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— Clinical

The Impact of a 12-Foot Conference Table

How the activation of the Hospital Command Center on February 5, 2020 made history at UC San Diego Health

When you enter the conference room on the first floor of UC San Diego Medical Center in Hillcrest, it looks like most spaces where meetings are held: A 12-foot-long, walnut-colored table takes up the middle of the room. Chairs and mostly blank walls surround it.

But in emergencies, that room becomes a sort of crisis control center, where experts, highly skilled at operating clinical and non-clinical areas and aspects of the hospital system, convene to sort out issues, make decisions and find remedies. When that happens, phones on the table start ringing constantly. The walls start to fill with pinned notes and broad sheets of butcher paper covered with names, numbers and data. A large, flat-screen TV at one end of the room is turned to local news or video feeds around the hospital. Doctors, nurses, administrators and staff hustle in and out.

The room is transformed. It is now a Hospital Command Center (HCC), a designation activated by events ranging from local wildfires or major power outages to internal issues that might temporarily and significantly disrupt services. It’s a carefully structured operation with specific roles, such as Incident Commander, Safety Officer, Logistics Officer and Public Information Officer, each with its own set of responsibilities.

“We all hung on their every last word, afraid to miss a vital piece of information and hungering to learn more about the novel coronavirus.”

Yadira Galindo

On February 5, 2020, the HCC was activated for what would become the COVID-19 global pandemic.

Staff across all areas of the hospital system were alerted by their pagers suddenly and loudly pinging. It was their cue to head toward the HCC ASAP, and take their seat at the table.

“What has never ceased to amaze me in the 12 years I’ve had the privilege and honor to be a part of the organization, is that people always come in willing to help, even if they are nervous to step out of their comfort zone,” said Monique Imroth, director of Emergency Management and Business Continuity and Telecom Operator Services at UC San Diego Health.

Carrying the communications pager and on-call, Yadira Galindo, then-senior communications and media relations manager at UC San Diego Health, was among the first staffers to arrive at the HCC that February day.

“There was a frenzy of requests to develop internal and external communications, yet the command center became unnervingly quiet when a member of the infectious disease team gave an update,” said Galindo. “We all hung on their every last word, afraid to miss a vital piece of information and hungering to learn more about the novel coronavirus.” Soon, Galindo was joined by colleague Jeanna Vazquez, who had only joined the communications team a few weeks prior.

“I often found myself going to work and coming home in the dark,” said Vazquez. “The energy walking into that room every day was palpable. We were surrounded by such incredible minds that wanted to help and prepare our staff for this crisis as best as possible.”

“The energy walking into that room every day was palpable. We were surrounded by such incredible minds that wanted to help and prepare our staff for this crisis as best as possible.”

Jeanna Vazquez

As the hours turned to days, weeks, months and now more than a year, the pandemic has become the longest HCC activation in UC San Diego Health history at more than 650 days, and counting.

“The longest HCC activation prior to the pandemic was seven days during the 2007 San Diego wildfires,” said Imroth.

In the beginning, the HCC was open seven days a week, with some staff members putting in 70- to 90-hour weeks. Daily topics ranged from proper PPE protocols, staffing and training for the COVID-19 units to communicating with Chinese patients airlifted from Wuhan and how to best submit COVID-19 tests to the Centers for Disease Control in Atlanta for processing.

People who had never been part of an HCC were tapped. “We were using our collective knowledge, skills, abilities, talents, desires and efforts to synergize and band together,” said Imroth.

There was also a fear factor. “The command center sits in the hospital setting. People were wondering if they were going to catch the virus and bring it home to their families.

“Part of my job is to connect with everyone in that room and let them know I am there for them. If I found out someone in the HCC liked peanut M&Ms or had a dietary requirement or drink preference, we made sure to provide those comforts. If I knew someone was feeling uneasy, I shared my own feelings with them. I am a fan of candid conversation, and sometimes humor, to eliminate anxiety and let others know they are not alone. And during that time, we all needed to know we were not alone.”

As more was learned about the novel coronavirus and COVID-19, and guidelines emerged and evolved regarding masking, physical distancing and reducing transmission risks, HCC operations settled into a sort of routine. After seven months working around that conference room table, and realizing that the pandemic was not going to end any time soon, the decision was made to go remote. It had never been done before for a major crisis event.

“We transitioned to a virtual command center slowly. It was similar to the physical command center in that we still had a plethora of meetings and briefings. We just did them over Zoom instead of from across a table,” said Imroth. “As things changed with the pandemic, we adapted too.”

The virtual HCC continues, with weekly briefings for key leaders and occasional sessions as needed. Hundreds of all-staff emails have been sent, updating employees to the situation and needs.

Recalling 2020, Imroth said some lessons carry forward.
“I think what we found out is that we need each other.
We need each other to get through these difficult times.
We need each other as cheerleaders.
We need each other as support teams.
We need each other to laugh with.
We need each other to cry with.
We need each other to rant with.
We need each other.”

Happy Orange

On the morning of February 5, 2020, with the first potential COVID-19 patients en route to UC San Diego Medical Center in Hillcrest from quarantine at Marine Corps Air Station (MCAS), a Code Orange was called.