For clinicians and medical professionals, some of the most infuriating and upsetting images from the COVID-19 pandemic were those showing emergency department workers fashioning personal protective equipment
(PPE) out of garbage bags during the height of the first wave of the pandemic in spring 2020. Though this situation was not universal in every state/city and hospital setting, it is still important to discuss this issue so as to prevent this serious lack of safety standards in the future. While one can applaud the ingenuity of the personnel on the frontlines during a time of scarcity, the absence of sufficient amounts of PPE was abominable. Every medical professional is a highly trained and highly specialized individual whose well-being and safety should be respected. Though our work often places us in extremely perilous environments, and we voluntarily chose this profession knowing quite well that we could potentially be exposed to dangerous pathogens and situations, very few would find it controversial to say that this does not mean that we should be expected to obsequiously agree to operate in these environments without proper protective equipment. Looking back, every effort should be made to make sure that there should never be a nationwide shortage of this kind of equipment even in the most extenuating of circumstances. It would be like sending an entire army to the frontlines without any form of armor or camouflage.

Of course, material support is not the only thing that clinicians need in the time of crisis. They also need training to keep themselves and patients safe. Without this training, medical professionals are similarly walking into a situation without proper protection. Consequently, crisis resource management (CRM) should be a necessary part of any medical professional’s training. CRM focuses on improving nontechnical skills like interpersonal communication, problem-solving, situational awareness, team coordination, and resource management.

It has been estimated that 40,000 to 100,000 Americans die annually due to medical errors.² The majority of these errors do not arise because of a lack of knowledge on the part of medical professionals or even poor judgment on the part of one clinician but rather due to miscommunications and dysfunctional team dynamics. Ensuring that students learn practical skills to prepare them for a career that is heavily reliant on being part of a team will go a long way to improving coordination during emergency situations, especially novel ones that require ingenuity and the ability to follow and respond to ad hoc protocols.

While didactic teaching is necessary for medical professionals, it can be supplemented by simulation-based active learning and team-building exercises, including some that can be conducted virtually when in-person options are unavailable.³ A meta-analysis found that the expanded use of team training exercises for medical professionals optimized team outcomes.⁴ However, this kind of training can also improve CRM among students, thereby better preparing them for real-world scenarios. Saravana-Bawan and colleagues found that a single session of low-fidelity
simulation-based noncontextual active learning improved students’ CRM performance when compared to students who were only given instruction via didactic teaching. When compared to a group that was provided didactic teaching, the active learning group scored significantly better (6.7 points higher on a scale of 42). However, these effects became statistically insignificant 4 months after follow-up, suggesting that active learning exercises should be regularly employed to improve retention.⁵

Yet another facet of training that is often overlooked in medical school is palliative care. Personally, I have often found that hospital chaplains are far better equipped to offer guidance to patients who are in need of end-of-life care and to their grieving families who often feel unmoored by the loss of their loved one. Gaining communication competencies often requires first-hand experience, but simulation-based learning exercises could be utilized to supplement didactic teaching to better prepare medical professionals to offer comfort and empathy to those who struggling with existential anxiety or grief.⁶ One need not be deeply religious to learn to speak the language of compassion.

Predictive algorithms and machine learning have been put to use to predict outcomes for emergency departments and intensive care units with some success. This can help medical professionals better allocate resources during times of crisis, as well as assess whether a patient may be more susceptible to postacute sequelae through the use of psychometric and biomarker data collected through electronic medical records. Given the well-established existence of postacute sequelae of SARS-CoV-2 (see Chapter 4, Neuropsychiatric Symptoms and Postacute Sequelae of SARS-CoV-2—The Long Haulers), a predictive algorithm for what is being called long COVID would be beneficial to many patients, especially if it is later discovered that early intervention can mitigate symptom severity or even eliminate the syndrome entirely.

This is an extremely important point since many patients who experience long COVID may not even develop acute symptoms of the disease and may only develop postacute sequelae. A study involving approximately 2 million people who had COVID-19 found that only 5% of those who reported lingering symptoms were hospitalized, while 55% were asymptomatic and another 40% experienced mild symptoms and recovered at home.⁷ What this suggests is that only a minority of patients with COVID-19 will seek out medical attention, making such interventions relatively ineffective.

However, medical personnel in emergency departments are in a unique position to collect psychometric and biological data directly following a traumatic event, including recovery from severe COVID-19, to assess the potential for posttraumatic psychiatric disorders. Such predictive algorithms, if utilized during either a large-scale traumatic event like a natural disaster or yet another pandemic, could help mitigate subsequent psychopathology, particularly PTSD.

Emergency departments in the United States discharge an estimated 30 million patients who have experienced a traumatic event as defined by criteria A for PTSD in Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).⁸ This includes the following: