Open Access Open Access  Restricted Access Subscription or Fee Access

Maintaining trauma center operational readiness during a pandemic

Alexander C. Cavalea, MD, Robin McGoey, MSGC, MD, Rebecca W. Schroll, MD, FACS, Patrick R. McGrew, MD, Jonathan E. Schoen, MD, MPH, Lance E. Stuke, MD, MPH, FACS, Chrissy Guidry, DO, FACS, Alan B. Marr, MD, FACS, Juan C. Duchesne, MD, FACS, John P. Hunt, MD, MPH, FACS


The coronavirus disease 2019 (COVID-19) pandemic is a slow-moving global disaster with unique challenges for maintaining trauma center operations. University Medical Center New Orleans is the only level 1 trauma center in New Orleans, LA, which became an early hotspot for COVID-19. Intensive care unit surge capacity, addressing components including space, staff, stuff, and structure, is important in maintaining trauma center operability during a high resource-strain event like a pandemic. We report management of the trauma center’s surge capacity to maintain trauma center operations while assisting in the care of critically ill COVID-19 patients. Lessons learned and recommendations are provided to assist trauma centers in planning for the influx of COVID-19 patients at their centers.


trauma center readiness, COVID-19, pandemic, surge capacity, disaster, coronavirus

Full Text:



Huang C, Wang Y, Li X, et al.: Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223): 497-506. DOI: 10.1016/s0140-6736(20)30183-5.

Institute for Health Metrics and Evaluation: COVID-19 projections: Lousiana. Seattle. 2020. Available at Accessed May 1, 2020.

News: Mayor Cantrell issues stay home mandate in response to COVID-19. New Orleans: City of New Orleans. 2020. Available at Accessed May 1, 2020.

Louisiana Department of Public Health: Health alert network message 20-13: Declaration of emergency rule for the protection of public health. Baton Rouge. 2020. Available at Accessed May 1, 2020.

Office of the Governor: COVID-19 stay at home order. 2020. Available at Accessed May 1, 2020.

Orleans Parish COVID-19 dashboard. NOLA ready. 2020. Available at Accessed May 1, 2020.

Seda G, Parrish JS: Augmenting critical care capacity in a disaster. Crit Care Clin. 2019; 35(4): 563-573. DOI: 10.1016/j.ccc.2019.06.007.

Gifford ASP: Augmenting critical care capacity during a disaster. In Fundamental Disaster Management, 3rd ed. Mount Prospect, IL: Society of Critical Care Medicine, 2009: 3-1-3-10.

Nager AL, Khanna K: Emergency department surge: Models and practical implications. J Trauma. 2009; 67(2 Suppl.): S96-S99. DOI: 10.1097/TA.0b013e3181ad2aaa.

Hirshberg A, Holcomb JB, Mattox KL: Hospital trauma care in multiple-casualty incidents: A critical view. Ann Emerg Med. 2001; 37(6): 647-652. DOI: 10.1067/mem.2001.115650.

The Boston Trauma Center Chiefs’ Collaborative: Boston Marathon bombings: An after-action review. J Trauma Acute Care Surg. 2014; 77(3): 501-503. DOI: 10.1097/TA.0000000000000397.

Born CT, Briggs SM, Ciraulo DL, et al.: Disasters and mass casualties: I. General principles of response and management. J Am Acad Orthop Surg. 2007; 15(7): 388-396. DOI: 10.5435/00124635-200707000-00004.

Farmer JC, Carlton PK Jr: Providing critical care during a disaster: The interface between disaster response agencies and hospitals. Crit Care Med. 2006; 34(3 Suppl.): S56-S59. DOI: 10.1097/01.Ccm.0000199989.44467.2e.

Dara SI, Ashton RW, Farmer JC, et al.: Worldwide disaster medical response: An historical perspective. Crit Care Med. 2005; 33(1 Suppl.): S2-S6. DOI: 10.1097/01.ccm.0000151062.00501.60.

Parker MM: Critical care and disaster management. Crit Care Med. 2006; 34(3 Suppl.): S52-S55. DOI: 10.1097/01.Ccm.0000199988.96002.Cc.

Nates JL: Combined external and internal hospital disaster: Impact and response in a Houston trauma center intensive care unit. Crit Care Med. 2004; 32(3): 686-690. DOI: 10.1097/01.ccm.0000114995.14120.6d.

Park C, Sugand K, Nathwani D, et al.: Impact of the COVID-19 pandemic on orthopedic trauma workload in a London level 1 trauma center: The “golden month”. Acta Orthop. 2020; 91(5): 556-561. DOI: 10.1080/17453674.2020.1783621.

Kamine TH, Rembisz A, Barron RJ, et al.: Decrease in trauma admissions with COVID-19 pandemic. West J Emerg Med. 2020; 21(4): 819-822. DOI: 10.5811/westjem.2020.5.47780.

Christey G, Amey J, Campbell A, et al.: Variation in volumes and characteristics of trauma patients admitted to a level one trauma centre during national level 4 lockdown for COVID-19 in New Zealand. N Z Med J. 2020; 133(1513): 81-88.

Aljuboori Z, Sieg E: The early effects of social distancing resultant from COVID-19 on admissions to a Level I trauma center. Injury. 2020; 51(10): 2332. DOI: 10.1016/j.injury.2020.06.036.

Beyer CA, Hopper LD, French CE, et al.: The effect of California’s stay-at-home order on trauma patient volume during the coronavirus disease 2019 pandemic. Ann Surg Open. 2020; 1(2): e005. DOI: 10.1097/as9.0000000000000005.

Way TL, Tarrant SM, Balogh ZJ: Social restrictions during COVID-19 and major trauma volume at a level 1 trauma centre. Med J Aust. DOI: 10.5694/mja2.50843. Accessed May 1, 2020.

Forrester JD, Liou R, Knowlton LM, et al.: Impact of shelter-in-place order for COVID-19 on trauma activations: Santa Clara County, California, March 2020. Trauma Surg Acute Care Open. 2020; 5(1): e000505. DOI: 10.1136/tsaco-2020-000505.

Clausewitz CHM, Paret P, Brodie B: Strategic Reserve and Economy of Forces. On War. Princeton, NJ: Princeton University Press, 1984.

American College of Surgeons Committee on Trauma: Maintaining trauma center access and care during the COVID-19 pandemic: Guidance document for trauma medical directors. 2020. Available at Accessed May 1, 2020.

Rubinson L, Nuzzo JB, Talmor DS, et al.: Augmentation of hospital critical care capacity after bioterrorist attacks or epidemics: Recommendations of the working group on emergency mass critical care. Crit Care Med. 2005; 33(10): 2393-2403. DOI: 10.1097/01.ccm.0000173411.06574.d5.

Guérin C, Reignier J, Richard J-C, et al.: Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013; 368(23): 2159-2168. DOI: 10.1056/NEJMoa1214103.

Christian MD, Sprung CL, King MA, et al.: Triage: Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014; 146(4 Suppl.): e61S-e74S. DOI: 10.1378/chest.14-0736.

World Health Organization: Modes of transmission of virus causing COVID-19: Implications for IPC precaution recommendations. 2020. Available at Accessed May 1, 2020.



  • There are currently no refbacks.