Providing Food and Nutrition Services during the COVID-19 Surge at the Javits New York Medical Station

Abstract

Military field hospitals typically provide essential medical care in combat zones. In recent years, the United States (US) Army has deployed these facilities to assist domestic humanitarian emergency and natural disaster response efforts. As part of the nation’s whole-of-government approach to the coronavirus disease (COVID-19) pandemic, directed by the Federal Emergency Management Agency and the Department of Health and Human Services, during New York City’s (NYC) initial surge of COVID-19, from 26 March to 1 May 2020, the US Army erected the Javits New York Medical Station (JNYMS) field hospital to support the city’s overwhelmed healthcare system. The JNYMS tasked a nutrition operations team (NuOp) to provide patient meals and clinical nutrition evaluations to convalescent COVID-19 patients. However, few guidelines were available for conducting emergency nutrition and dietary response efforts prior to the field hospital’s opening. In this case study, we summarize the experiences of the NuOp at the JNYMS field hospital, to disseminate the best practices for future field hospital deployments. We then explain the challenges in service performance, due to information, personnel, supply, and equipment shortages. We conclude by describing the nutrition service protocols that have been implemented to overcome these challenges, including creating a standardized recordkeeping system for patient nutrition information, developing a meal tracking system to forecast meal requirements with food service contractors, and establishing a training and staffing model for military-to-civilian command transition. We highlight the need for a standardized humanitarian emergency nutrition service response framework and propose a Nutrition Response Toolkit for Humanitarian Crises, which offers low-cost, easily adaptable operational protocols for implementation in future field hospital deployments.

Strategies, challenges and opportunities in the implementation of COVID-19 field hospitals: a scoping review

“…One article on field hospital rehabilitation services used a reliable and valid short questionnaire to screen patients for major mobility limitations 32. One article described the nutrition team’s responsibility in monitoring meal provision and analysing intensive care unit (ICU) patients’ nutrition risk 33…”

“…An estimated 27% of medical malpractice cases resulted from communication barriers, where better communication could reduce medical errors and patient injury 56. Field hospital human resources often comprise healthcare workers from one or multiple hospitals and involve other agencies such as the army, academic medical centres, and governmental and non-governmental organisations 23 33. The unfamiliarity between the healthcare workers working in the makeshift field hospitals and the new system and workflow might be the risk factors for miscommunication.…”

“…Tracking and remote follow-up systems for patients with COVID-19 must be developed and adapted to ensure that patients will continue to receive rehabilitative care and follow-up management practices 32 60. Sanchez et al highlighted the essential role of dietitians in improving COVID-19 field hospital efficiency 33. The importance of nutritional screening and monitoring was supported by the findings from Wuhan, China, as the prevalence of malnutrition among elderly patients with COVID-19 was 52.7% 61.…”

“…Sanchez et al highlighted the essential role of dietitians in improving COVID-19 field hospital efficiency. 33 The importance of nutritional screening and monitoring was supported by the findings from Wuhan, China, as the prevalence of malnutrition among elderly patients with COVID-19 was 52.7%. 61 Nutrition screening and assessment of patients with suspected or confirmed COVID-19 should be continued to identify individuals with reduced appetite, food insecurity, social isolation or other nutrition risk factors, as it will aid healthcare providers in recognising whether a dietitian referral or community service assistance is required.…”

“…32 One article described the nutrition team's responsibility in monitoring meal provision and analysing intensive care unit (ICU) patients' nutrition risk. 33…”