From Concerts to COVID: Transforming the RI Convention Center into an Alternate Hospital Site in under a Month.

Field hospitals have long been used to extend health care capabilities in times of crisis. In response to the pandemic and an anticipated surge in patients, Rhode Island Gov. Gina Raimondo announced a plan to create three field hospitals, or "alternate hospital sites" (AHS), totaling 1,000 beds, in order to expand the state's hospital capacity. Following China's Fangcang shelter hospital model, the Lifespan AHS (LAHS) planning group attempted to identify existing public venues that could support rapid conversion to a site for large numbers of patients at a reasonable cost. After discussions with many stakeholders - pharmacy, laboratory, healthcare providers, security, emergency medical services, and infection control - design and equipment recommendations were given to the architects during daily teleconferencing and site visits. Specific patient criteria for the LAHS were established, staffing was prioritized, and clinical protocols were designed to facilitate care. Simulations using 4 different scenarios were practiced in order to assure proper patient care and flow, pharmacy utilization, and staffing.

Strategies Used by Prehospital Providers to Overcome Language Barriers.

OBJECTIVE: Language barriers are commonly encountered in the prehospital setting but there is a paucity of research on how prehospital providers address language discordance. We sought to identify the communication strategies, and the limitations of those strategies, used by emergency medical services (EMS) providers when confronted with language barriers in a variety of linguistic and cultural contexts. METHODS: EMS providers were queried regarding communication strategies to overcome language barriers as part of an international, multi-site, sequential explanatory, qualitative-predominant, mixed methods study of prehospital language barriers. A survey of EMS telecommunicators was administered at dispatch centers in New Mexico (United States) and Western Cape (South Africa). Semi-structured qualitative interviews of EMS field providers were conducted at agencies who respond to calls from participating dispatch centers. Survey data included quantitative data on demographics and communication strategies used to overcome language barriers as well as qualitative free-text responses on the limitations of strategies. Interviews elicited narratives of encounters with language-discordant patients and the strategies used to communicate. Data from the surveys and interviews were integrated at the point of analysis. RESULTS: 125 telecommunicators (overall response rate of 84.5%) and a purposive sample of 27 field providers participated in the study. The characteristics of participants varied between countries and between agencies, consistent with variations in participating agencies' hiring and training practices. Telecommunicators identified 3rd-party telephonic interpreter services as the single most effective strategy when available, but also described time delays and frustration with interpreter communications that leads them to preferentially try other strategies. In the field, all providers reported using similar strategies, relying heavily on bystanders, multilingual coworkers, and non-verbal communication. Prehospital providers described significant limitations to these strategies, including time delays, breaches of patient confidentiality, and inaccurate interpretation. Participants suggested various resources to improve communication with language-discordant patients. CONCLUSIONS: Prehospital providers rely upon similar, informal strategies for overcoming language barriers across a variety of locations, provider types, and linguistic and cultural contexts.