Since the spread of the coronavirus disease 2019 (COVID-19) was designated as a pandemic by the World Health Organization, health care systems have been forced to adapt rapidly to defer less urgent care during the crisis. The United States (U.S.) has adopted a four-phase approach to decreasing and then resuming non-essential work. Through strong restrictive measures, Phase I slowed the spread of disease, allowing states to safely diagnose, isolate, and treat patients with COVID-19. In support of social distancing measures, non-urgent studies were postponed, and this created a backlog. Now, as states transition to Phase II, restrictions on non-essential activities will ease, and radiology departments must re-establish care while continuing to mitigate the risk of COVID-19 transmission all while accommodating this backlog.
In this article, we propose a roadmap that incorporates the current practice guidelines and subject matter consensus statements for the phased reopening of non-urgent and elective radiology services. This roadmap will focus on operationalizing these recommendations for patient care and workforce management. Tiered systems are proposed for the prioritization of elective procedures, with physician-to-physician communication encouraged. Infection control methods, provision of personal protective equipment (PPE), and physical distancing measures are highlighted. Finally, changes in hours of operation, hiring strategies, and remote reading services are discussed for their potential to ease the transition to normal operations.
The aims of this article are to describe the events of a recent mass casualty incident (MCI) at our level 1 trauma center and to describe the radiology response to the event. We also describe the findings and recommendations of our radiology department after-action review. An MCI activation was triggered after an amphibious military vehicle, repurposed for tourist activities, carrying 37 passengers, collided with a charter bus carrying 45 passengers on a busy highway bridge in Seattle, WA, USA. There were 4 deaths at the scene, and 51 patients were transferred to local hospitals following prehospital scene triage. Nineteen patients were transferred to our level 1 trauma center. Eighteen casualties arrived within 72 min. Sixteen arrived within 1 h of the first patient arrival, and 1 casualty was transferred 3 h later having initially been assessed at another hospital. Eighteen casualties (94.7 %) underwent diagnostic imaging in the emergency department. Of these 18 casualties, 15 had a trauma series (portable chest x-ray and x-ray of pelvis). Whole-body trauma computed tomography scans (WBCT) were performed on 15 casualties (78.9 %), 12 were immediate and performed during the initial active phase of the MCI, and 3 WBCTs were delayed. The initial 12 WBCTs were completed in 101 min. The mean number of radiographic studies performed per patient was 3 (range 1-8), and the total number of injuries detected was 88. The surge in imaging requirements during an MCI can be significant and exceed normal operating capacity. This report of our radiology experience during a recent MCI and subsequent after-action review serves to provide an example of how radiology capacity and workflow functioned during an MCI, in order to provide emergency radiologists and response planners with practical recommendations for implementation in the event of a future MCI.
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