协同调整得以解决。军方临时医疗救治设施内的患者追踪、病历管理及标准化住院与出院流程等环节，被列为后续优化的重点方向。民用政府、医疗系统及军方领导层在规划未来用于支援国内医疗应急响应的军方部署时，应充分考量本次研究的相关经验与建议。