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Harvard Public Health Review: A Peer-Reviewed Journal

Commentary

Closing the Supply Gap: How a Student Clinic Organization Adapted Their Role During COVID-19 Clinical Suspension to Support Frontline Providers

Woodbridge A, Foroushani  S, Hopper T, Perez-Chaumont A, Frechtling D, Phillips B, Ngo L, Dywer J. Closing the supply gap: how a student clinic organization adapted their role during COVID-19 clinical suspension to support frontline providers. Harvard Public Health Review. 2021; 27.

Abstract

With the emergence of the COVID-19 pandemic and national personal protective equipment (PPE), the Tulane University School of Medicine (TUSOM) Student Clinic Council (SCC) pivoted their focus from community student-run clinics to organizing a PPE drive to address the urgent needs of local hospitals’ supply shortages. Entitled the TUSOM COVID Response Group, the primary goal was to collect and distribute donated personal protective equipment (PPE) to frontline healthcare providers in New Orleans, Louisiana to temporarily bridge the supply chain gap. In total, from March 20th, 2020 to May 6th, 2020, the group distributed 29,217 N95s, 181,467 surgical masks, 22,747 face shields, 1,100 goggles, 3,382 boxes of gloves, 13,446 gowns and coveralls, 4,525 sleeve, shoe, and head covers, 175 pairs of scrubs, 762 bottles of hand sanitizer, 699 bottles of cleaning supplies, and 38 tablets which were distributed to 17 local hospitals and healthcare faculties. During this time, the five student leaders oversaw 82 student volunteers and coordinated donations from 169 individual and business donors. All facets of medical education and medical student organizations have been forced to adapt to the new era of COVID-19. This PPE drive demonstrates the adaptability of medical student organizations and the ability to enact change in their communities beyond their clinic sites.

Introduction: Background on the Tulane University School of Medicine Student Clinic Council

The Tulane University School of Medicine (TUSOM) Student Clinic Council (SCC) is a student-led organization that oversees the 29 student-run clinical experiences located at 13 sites across New Orleans, Louisiana. These clinics operate primarily in homeless shelters, substance use rehabilitation facilities, and low-income housing developments. An executive board – comprised of four third-year and one second-year medical student – oversees all clinical experiences, providing guidance and oversight to roughly 80 second-year student clinic leaders and almost 400 first- and second- year student volunteers. The SCC Executive Board also serves as the primary liaison between the TUSOM administration, SCC leaders, clinic site administration, and TUSOM student volunteers.

Methods

PPE Donation Project Creation

The first confirmed case of COVID-19 in New Orleans, LA was detected on March 9th, 2020.1 On March 10th, 2020 after careful deliberation and discussion with TUSOM administration, it was decided that all TUSOM student-run clinical experiences would be temporarily suspended until it was deemed safe to return to those spaces. This decision was quickly reinforced by the American Association of Medical Colleges (AAMC) guidelines recommending that all medical students be withdrawn from clinical and in-person volunteer activities on March 17th. 2,3

Shortly after its first reported case, Louisiana became an early epicenter of the COVID-19 outbreak in the United States4 and nationwide personal protective equipment (PPE) shortages began to affect New Orleans hospitals. Due to the suspension of student-run clinical activities, the SCC Executive Board looked for ways to help the healthcare community while abiding by administrative and AAMC guidelines.

Because of increasing PPE shortages in local hospitals, the SCC Executive Board reached out to TUSOM Administration with an offer to donate the small supply of existing SCC PPE such as surgical masks, N95s, and gloves. After presenting the offer, the TUSOM Associate Dean of Admissions and Student Affairs connected the Executive Board with an Infectious Disease physician who was seeking help in coordinating a PPE donation program. The SCC Executive Board was connected with hospital physicians on March 20th, 11 days after the first case of COVID-19 was diagnosed in New Orleans and the Tulane University School of Medicine COVID Response Group was formed.

