By Ben Hellwarth
If you happened to walk through the main doors of an Oregon hospital recently, like Providence St. Vincent Medical Center in Portland, or the much smaller Mercy Medical Center in Roseburg, you might have been surprised to find a handful of Oregon National Guard soldiers staffing the front desk. Their desert-hued camouflage uniforms, a striking contrast to the river-blue scrubs and snow-white lab coats common to hospital attire, are more often associated with scenes of natural disasters, urban unrest, and foreign war zones. Yet the National Guard, whose military roots predate the founding of the Republic, can be called up to help contend with domestic crises of any kind—thus the Guard motto: “Always Ready, Always There.”
So, when a summer surge in sickness related to COVID-19 infections put an unprecedented strain on hospital staffs, Gov. Kate Brown ultimately made more than 1,500 of the state’s roughly 8,000 Guard members a frequent sight in and around some 50 Oregon hospitals with an urgent need for extra hands.
“In my 20 years-plus in health care, never in my life did I imagine that I would be soliciting the National Guard’s help,” said Elva Sipin, vice president of operations at PeaceHealth Sacred Heart Medical Center at Riverbend, in Springfield, the main destination for COVID patients in Lane County. “I’m just extremely grateful that they were able to help with our operational needs, at such a critical time, to help make sure that we were there for our community.”
In the spring of 2021, Guard members could already be seen on the frontlines of the fight against COVID, mainly helping to staff Oregon’s mass vaccination sites— in spaces like fairgrounds, community centers, parking lots and gyms—to get the newly-approved immunization shots into thousands of waiting arms. That mission, known as Assurance, was largely winding down by the Fourth of July. Then came the summer’s surge in COVID infections from the highly contagious Delta variant—and the beginnings of the mobilization that put soldiers and airmen to work inside hospitals, a mission the Guard dubbed Reassurance. At a 347-bed facility like PeaceHealth Riverbend, COVID hospitalizations in July had dwindled to as few as about 20 per day, Sipin said. Then in August and September, the daily number of COVID patients hovered at more than 100.
An hour’s drive to the north, at Salem Hospital, with its 494 licensed beds, the COVID caseload peaked on Labor Day, with 112 patients hospitalized, of which 22 were in the Intensive Care Unit and 14 on ventilators; 90 of those patients were unvaccinated. Hospitalization tallies were only slightly lower in the days just before and after Labor Day at Salem Health, the single hospital serving the state’s capital city, a metropolitan area with a population of more than 400,000 and surrounding rural areas in the mid-Willamette Valley.
By early November, at least 1,440 Oregonians with COVID-19 had died over the previous three months, more than the 1,435 fatalities last winter, from November 2020 through January 2021, prior to vaccines being available, according to Oregon Health Authority figures. By the end of the Thanksgiving holiday, Oregon had another 27 COVIDrelated deaths, bringing the state total to 5,142. The number of hospitalized patients with COVID-19 stood at nearly 400, with 91 of those patients in ICU beds. Statewide, there were just 68 available adult ICU beds out of 679 total, a 10% availability, and 368 available adult non-ICU beds out of 4,092, a 9% availability, according to the OHA.
At Salem Health, the summer strain on staff was compounded by what President and CEO Cheryl Nester Wolfe called “a perfect storm of accumulation,” brought on by so many people having delayed their care because of fears of catching COVID. By last summer, Nester Wolfe said, as vaccines became available and the virus’s threat seemed to be waning, those patients finally started to seek appointments. But by then, many were even more sick, and required more urgent medical attention—at the same time as the new Delta-propelled wave of COVID patients was filling beds.
“This kind of steamrolls after a while,” Nester Wolfe said. “You start to get the number of individuals who are so sick that they’re coming in because we absolutely have to do their surgery right away, or they haven’t taken care of their high blood pressure, or their diabetes—so now they’re just sicker, they have to stay with us longer, and they require more resources.”
One of the most critical resources, at Salem Health and hospitals across the state: staff.
