Lesley Osborn
Former Medical Director of Memorial Hermann Life Flight
Memorial Hermann Health System, Houston, Texas
Flights for Life
During the height of the pandemic, Lesley Osborn oversaw trauma care at the University of Texas Memorial Hermann Medical Center in Houston – one of the state’s largest trauma centers. Her job included serving as medical director of the center’s Life Flight program, one of the busiest air medical companies in the United States.
COVID Cruise
An early struggle of the pandemic was finding places to house potentially infected travelers.
“I was one of the first physicians in Texas to respond when patients came off the DIAMOND PRINCESS cruise ship in Japan and were flown to San Antonio. The majority of the passengers from the ship were housed at Joint Base San Antonio-Lackland. Those who were COVID positive, but who didn’t require hospitalization, were housed in one of the only remaining tuberculosis hospitals in the country.
Very quickly, it was easy to realize that this probably wasn’t our best approach. We took these patients that had almost no symptoms, put them in TB isolation rooms and asked them to stay there until their COVID tests were negative twice.”
“If we remember the beginning of the pandemic – how long it took to get those COVID tests back from Atlanta, since they all were sent there – there were patients who were there for weeks. These were healthy, middle-aged adults, and it was a very frustrating and jarring experience for them to be in an isolation unit and have no contact with anybody outside of someone in full PPE handing them a cold meal a few times a day. Looking back, it was the only place we had to put patients at the time, but probably not the best approach moving forward. That’s where we started in February 2020.”
Flights for Life
Flying with critically ill patients risked exposing healthcare staff to the virus.
“It was easy to see that we were going to be tapped with caring for those critically ill and injured patients who were positive with COVID. Texas becomes very rural very quickly, and we were going to be called by community hospitals and critical access hospitals to fly these patients, typically on ventilators, back to Memorial Hermann to care for them. Within a few weeks we stood up a committee to figure out our policy and our guidelines to care for these patients, and my focus was keeping flight crews safe.”
“I focus on patient care all the time, and I have high expectations for my flight crews, but there was so much unknown to my EMS providers, flight nurses, and flight paramedics. They were very concerned about flying these patients in an aircraft where you can’t filter anything out…because we just didn’t truly understand what it was at the time.
“To my knowledge, at least, early on there were no conversions of my flight crews to COVID-19, and I think that helped them gain confidence in caring for these patients, and we’re talking about the most critically ill patients.
“Our first COVID-19 flight was a patient that was placed on ECMO [extracorporeal membrane oxygenator], and then we flew them back to the medical center. These were the sickest of the sick. A lot of them did not survive, but at least they had access to high-level care.”
Creating Safety Protocols From Scratch
Osborn was in charge of developing a playbook for keeping her flight crews safe as they worked to transport patients.
“I didn’t have much to draw from. There was almost nothing from the SARS and MERS responses. In Ebola large military aircraft were utilized, which didn’t apply at all to what we were using (for COVID-19). We didn’t have the space or ability to truly isolate the patient in a pod or separate the patient compartment from the pilots. I took from those experiences, but I’ll be honest: there was almost nothing.”
“So we started from the beginning, and I think the key part for me was making sure that every single player was involved from my pilots and mechanics on these aircraft to my infectious disease professionals at the hospital. Not everyone was completely comfortable. Even our dispatchers were involved because we had to change our dispatch system. We needed to know all the details before we picked these patients up. Normally, we blind our crews to these patients, so that they don’t decide when to fly based on how sick the patient is. But we had to flip our script in order to not expose all of our equipment to COVID-19. We had to have everything out and ready and prepared before we ever got to the patient’s bedside.
“Our ground paramedics in the field didn’t have the option of waiting –the 911 system never stops, and they were thrust into this pandemic without much information, and so it was important to help with their fear. Making sure they had appropriate PPE was a lot of the initial response because they didn’t have enough to burn through in a day, as well as making sure they had a team to decontaminate their trucks and given them a break to change and wash clothes, and do the often overlooked tasks like eat and rest.…they were exhausted. We also had to work out things like: Where do we take these patients? What hospitals are prepared to care for them? Everyone was overwhelmed.
“I think we all remember that flurry of equipment that was being advertised to buy certain types of masks and respirators. But, when you think about a flight crew and what they have to wear with their night vision goggles and helmet, finding something that fit them was important.”
“I published on this shortly thereafter to put our blueprint out there. It was not perfect, and we changed it frequently, but it was a starting point for medical companies to look at hopefully and say, this is what someone’s doing, and maybe we can build on this, or it doesn’t perfectly fit. They’re still using the majority of that blueprint when it comes to highly infectious disease patients in the greater Houston area. We changed a couple of things as we moved along. But. it definitely made our flight crews more comfortable with that process, and I think they felt supported by our group, which was important for me.”
“Most of my guidance came from our Regional Advisory Councils (RACs) in Texas, who very quickly said, ‘we also don’t know what we’re doing, but we all need to meet.’ So we got everyone together…from our forensic health team all the way through to our hospital system leaders in the same room.”
Leaving a Stronger Capability Behind
Osborn designed protocols to keep her flight teams safe and to support first responders who were meeting them when they landed. Her work eventually settled into a rhythm.
“Today, they continue to follow the protocols we created, whether they have a patient with tuberculosis, a patient with COVID, or a ‘fill in the blank’ highly infectious disease. They learned to work in the Texas heat and 115 degrees in full PPE.
“Now, there is a much more robust state level emergency response program in Texas. I think if that had been in place during the height of COVID, it would have been a little different. The Texas emergency response program was initially created for fire response, but it now includes any disaster. [During 2020] it felt very disjointed – like they weren’t completely speaking with each other, or if they were, there just wasn’t enough information known to be able to push it out and feel like it was a concise message to the rest of us that were dealing with the people who were meeting these patients at their front doors.”
“At some point we settled in – at least on the air medical side. We transported about 150 patients. These were all critically ill or injured patients that were positive with COVID. A lot of them were intubated or on ECMO, as well as some pediatric patients. We found ways to support our families and our crew members…Then we eventually just expanded it to all of our aircraft. We realized that the volume was high enough, that we didn’t need to just be putting these patients off and waiting for one dedicated aircraft to decontaminate. So we essentially spread it out to everybody, and it became the norm.”
“The place where I saw more fatigue was with the ground EMS crews, because we were asking them to get in full head-to-toe white suits and put on goggles in terrible Texas heat…and they’re pouring sweat. As soon as they got done, they pulled the ambulance right up to a bay where we were doing decontamination, and the crews got out, went in, took showers, changed, and then we had a whole different set of people that were decontaminating their equipment for them so they could have a break, and hopefully get some kind of respite from what they’ve been doing.”