Major General Dale Lyles
59th Adjutant General of Indiana Indiana National Guard
Guarding our Future
The National Guard played an enormous role in the American COVID-19 pandemic response, providing a professional and organized workforce to help with everything from testing to vaccinations to staffing healthcare facilities. In Indiana, the Guard was a key part of Governor Eric J. Holcomb’s command and response operations, serving in vulnerable long term care facilities and aiding in food distribution, among other contributions.
Chain of Command
In Indiana, the Governor asked Health Commissioner Kristina Box to lead the state’s COVID-19 response, with support from the state’s Family and Social Services Administration (FSSA), Department of Homeland Security, and the National Guard.
“Quite honestly, we struggled initially with who was really in charge, and then it became evident that we needed to name someone. The governor and his chief of staff named the Indiana Department of Health – ‘Dr. Box, you’re the 4 Star, and FSSA Dr. Jennifer Sullivan, you’re the 3 Star, General Lyles, you’re the 2 Star, and the Department of Homeland Security, you’re the one star.’ That was then our hierarchy on how we serve, and my role in this was a supporting role.”
“Sometimes, that role is not conducive to a medical provider, and a military person being in charge in some states works better. In our state, that wouldn’t have worked as well, and the three of us worked very well together because we got along very well. Where there were friction points, we solved them regularly. I really think it depends on your state, and who’s particularly leading those agencies.”
“The civilian-military relationship is not always smooth because in the military, we are very rigid, very formal, very process-oriented. There’s a very logical process for making assumptions. We would go into strategy meetings with civilian counterparts and try to introduce a rigid, forthright structure, and there would be a little bit of friction there. But we would overcome that. When you start to build these relationships, you’ve got to understand the civilian-military component. The three of us worked very well together because we got along very well.”
Regular Battle Rhythm
Constant communication and an open-ended budget ensured resources and personnel went where they were most needed.
“We set up a weekly battle rhythm where we brought the governor’s chief and all the right players into a meeting. Every morning, we would sit down with Dr. Box and Dr. Sullivan at the time, and we would talk about current operations, what was going on in the current environment, and then we would start to look out and see what we were going to do in the future as well.”
“We also inserted a weekly meeting with more than just us, where we had the right leadership, from the governor down to the governor’s chief and deputy chief, to ensure they understood what we were doing. Our governor was the type of leader who said things like, “Stop worrying about the money. You go to the nursing homes that need you, that need the soldiers into them. We’ll sort this out afterwards.” That particular leadership in Indiana helped a lot, that we were able to do things without having to look over our shoulder and figure out who is going to pay for it.”
Defining the Problem
State leaders worked together to maximize the Guard’s potential
When the pandemic hit, we sat down and started to develop a strategy, and it became evident that there was a superficial understanding of what the National Guard had to offer. Indiana has over 400 medics, who are qualified to give shots, and they are an EMT-type level of professionalism, and we have medical providers in the National Guard. We have 68 armories around the State of Indiana.
The first thing that we had to do was figure out how to help the food banks. Most people who volunteered at food banks were of the age where they were very susceptible to the virus. So we placed about 500 soldiers and airmen in the food banks to help with the distribution of food, which became vitally important in the early stages of the pandemic, because transportation resources weren’t being used, and supermarkets were not being stocked the way they needed to be.
“Then we rapidly found a need to open our armories throughout the state once we started doing testing – Dr. Box was big on testing, and we started to help with testing.”
“We provided medics to help in some of the hospitals that were becoming overburdened by the pandemic, which then transcended into a need to have guardsmen help with the long-term care facilities, because we were finding that the virus was coming into long-term care facilities and contributing to the death rates at an extraordinary high rate because of the transmission of the virus from the workers that were bringing it in, as well as people that were visiting.”
Restoring Confidence in Nursing Homes
The Indiana National Guard took on an out-sized role in staffing nursing homes – a role that General Lyles credits to restoring confidence in managing those facilities, which were becoming major sources of staffing shortages, infections, and COVID-19 related deaths. They started with defining the problem and the solution set the Guard could bring.
Very early on, we identified about 25 long-term care facilities that were in a crisis mode, where the staff was completely overburdened with 24/7 operations and the extraordinarily high death rates that were happening. They had a very serious fatigue issue going on there, and they needed help, and this was at a time when we couldn’t really get a lot of people to come to work, because people were quarantined. When we went into the nursing home(s), that was the most profound effect, the confidence, and the regeneration of the purposeful reason of why they were there and saving lives. It really re-instilled a sense of confidence in the staff.
“We took an ill-defined problem, we defined it, and then we trained the men and women before we sent them there. You must do that. You can’t just send them. Because then it would have been haphazard. And we added a regional approach that we put together, and we put oversight on it, and we put control measures in place. We followed up to make sure that it was going well.”
“You must first identify where your facilities are, who owns them, how are they being operated, and then what potentially could you do to surge things in there to help prevent the spread of the virus. Because one of the things we learned in this environment was any type of congregation, or people that gather, with people coming and going from the outside, was bringing the virus into the facilities. And we had to do something to control that, to stop it from being spread.”
Over the period of nearly two years, the Indiana National Guard staffed more than 500 nursing homes in Indiana, performing roles as caregivers and gatekeepers.
“We started with putting our medics into that first batch of 25 nursing homes, and they started to make an immediate impact there. When the uniform showed up, the high order of discipline and order and professionalism that the soldiers showed brought a sense of relief to the staff, and confidence was restored.”