Tulane University School of Medicine COVID Response Group

The TUSOM COVID Response Group’s primary goal was to collect and distribute donated personal protective equipment (PPE) to frontline healthcare providers in New Orleans, Louisiana. Specifically, donations such as N95 respirators, surgical masks, gowns, gloves, eye protection, face shields, hand sanitizer, sanitizing wipes, and industrial cleaning supplies were prioritized. As the city faced a critical shortage during the surge of COVID-19 cases in the greater New Orleans area, the PPE donation drive would serve to bridge the gap prior to the procurement, receipt, and distribution of PPE through official supply chains. Secondary goals included raising awareness of the dire PPE needs of the health system via social media campaigns, news appearances, and community partnerships along with volunteer recruitment for both the PPE donation drive and other projects supporting the TUSOM’s COVID-19 response efforts.

 

After the creation of the TUSOM COVID Response Group, leaders spent the initial days meeting virtually with physician advisors, TUSOM administration, and local hospital administration to create a protocol and plan for a functional, effective PPE drive, while recruiting student volunteers for their efforts. Collection of donations began on Monday, March 24th, with distribution of donated material commencing the following day.

The COVID Response Group leaders were comprised of second- and third-year medical students, including SCC Executive Board Members, former SCC leaders, along with non-SCC affiliated medical students. The following were the COVID Response Group leadership roles, filled entirely by medical students:

  • ExecutiveDirector: oversaw all COVID Response Group operations, primary contact between administration and community
  • Donation Coordinator: oversaw all donation protocol, inventory, and volunteers
  • AdministrativeManager: coordinated with other volunteer groups and donors
  • Operations Coordinator (2x): primarily coordinated PPE distribution to the hospitals
  • PPEProduction Coordinator: oversaw and coordinated with student and community PPE Production groups (face shields, masks, gowns)
  • Logistics Coordinator: Organized donations of delivery trucks and packing materials for efficient donation distribution; while also stepping up to fill any personnel shortages.

PPE Donation Volunteer Recruitment

Within the first three days of the PPE drive, roughly 100 medical student volunteers (M1-M4s) volunteered to help with PPE donations. Initially recruitment was limited to those within the SCC email list which comprised SCC clinic and other operational leaders. However, these students are mostly second-year medical students and it was determined that the effort would be more successful if recruitment included the whole TUSOM student body. A recruitment email was sent to all four class (M1-M4s) email list along with each class’ social media pages and group chat applications.

A virtual informational meeting was hosted to describe the PPE drive operational plan and address any volunteer questions or concerns. All interested students were added to a new TUSOM COVID Response Group email list in order to efficiently relay information and task sign-ups. Students were recruited for one of three efforts: (1) PPE donation solicitation, (2) PPE hotline shifts, and (3) PPE donation and inventory shifts. By the end of the drive, over 130 students were receiving email list updates.

Additional Volunteer Opportunity Recruitment

Throughout the course of the PPE donation drive, several volunteer opportunities arose to lend support for other needs during the COVID-19 outbreak. These included fundraising for the GreenWave Heroes fund, delivering food to frontline providers purchased through the fund, maintaining an accurate and up-to-date testing site list, PPE sanitization efforts, Veterans Administration COVID-19 research projects, and COVID-19 patient follow-up calls after hospital discharge. The PPE drive student leadership connected students with projects by communicating descriptions of projects and the number of requested volunteers from the TUSOM administration to the COVID Response Group email list. Thus, PPE drive student leadership served as a connection between students eager to help in whatever way possible with individuals and groups in need of volunteers. Student leadership involvement was limited to solely volunteer recruitment with these opportunities.

Other opportunities included student groups working on PPE Production projects, including manufacturing single-use gowns, reusable face shields, and 3D-printed masks. This group also conducted a literature review on the safety and optimal designs of homemade PPE in order to provide evidence-based recommendations to students, community members, and city leaders regarding appropriate use of homemade PPE. Furthermore, the TUSOM COVID Response Group served in an advisory role to other volunteer organizations by providing contacts at local hospitals, logistical support, and social media promotion.

PPE Donation Management

A Gmail account was created, and the address publicized to the community in order to handle donation inquiries. This account was managed by the TUSOM COVID Response Group leadership and a physician to respond to these emails and connect inquiries to the appropriate party (administration, purchasing, etc.). In addition, 45 student volunteers participated in PPE donation solicitation. Students contacted over 400 local and national businesses and nonprofits by making phone calls and sending emails soliciting donations. Businesses and industry that use PPE, such as construction companies and refineries, were asked to donate their surplus PPE and to share supplier information to allow for potential purchase. This allowed for students who were no longer in New Orleans to participate remotely. Response Group student leaders also solicited donations through national PPE donation groups such as #GetUsPPE and #GetMePPE and through applying to larger corporate programs.

