After an amazing Christmas in Bali, Indonesia and bringing in the new year in Singapore, my vision of 2020 and beyond was altered on February 23, 2020. It was only the week prior that I had inducted the first class of EMD recruits since 2015; updated many SOPs dealing with call processing, dispatching and disaster recovery; operationalized a Clinical Command unit inside the National Command Center (NCC-999); and completed an initial review the MPDS v13.1 response configurations for transition to v13.2. Perhaps it was the gift of foreseeability, because on this day, what was to be a pandemic exercise escalated into a major incident activation.
Hamad Medical Corporation
In the beginning
When I arrived to the first meeting of the System Wide Incident Command Center (SWICC) where multiple agencies convene to coordinate national health incident response, all I could think was, “It’s showtime Synergy”. As Assistant Executive Director of Communications, I was now part of the COVID-19 contingency planning and strategy team for the national ambulance service with a focus on how to prepare the control rooms (dispatch) to respond to the threat of an imminent outbreak. Alongside the strategic intent to preserve and protect lives as well as mitigate and minimize the impact of this seemingly protracted event, my assigned priorities were:
- Anticipating that the ambulance service workload would increase during the outbreak;
- Anticipating that absenteeism levels could vary according to the severity, duration and timing of the outbreak; and
- Anticipating that hospitals would overflow and that the ambulance service would be involved in capacity and demand management.
In all my years’ experience being involved in public safety and emergency services, this was truly a test of patience, cognizance, endurance, resilience and fortitude. Despite having a bachelor’s degree, two master’s degrees, multiple certifications and actively working on my PhD, as things unfolded around that committee table, the immaterial became, immaterial. Facing unprecedented times, I drew on strength from a presentation on leadership and supervision I did at Navigator 2017 quoting ‘I don’t know what I’m supposed to do, I only know what I can do’. I transitioned from a strategic role to an operational role to address these assigned priority initiatives which I will write about over three different segments.
State of Qatar
The State of Qatar is approximately the size of the nine-county San Francisco Bay Area. However, while the State of Qatar has 2.7 million inhabitants, the majority of which are expatriates, the Bay has 7.7 million people. Central to the Bay is the City/County of San Francisco which has 800,000 constituents, approximately the same size as the central municipality of Doha which has 1.5 million residents.
The Hamad Medical Corporation (HMC) is the principle public healthcare provider in the State of Qatar and its national ambulance service has an emergency services control room (dispatch) within NCC-999. NCC-999 as a consolidated emergency operations center includes police and civil defense (fire department) agencies which receive roughly 6500 calls a day. In 2019, the HMC Ambulance Service dispatched nearly 220,000 emergency incidents from NCC-999 and handled another 100,000 scheduled transports from the Healthcare Coordination Center (HCC).
Increased Workload
Keeping in mind there were still other types of routine urgent and emergent business (not COVID-19 related), from the peak months of March through June, the ambulance service control rooms of NCC-999 and HCC received 20,000 more calls per month and initiated some 10,000 more dispatches per month. This was in part due to the several impactful infection control measures which included the ambulance service retrieving patients from the community as quickly as possible to mitigate the spread of COVID-19. I operationalized a COVID-19 ‘Desk’ inside of NCC-999 to process the requests and dispatch specialized resources for confirmed and suspected COVID-19 patients. In association with the Ambulance Service Incident Commander, dedicated operational staff, and the newest EMD recruits, this unit would receive the details of all the COVID-19 positive patients from the Ministry of Public Health (MOPH), contact the patients and then organize/transport them to isolation facilities located across the country. Additionally, through the communicable disease transportation hotline which this unit managed, calls would come in regarding suspected patients around the country we would then transfer to quarantine facilities and assessment centers.
As Head of Profession, my duty in the presence of the changing case definition of COVID-19 was to constantly update the call processing protocols and pathways. So much like a commercial call center, new scripts where developed for the outbound calls which is something inherently new to the traditional realm of dispatch centers. With the activation of the COVID-19 ‘Desk’, we were making four times the amount of inbound calls. The EMD recruits who were still relatively new to taking inbound calls followed these rapidly changing protocols contacting people to tell them that that they would need to be transferred to an isolation facility for a period of time. This was, especially at the start of the outbreak, a very worrying time for these people and their families. Let me be clear… the State of Qatar bested many nations with the most effective, proactive, responsive, and comprehensive healthcare practices in the evolution of this pandemic, nonetheless, the level of compassion experienced by us practitioners was heartfelt.
Overwhelmed
At the peak of the virus there were often over two thousand names of patients coming through my office each day for which there was immense pressure to transfer them into an isolation facility so they would not infect other people. I empathized with the staff regarding the conversations they were subjected to which could lead to a great deal of stress and anxiety.
As the unit struggled to keep up with the calling campaigns to contact people to advise them of their status and arrange their transfer, I worked with Human Resources who had staff already working within the Quarantine Command Center to do our outbound calling as part of the newly formed Isolation Service Control Center (ISCC). Gradually, we split up the patient population responsibilities with the Ambulance Service retrieving only those who were primarily with mild to severe symptoms and ISCC doing everything else.
Full disclosure, the events described in this article which occurred between February 2020 through to August 2020 are not all encompassing. Additionally, the figures are approximate and the details while factual are generalized for reasons of national security. The purpose of this article was to provide my lived experience of being on the front lines of the COVID-19 pandemic response efforts in the State of Qatar. At the time of writing September 27, 2020, the Ministry of Public Health (MOPH) had published that there were 760,267 people tested, 125,084 COVID-19 infected, and 214 deaths in the State of Qatar. Qatar has one of the lowest COVID-19 mortality rates in the world.
