How ambulance strike teams tackled South Florida COVID-19 outbreak

Incident Commander Nick Pachota was deployed for 160 days as part of a team covering one of Florida's largest population areas


Earle Kimel
Sarasota Herald-Tribune, Fla.

VENICE, Fla. — Once the COVID-19 pandemic started, Venice resident Nick Pachota was deployed twice in his role with the Florida Division of Emergency Management’s State Emergency Response Team.

The first deployment, on March 20, lasted four days and came as the state of Florida needed to assess the COVID-19 outbreak at Atria Willow-Wood, an assisted-living facility in Broward County, shortly after the first of seven patients there died.

Ambulance strike teams deployed to South Florida worked to mitigate the spread of COVID-19 through hundreds of facilities in the region. (Photo/FL Division of Emergency Management Twitter)
Ambulance strike teams deployed to South Florida worked to mitigate the spread of COVID-19 through hundreds of facilities in the region. (Photo/FL Division of Emergency Management Twitter)

Then, Pachota – technically incident commander for Region 7 with the volunteer nonprofit Central Florida Disaster Medical Coalition – was part of a team of 28 individuals tasked with taking command and control of the situation and assessing the outbreak at the facility.

The second time came on April 2, and lasted for 160 days – a typical deployment lasts seven to 14 days.

During that time Pachota and a team of five oversaw the establishment of tent hospitals – that, fortunately, were not needed to care for a possible surge in COVID-19-infected patients.

Within a week, they switched to creating teams that would assess the care of patients and mitigate the spread of COVID-19 at 1,481 long-term care facilities in Southeast Florida.

In the beginning, Pachota noted, more than 60% of the known COVID-19 positive population was in Southeast Florida. His region includes Palm Beach Broward, Miami-Dade and Monroe counties.

Those ambulance strike teams were able to have direct contact with each of the assisted living facilities in Region 7, responsible for the care of more than 58,000 senior citizens.

“By this point we’re starting to learn a lot more about COVID and that the most susceptible population in the state of Florida is going to be our elderly,” Pachota said.

That strategy grew out of the State Emergency Response Team’s initial action with Atria Willow-Wood was to deploy more people than needed to take control of the problem in one facility.

“We were way too robust for what we were trying to do,” Pachota said. “It could have been a 14-day mission but we finished it in four days.”

After that, Pachota and the state adopted an ambulance strike team method, where ambulances filled with trained EMTs and paramedics embarked on the mission of visiting every facility – reaching roughly 664 in Broward County the first five days.

“It was a matter of touching base with the facility to make sure, ‘Is everything OK? Do you have PPE? Did you hear about the new guidelines?” Pachota said.

“You would think it would be easy to just pick up the phone and call 600 facilities but it wasn’t easy to make those calls at all.”

They tried but discovered bad phone numbers or an out-date list of contacts.

The ambulance strike teams were able to visit each facility, deliver PPE, and assess the facilities to make sure they were doing screening and determining essential needs.

The team also conducted mass testing inside the facilities – the individuals on the response staff were tested twice a week.

Pachota said one of the key positions in the overall response was a certified infection specialist, typically a nurse who has certified training and experience in infection prevention. 

Most, he added, also have a masters degree in public health or epidemiology and may be nurse practitioners.

“Trying to find one of these that’s actually certified and credentialed was the big task,” Pachota said. “I was lucky, I had one when I started, then we went to two through the Florida Hospital Association.”

Eventually after working with private contractors, they found as many as 25 certified infection specialists to help respond to those 1,481 facilities.

At its largest, the team Pachota managed had about 32 ambulances and 250 nursing staff – working in concert with National guardsmen, U.S. Public Service, Veterans Affairs response teams and Florida Department of Health teams – ensuring assisted living facilities, as well as Florida DCF facilities and even correctional facilities were being operated as safely as possible.

The first level response called for paramedics and emergency medical technicians on the ambulance strike teams to visit each facility and ask five questions: “Do you have any PPE needs? Do you have the latest CDC guidelines? Are there any gaps in infection prevention? Is the screening process in place? Do you have any unmet needs?”

The specialists were checking on gaps in infection control, the amount of personal protection equipment on hand, and the number of sick residents.

Because Pachota and the team were still learning about how COVID-19 was transmitted, they skipped paper forms and went with an online system, which had the added benefit of giving the incident management team a real-time sense of which facilities needed an immediate visit by an infection control specialist.

The infection control specialist typically needed three hours on site to do a full assessment of the facility and make recommendations to the emergency response team.

“You knew that if you got the bulk of the facilities under control and got everybody educated and got PPE out, that the bulk of the facilities would be OK,” Pachota said. “But you knew that you would have whatever the percentage would be that would not be able to manage it.”

From that, they could decide the next appropriate steps, whether to group COVID-19 positive residents in one area to control spread, or evacuate a facility entirely.

“I only had to do that two times in my entire deployment,” Pachota said “We had to go in and evacuate facilities because the problem was so big that staff, residents, everybody was sick, there’s no way to contain it at this point.”

Nurses and CNAs at a typical facility were not trained to assess patients with respect to COVID-19.

“They would get this COVID delerium where they would appear happy and asymptomatic but you would take their vital signs and look at their pulse oximetry they’d be down in the 80s you could tell by looking at the data that they were sick,” Pachota said. “But because they were so hypoxic, they were actually euphoric, they’d look just fine.

“You’ve got to remember, a lot of assisted living facilities don’t have the equipment to really medically monitor people,” he added. “By the time they realize there’s something going, it’s way too late.”

At the same time, when staff got sick, a main concern was determining what went wrong that resulted in an exposure.

“We need to learn from it so we make sure it doesn’t happen again,” Pachota said, then added that because south Florida was such a hot spot, they were able to learn how COVID-19 was spreading and make recommendations to control the spread elsewhere.

For example, with the adult care facilities, the concern was always with individuals bringing the virus inside. In the case of Atria Willow-Wood it was initially construction workers.

Elsewhere, the economic reality that many healthcare workers served multiple shifts at more than one facility aided in the spread too.

“A lot of those folks would work at three of those institutions,” Pachota said. “So If I'm an infected CNA that’s not sick, not symptomatic and I go to three separate facilities I could infect 150 at each facility. It just keeps going.

Then, when a resident needed to leave for treatment at a dialysis center, that became another way for the virus to spread.

The emergency response teams were able implement and enforce state isolation protocols that Pachota said he felt helped reduce the mortality rate.

The incident management team he deployed with is similar to the one he worked with in 2016, as part of the response to Hurricane Matthew that set up mobile hospitals in Volusia County.

His wife, Katherine Pachota, who served as operations section chief, joined the team a couple of weeks into his deployment and was herself deployed for 139 days.

“We deployed over 30 people throughout the course from the deployment from the coalition,” Pachota said. “Knowing we still have that camaraderie, that’s still pretty big for me.

“The most rewarding part about this particular deployment was being the tip of the sword for the most affected population,” he continued, noting that his region was the first incident management team out in the field, responsible for one of the state’s larger population areas, once all facilities and the first-responders were accounted for.

“We were probably responsible for over 100,000 people,” Pachota said. “That’s huge.”

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©2020 Sarasota Herald-Tribune, Fla.

McClatchy-Tribune News Service

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