Donors were instructed to either drop-off or mail their donations to one of several locations which included the warehouse and receiving sites operated by Tulane University or the TUSOM COVID Response Group workspace created on the Tulane University School of Medicine campus. A PPE Donation Hotline was created to help answer donor questions and give directions on how to donate. The hotline was staffed by volunteer medical students from 8AM-5PM for the entirety of the drive. The calls were forwarded to volunteer’s cell phones to allow for remote volunteering. If the line was busy due to another call or after hours, voicemail messages were forwarded to student leadership to review and follow-up. 27 students participated in manning the three three-hour hotline shifts per day.

The downtown New Orleans Response Group workspace was staffed Monday through Friday roughly from 8AM to 6PM and on occasional weekends. During this time, the team received walk-in donations from the community along with delivered packages with donations and donations sent initially to the other warehouse sites. At least two student leaders were present every day during PPE donation, and over the course of the drive 39 student volunteers participated in shifts where donations were received, sorted, and distributed.

Updated inventory was completed at the end of each day and duplicated by at least two leaders to ensure accuracy. Based on the end-of day inventory, distribution was planned for the following day.

Results

PPE Donation Distribution

The organizing team of students were able to serve in a unique role as an unbiased third party with no formal affiliation to the local hospital systems. Medical student leaders worked closely with donors, TUSOM administration, local hospitals, and frontline providers to coordinate PPE donation distribution. Student leaders served as liaisons with local hospital administration, supply chain managers, and infection control. This empowered student leaders to make informed decisions regarding which hospitals and which supplies were in the most need on a continuous basis. Student leaders devised an allocation algorithm emphasizing equity and transparency based on COVID-19 patient censuses and hospital supply inventory. Furthermore, donor wishes for distribution were also honored (i.e. donors were allowed to specify sites to receive their donation). PPE donations were distributed to a total of seventeen hospitals in the greater New Orleans area.

 

PPE Donation Total and Project Resolution

The COVID Response Group PPE Donation Drive took place between Friday, March 20th and Wednesday, May 6th. In 48 days, five student leaders and 82 student volunteers logged 2,142 combined hours exclusively for PPE donation efforts (excluding additional COVID-19 related volunteer activities and support).

Scores of individuals and local businesses contributed whatever PPE they could find. As media coverage of the outbreak in New Orleans increased, corporate interest did as well. At the end of the PPE donation drive efforts, donations from 85 individuals and 84 businesses were allocated to 17 local hospitals and healthcare facilities. In total, the group distributed 29,217 N95s, 181,467 surgical masks, 22,747 face shields, 1,100 goggles, 3,382 boxes of gloves, 13,446 gowns and coveralls, 4,525 sleeve, shoe, and head covers, 175 pairs of scrubs, 762 bottles of hand sanitizer, 699 bottles of cleaning supplies, and 38 tablets.

Toward the end of the drive, smaller community-based donation plummeted, and donations primarily began to come from bulk shipments from national corporations and groups (Apple, Life Preservation Initiate, etc.). As the volume of donations continued to decline and walk-in donations ceased, it became clear that it would be more practical to have TUSOM Administration take over the PPE Donation efforts especially with the large corporate donations. Additionally, the student leaders were beginning to return to clinical rotations and other educational obligations such as their national licensing exams (Step 1 and Step 2CK) and could not feasibly devote full days to the project.

 

Social Media Campaigns and News Appearances

With the creation of the COVID Response Group PPE Donation Drive, it became immediately clear that social media would allow information regarding donation efforts to reach a larger audience. Accounts on Facebook, Instagram, and Twitter social media platforms were created. Social media platforms were used to advertise the PPE donation efforts and provide donation information, make COVID Response Group announcements, report PPE donation numbers, thank donors and volunteers, and highlight other TUSOM student projects related to COVID-19 efforts.

Student leaders were interviewed on both local and national print and broadcast media, allowing the COVID Response Group to promote PPE donation efforts and engage with the community on a larger scale. Leaders collaborated with the medical school and hospital public relations departments to ensure consistent messaging and get aid in connecting to local and national media outlets.  This exposure helped attract large donations and greater community outreach.

