Cross-training/Up-training

All healthcare personnel should be up-trained and practice at the top of their licensure. All healthcare personnel should familiarize themselves with or review how to conduct certain critical activities (in case of personnel shortages):

1. Use of critical care medications and ward stock.
2. Daily preventative maintenance checks and services (PMCS) of critical equipment.
3. Oxygen burn rate for patient usage and refill plan.

The following are recommended critical care topics for providers to review and drill to improve response and success in managing COVID-19 critical patients:

1. Code Blue management of COVID-19 patient.
2. Rapid Sequence Intubation roles of nursing staff.
3. Ventilator management and Arterial Blood Gas (ABG) interpretation.
4. Titration of critical care medications and side effects.
5. PPE donning and doffing.
6. Rapid response team parameters.
7. Proning of a patient in an austere environment.
8. Working knowledge of critical equipment (POGS, EDOCS).
9. Unit specific standard operating procedures.

Units should conduct practice drills: PPE donning/doffing, patient procedures, transfers, proning, Code Blue, etc.

Leadership should consider cross-training non-medical personnel to assist clinical staff as appropriate and allowable. Non-medical personnel must perform Just-in-Time Training: DHA US-001 HIPAA and Privacy Act Training. CAC required.

Society of Critical Care Medicine provides free COVID-19 Resources for Non-ICU Clinicians. Topics include:

- Recognition and Assessment of the Seriously Ill Patient
- Critical Care for the Non-ICU Nurse
- Airway Management
- Airway Assessment and Management
- Diagnosis and Management of Acute Respiratory Failure
- Mechanical Ventilation
- Prone Positioning
- Diagnosis and Management of Shock

RESOURCES:

Crisis Level Surge – Critical Care Triage Tool Example, DoD COVID-19 Practice Management Guidelines, 3 March 2021. p138

The Elsevier, COVID-19 Health Care Hub provides clinical toolkits, podcasts, expert opinions and many other tools for providers and staff in the COVID-19 response.

There are also resources for care of older adults and children. The web-based resources are free but require initial completion of a basic online form https://www.sccm.org/COVID19

The Defense Institute for Medical Operations (DIMO, www.dimo.af.mil) hosts the following courses:

- MASL D319329 - Medical Readiness Principles of Food Protection
- MASL D319328 - Malaria & Other Infectious Disease Threats
- MASL D319318 - Infection Control in Ebola & Pandemic Management