Surgical Re-entry Strategy Following COVID-19 Pandemic: A Tiered and Balanced Approach.

Following the Presidential declaration of a national emergency, many health care organizations adhered to recommendations from the Centers for Medicare and Medicaid (CMS) as well as the American College of Surgeons (ACS) to postpone elective surgical cases. The transition to only emergent and essential urgent surgical cases raises the question, how and when will hospitals and surgery centers resume elective cases? As a large health care system providing multispecialty tertiary/quaternary care with across the Southeast United States, a collaborative approach to resuming elective surgery is critical. Numerous surgical societies have outlined a tiered approach to resuming elective surgery. The majority of these guidelines are suggestions which place the responsibility of making decisions about re-entry strategy on individual health care systems and practitioners, taking into account the local case burden, projected case surge, and availability of resources and personnel. This paper reviews challenges and solutions related to the resumption of elective surgeries and returning to the pre-COVID-19 surgical volume within an integrated health care system that actively manages 18 facilities, 111 operating rooms, and an annual operative volume exceeding 123,000 cases. We define the impact of COVID-19 across our surgical departments and outline the staged re-entry approach that is being taken to resume surgery within the health care system.

Time for a revolution: smart energy and microgrid use in disaster response.

Modern health care and disaster response are inextricably linked to high volume, reliable, quality power. Disasters place major strain on energy infrastructure in affected communities. Advances in renewable energy and microgrid technology offer the potential to improve mobile disaster medical response capabilities. However, very little is known about the energy requirements of and alternative power sources in disaster response. A gap analysis of the energy components of modern disaster response reveals multiple deficiencies. The MED-1 Green Project has been executed as a multiphase project designed to identify energy utilization inefficiencies, decrease demands on diesel generators, and employ modern energy management strategies to expand operational independence. This approach, in turn, allows for longer deployments in potentially more austere environments and minimizes the unit's environmental footprint. The ultimate goal is to serve as a proof of concept for other mobile medical units to create strategies for energy independence.