Community Partnerships

Working with local and national community organizations, including nonprofits and organizations created specifically to tackle PPE shortages, the Response Group student leaders worked to increase community engagement. This was done in concert with local and national media appearances and social media campaigns. Community partnerships allowed continued widespread dissemination of the group’s messaging and resulted in significantly increased donations. Many local organizations, including The New Orleans Chinese Association, The Cajun Army, local branches of GetMePPE and GetUsPPE, and Supplies for Saints, used our hospital distribution network to get donated supplies they received to the front lines.

 

Discussion: Lessons and Application for other Student-Run Clinic Systems

As the COVID-19 pandemic rages on within the United States and abroad, medical education – and how students engage with their community – has transformed in response to create new safe clinical spaces for providers, students, and patients. While medical students are being allowed back into the clinical sphere, the possibility of additional surges of cases may interrupt their clinical duties again in the coming year. Furthermore, as some cities begin to flatten the curve, others are just beginning to see the types of surges that epicenters, such as New Orleans, experienced earlier in the year.

In short, medical student-run clinics must adapt to the new era of COVID-19 with both clinical and non-clinical practices. One of the key takeaways is that student clinic leaders can take initiative and use their position and its advantages to enact change in their communities beyond their clinic sites. Students in the TUSOM COVID Response Group were able to make a significant impact in the local New Orleans healthcare community during the initial months of the pandemic, despite not being allowed in hospitals. Staying engaged with the local community and engaging networks of student-run clinics and medical students at their institution is key to successful results. Many in the TUSOM network had contacts in companies who were able to donate, media connections, and connections with the New Orleans community that proved to be vital to the donation drive’s success. In times when clinical activity may be suspended, PPE donation drives are one avenue that allows for robust student-run clinics to adapt and use their volunteer base and community connections to impact change. With sharp surges of COVID-19 cases, local and national healthcare systems face the potential for overburdening and critical PPE shortages. This project has successfully demonstrated that student-run organizations can help address this problem by sourcing and distributing PPE for frontline healthcare workers until the traditional PPE acquisition systems can appropriately respond.

This opportunity provided a unique learning opportunity that is unparalleled in the traditional medical school experience. When COVID-19 fragmented medical education, this donation drive allowed students to develop initiative, leadership, communication and coordination skills, and independence, as well as nurture relationships between providers at all levels and administrators in both local hospitals and the medical school.

Conclusions

With the arrival of COVID-19 in New Orleans, the city and the Greater New Orleans area very quickly became an epicenter of the pandemic and faced a perilous shortage of PPE in local hospitals.

Led by a group of medical students unwilling to sit idly as future colleagues were overwhelmed with PPE need, the Tulane University School of Medicine COVID Response Group bridged the gap with their donation drive until supply chains were restored. What started as an effort to offer a few masks by TUSOM’s SCC turned into the donation of hundreds of thousands of PPE units. This effort not only demonstrated the resiliency of the New Orleans community in the face of adversity, but the adaptability and impact that medical students can have on the local healthcare landscape, even without being in the clinical setting.

Acknowledgements

TUSOM COVID Response Group PPE Donors

TUSOM COVID Response Group Student Volunteers

TUSOM COVID Response Group Community Partners

New Orleans Community

Tulane Medical Center

LCMC Health

Lee Hamm, MD

Sue Pollack, MS, MPH

Sarah Cossich, MD

Callie Linden, MD

 

References

  1. Johns Hopkins University and Medicine. (2020, May 5).  COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE). https://coronavirus.jhu.edu/map.html

  1. Association of American Medical Colleges. (2020, May 3). Important Guidance for Medical Students on Clinical Rotations During the Coronavirus (COVID-19) Outbreak. https://www.aamc.org/news-insights/press-releases/important-guidance-medical-students-clinical-rotations-during-coronavirus-covid-19-outbreak

  1. Association of American Medical Colleges. (2020, April 14). Guidance on Medical Students’ Participation in Direct Patient Contact Activities. https://www.aamc.org/news-insights/press-releases/covid-19-updated-guidance-medical-students-roles-direct-patient-care

  1. Fauver JR, Petrone ME, Hodcroft EB, et al. Coast-to-Coast Spread of SARS-CoV-2 during the Early Epidemic in the United States. 2020;181(5):990-996.e5. doi:10.1016/j.cell.2020.04.021