“Staff were getting exhausted,” said Elaine La Rochelle, director of facilities at Grande Ronde Hospital in La Grande, who has been in charge of the 25-bed hospital’s COVID response. Their exhaustion was not just a product of working long shifts. “Beyond the physical toll there was the mental toll of feeling like they weren’t getting people better,” La Rochelle said. “They were used to treating people and caring for them, and they went home happy, and everything was good.” But as the surge hit, “we were seeing deaths on a weekly basis which we just don’t see,” La Rochelle said. “Our staff is not used to that. We’re not a terminal-care facility. We’re a make-you-get-better-and-gohome facility.”
In addition, the staff at Grande Ronde, midway between Portland and Boise, became more shorthanded as the spread of COVID in the surrounding community of 25,000 forced workers to stay home to quarantine, La Rochelle said.
“So, we were pushing on staffing anyway, and now you add, all of a sudden, 20% of your staff is out because they’ve had a contact exposure somewhere out in the community”—there was only one known case of patient-to-staff infection—“and now those that are left have even more work, and more patients.”
Having up to ten Guard members, while one of the smaller hospital mission contingents, made a huge difference at Grande Ronde, La Rochelle said.
Prior to the surge, her hospital was seeing between eight and 20 people a day with COVID-related symptoms. Then those numbers more than doubled, to between 30 and 60, putting the rural hospital on the brink of having to care for COVID patients only—and possibly postpone surgeries and other non-COVID-related treatments.
“Every four hours we were assessing: do we have enough beds to do the next round of surgeries? OK— we’re good,” La Rochelle explained. “The next four hours: do we have enough beds and people to do the next set of surgeries? People were still getting sick with other things.”
Enter the National Guard, which Gov. Brown initially called up for hospital duty in mid-August. What began as a mission to combat the summer’s Delta surge has recently been extended, for several hundred Guard members, to the end of 2021. From the start, the Guard’s orders have essentially been to do just about whatever non-clinical jobs needed to be done.
Maj. Gen. Michael Stencel, the Oregon National Guard Adjutant General, speaking to hospital mission members of the 41st Infantry Brigade Combat Team on September 2, at Camp Withycombe in Clackamas, said the soldiers should simply tell any hospital staffers they met, “I’m with the National Guard, and I’m here to help. You tell me what you need me to do, whether it’s sweeping the floor, folding sheets—we need to do everything we can to free them up to do the technical aspects of their job.”
This meant picking up the kind of slack that healthcare professionals, often nurses, were having to do, which cut into their time to do the most important parts of their jobs, namely, caring for patients— a persistent pandemic frustration.
“Doctors and nurses want to do the very best we can for our patients,” said Salem’s Nester Wolfe, who is herself a longtime registered nurse. “It just feels really bad when you can’t do things that you would normally do for a sick patient and being able to have those extra hands just made a huge difference.”
Those National Guard hands could be found doing a variety of jobs, and the fact that they were being done in so many hospitals, in so many departments, made this Reassurance mission something of a first in the long history of the Guard—and, at the very least, adds a new layer of meaning to “Always Ready, Always There.”
“The National Guard here, they typically will be delivering supplies, restocking things for the nurses to have them on hand, and just basically be on stand-by for nurses if they need a little assistance here or there,” said Pfc. Emilia Gomez, 19, standing in the ICU at Kaiser Permanente Sunnyside Medical Center in September, when up to 45 Guard members were working at the 233-bed hospital in Clackamas.
Gomez, of Hillsboro, and others in her support battalion, a subunit of the 41st Infantry Brigade Combat Team, were able to “help take out soiled linens, trash, and they also help with running down to get blood, and running down for a lab, just the many little things that actually make a difference in medical.”
That difference was measurable, said Josh Franke, chief project officer at Salem Hospital, where up to about 160 Guard members— about half from the Army National Guard and half from the Air National Guard—were integrated into the Salem Health Hospitals and Clinics systemwide staff of more than 5,000, of which 1,806 are registered nurses, 304 certified nursing assistants, and 64 nurse practitioners, most of them working at the main Salem Hospital. “They came right at the height of our COVID surge, and they were with us through the peak,” Franke said. “So, we had really good baseline data prior that we were able to compare the benefit of their being here with.”
A few examples:
• With more manpower to clean vacated rooms, a common Guard task at many hospitals, Salem was able to make rooms available more quickly for new patients as daily discharges from the hospital averaged between 50 and 70 per day in recent months. This also freed up nursing staff who may have had to help with cleaning prior to the Guard’s arrival.