Then we placed about 1,700 guardsmen in over 550 nursing homes in Indiana. After the first phase of 25, and before we launched into phase 2 with the rest of the facilities, we set out to have a very good and regimented training program. We brought all the soldiers that we were going to put into the facilities to a large auditorium, and we did a week’s worth of training to teach them how to handle an aging population – how to push someone in a wheelchair, how to care for someone (kind of level one care), how to assist, and we really started to define their role for them… how to wipe down surfaces, how to take temperatures, how to screen people before they came in, how to do routine admin logs of people that come in, how to ask the right questions of people to make sure the people you are allowing to have entrance into facility were allowed, how to maintain your PPE, and our soldiers are always quick to remind you when you don’t have your proper uniform on. We stopped allowing people to come in in a haphazard manner – not allowing people to come into the facility that didn’t have their temperature taken, that didn’t answer the questions right about being exposed to the virus.
“We defined the entrance requirements. You had to be a close relative. You had to make an appointment. And if you didn’t meet those criteria, you didn’t come in. And so then we immediately saw a decrease in the virus within the homes.”
“We placed two-to-three soldiers so that we could do a 24/7 shift. And these soldiers were not medically trained. They were infantrymen, military police, logisticians, cyber trained. Then we did a regional approach where we had a cluster of long-term care facilities that then had a medical professional from the National Guard that was in charge of that cluster. They would ensure that non-medical people, who were helping the facility, were doing the right things, were being supervised and trained, and they kept an eye on things.”
“If there were questions or they needed help, they would do reach-back to the person who was watching that cluster of facilities. We also further broke it down, with a commanding officer over the North, Central, and South regions. They ran and supported the operations logistically and administratively with all the resources that the soldiers needed that were working inside the facilities. The regional approach had non-medical people in facilities, but with medical oversight that absolutely worked well, and that’s something I would recommend as a part of the strategy going forward.”
The governor’s office made an executive decision to pay the Guard no matter what the federal government was able to reimburse.
In Indiana there are government-owned facilities, quasi-government private-owned facilities, and private facilities. The governor and the governor’s chief made an immediate decision that, if the nursing facility needed help, the Guard was going in, and then we would sort out all the costs and the financial share after all of it was over.
“The Federal Emergency Management Agency (FEMA) reimbursement schedules became a lot more broad when President Biden came in, and he made them retroactive to pay for some of the things we were doing that we weren’t going to get paid for, like food banks, things like that, they actually qualified for FEMA reimbursement.”
“When we were first mobilized…it’s called state active duty. The state of Indiana pays everything, the taxpayers of Indiana pay for all of that. Then, when FEMA got involved and made it a named operation, they started to pay for everything with federal funds, and they reimburse the state then to pay for those things.”
Protecting Indiana Residents
Using the Guard’s resources and logistical prowess for vaccinations and PPE distribution provided major contributions to the response.
When I look back at what we did and how effective we are at probably helping save lives, I think that the long-term care facility would rack up towards the top. But I think the most profound thing we did was assist with vaccinations.
“The Indiana National Guard has a very large medical force structure in Indiana, and we were able to mobilize almost all of our medics to be able to partner with the Department of Health when the vaccine came online to be able to provide the vaccine around our entire state.”
We did a lot of those vaccinations, we would set up vaccination sites, and a lot of those were done at our armories around the state of Indiana, as well as very highly trafficked facilities in Indiana, and they made a very profound effect.
“Here at Indiana, there also was a lot of PPE that was being manufactured. It all came to my headquarters in Indianapolis right here in the center of Indiana, and then we would make distribution to the Departments of Health around the State of Indiana based off of Dr. Box’s and the Department of Health’s logistical strategy to provide the PPE to the different counties. We would load the trucks, and then the Indiana Department of Transportation, and at some times the State Troopers, would help transport that down to the different counties.”
Exercising and Sustaining Pandemic Readiness
Lyles’ COVID-19 experiences led to strong views about sustaining state pandemic readiness.
One recommendation, in any pandemic or crisis that requires a collaborative effort, is to immediately establish a chain of command. There’s got to be someone who is the driver of policies, the resources, and the strategy.
Having regular exercises was one of the things that helped us in Indiana. We had just had an exercise with the Department of Health, where Dr. Box had come to our facilities and had an understanding. If there’s anything that I can recommend, it’s that state agencies must do some sort of annual training exercise. Even if you just stop for a day or two and do a tabletop exercise, where you all get around the table, and you put the map of the state of Indiana, or whatever, out there and you talk about a scenario, a pandemic, or an emergency of some sort and then you just do an action, reaction, counteraction, discussion and talk about resources and get to know each other through those tabletop exercises. I think that goes a long way with establishing relationships before a crisis happens. Then you have a good understanding of who you’re going to be working with and how they operate.
“If there’s anything we have to sustain going forward, it’s to continue to understand what the Guard has to offer and how the Guard can help each state. One of the benefits of the pandemic was our retention rates in the National Guard, all 54 states and territories, went through the roof because soldiers and airmen had a purpose and they felt like they were serving for a purpose. So it was enlightening to see that. I think the uniform, the sense of confidence that they brought is a “must” going forward as well.”
I think all of us realized that we’ll probably see another pandemic in our lifetime. I hope we don’t, but if we do, we need to be ready.