• In Nutrition Services, the time it took to deliver meals to patients throughout the hospital was cut by an average of 22 minutes per order. “You’ve got 400 people in the hospital, so 22 minutes per order is pretty significant,” Franke said.
• Helping to move patients around the hospital, especially on the busy route from the Emergency Department to Imaging, the Guard made possible a 19% improvement in the time it was taking to get from placing an imaging order in the ED to transporting a patient to the imaging location. During the baseline period in August, that process had taken an average of 10.8 minutes; by mid-September, after Guard members had arrived and been trained, the average time had been cut to 8.7 minutes. Those saved minutes add up in the busiest Emergency Department on the West Coast from San Francisco to the Canadian border, which had more than 91,000 visits in 2020 and by early December 2021 had already logged 88,000, while averaging nearly 300 visits per day.
• At Salem’s drive-through COVID testing site, where about 300 cars per day were lining up in September, the aggregate patient wait time was reduced by about six hours once Guard members were on the scene to assist—with such tasks as queuing cars, moving supplies from the tent to the building, and getting paperwork started.
“Beyond the boost that they’ve provided to the morale of the staff,” Franke said, “they’ve had some very tangible impacts on our operations.”
But the impact of the Guard’s morale boost was itself tangible, said Sipin of PeaceHealth, where up to 70 Guard members joined the staff. “When I talk to my team about what’s the biggest impact—aside from, of course, the help with logistics and stuff like that— what’s been the biggest impact of the National Guard, I can tell you, it’s just that morale boost. The way they just came in and were willing to do anything to help out with a smile on their face.” Guard members could feel the smiles in return.
“The reception from the nursing staff here at the hospital has been fantastic,” said Sgt. 1st Class Peter Powers, part of a Brigade Engineer Battalion, another sub-unit of the 41st Infantry Brigade Combat Team, and the non-commissioned officer-in-charge of Kaiser Permanente Sunnyside Medical Center, where up to 45 Guard members have been serving. “They’re happy to have us,” said Powers, 53, of Vernonia. “They’re happy to have the help. The patients we’ve dealt with are also happy to see us— though we’re harder to identify without the uniforms on,” he added, smiling, in recognition of how, in some settings, Guard members traded their camo for scrubs, but wore ID cards showing their Guard affiliation.
But there was no mistaking a 23-year-old Guard member like Spc. Dominic Deitrick, in uniform, also of the 41st IBCT, as he washed pots, pans, and dishes amid the stainless-steel fixtures in Nutrition Services at Providence Medford Medical Center—a very long distance, and a very different duty, from his previous station with a scout and sniper section of the headquarters unit of the 1-186 Infantry Battalion that had recently returned from Djibouti, in East Africa. Now, he was just down the road from his home in Eagle Point and said, “It is an honor to serve my community.”
“The staff here at Providence has been more than welcome to all of us soldiers, and we thank them for their help,” said Deitrick, one of the 65 Guard members working at Providence Medford at the surge’s peak.
That help often came in the form of what might be called crash courses in non-clinical hospital operations—how to clean rooms, how to move patients, how to check patients in, how to keep track of supplies in stock rooms, how to pick up and deliver medications from pharmacies, and how to deliver meals.
“We were very strategic in terms of where we wanted to deploy the National Guard. It really had to be plug and play,” said PeaceHealth’s Sipin, because there was scant time for training. But procedures for jobs like room cleaning could be taught quickly, and staff— especially nurses—who had been picking up a variety of essential, if sometimes unglamorous, slack, could then get back to focusing on their jobs.
One unanticipated consequence of the Guard’s hospital deployment has been the opportunity for some Guard members—whose average age is about 28, and whose civilian jobs are many and varied—to do work that opened their eyes to career paths they might like to follow, said Maj. Chris Clyne, an Oregon National Guard public affairs officer whose focus has been the hospital mission.
“I’ve heard quite a few stories of a lot of people deciding to go into health care professions after this experience,” Clyne said. “A lot of them got to work with people who had been doing the job for a while, and got to see the work conditions, and the hours, and they were very agreeable to them.”