Page 2 - Desert Lightning News, Nellis-Creech AFB Edition, May 28, 2021

2 May 28, 2021 Commentary Desert lightning news s. neVaDa Desert lightning news s. neVaDa news May 28, 2021 3
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An Air Force physician assistant’s experience during COVID pandemic

by 1st. Lt. Lance Andreasen with very limited inpatient experience. making capabilities were no longer Wing Commander
Nellis AFB, Nev. The internists appeared tired and intact.
overworked. For the past few months, We discussed the next best steps with
In the late winter months of 2020, they had gone without any days off, the family, who were not able to see him
while the COVID-19 virus was surg- missed holidays and sacrificed count- in person, and despite our recommen- takes one
ing throughout the United States, I was less time away from family. This, along dation for comfort care, reversed his
working as an active duty physician as- with the sheer amount of death they DNR. The patient’s condition worsened,
sistant at the Nellis Air Force Base, Nev., were handling daily, had worn on them. degrading to a codable dysrhythmia,
family health clinic. With only one year They decided we would be best utilized likely secondary to his chronic lack of O2.
of clinical experience, I was just begin- by managing high-flow COVID patients, Instead of passing away more comfort- last flight
ning to hone my craft. which would allow them to devote more ably in a controlled setting, he received
I had previously volunteered to be on time to the more critical intubated pa- six rounds of CPR before dying. When
a COVID disaster response team, and I tients. the patient’s family was informed, they
had a hunch that I would be supporting In medicine, we have tools to help were distraught and angry at the hospi-
a mission after reading headlines in the patients breathe. We start by delivering tal staff, convinced there was more that
news. The call came in early January, and oxygen by nasal cannula/mask, then could have been done.
in a few short days, our response team progress to a CPAP/BiPAP. If these fail, Similar scenarios occurred multiple Col. Sean Carpenter, 926th Wing commander, greets his family following his final flight
arrived in Los Angeles, Calif. we typically move to a bag valve, and, times every day. And it wasn’t only the as wing commander, May 13, 2021, at Nellis Air Force Base, Nev. In his civilian capacity,
At the time, I had no true idea that the finally, intubation. patient’s family questioning whether the Carpenter is a first officer with Delta Airlines flying the MD-88. A change of command
next month and a half was going to be The conundrum of this pandemic is right decisions were being made. This ceremony is scheduled for June 13 when Carpenter will hand command of the wing
one of the most difficult and challenging caring for patients who ultimately meet constant uncertainty of the unknown to Col. Sean M. Rassas. Rassas currently serves as vice commander of the 944th Fighter
experiences of my life, testing my intel- the criteria for intubation, but knowing stretched and distorted our beliefs in Wing at Luke Air Force Base, Ariz., and is a 1996 graduate of the U.S. Air Force Academy.
lect, mental health, and spirituality, and from the literature that when a patient science, medical decision-making and Courtesy photograph Air Force photographs by Natalie Stanley
leaving me hopeful that the world would is intubated, especially individuals with spirituality. First Lt. Lance Andreasen, 99th Medical
never again experience a pandemic such multiple comorbidities (i.e. elderly, obese, I relied heavily on the quick teaching Group physician assistant, aids in the
as this again. diabetic), the outcome tends to be poor, by internists over us of what the standard medical treatment of COVID-19 patients in
I was only one of two advanced prac- and potentially worse than if they weren’t of care was for these COVID patients. Los Angeles, Calif., January 2021. Andreasen
tice providers tasked to our designated intubated. They had been dealing with this disease was deployed with other members from the
hospital. The other PA had previously One of the most difficult parts of this for nearly nine months and were still 99th Medical Group to Los Angeles, Calif.,
been tasked for a similar mission during work was trying to explain to patients unsure as to what could be done to save in an effort to provide hospitals overrun
the initial COVID surge in early 2020. and family members the low rate of sur- the most lives. with COVID-19 patients with additional
She made it clear when we met that this vival. But, many would fixate on the slim Unfortunately, so many people had staff members.
wave the patients were sicker, and the chance of hope and request to remain full been infected and in critical condition
mission seemed much more difficult. code, ultimately requiring intubation. that the hospital was no longer able to sion added a layer of misery and defeat
We had both been reading local news During my time there, I personally accommodate patients appropriately. So that exacerbated the already profound
reports that the ICUs had been at 100 only saw one patient extubated who sur- many required critical care services and moment of the final moments of the
percent capacity and were overflowing, vived. high quantities of O2 that every unit in patient’s life.
but we were still unclear what our part in I was constantly reminded of the the hospital had been outfitted with a One of the strongest individuals I have
this would look like. When our team, a complexity of this disease throughout negative pressure outflow, which con- ever had the honor to meet was a patient
mix of medics, nurses and PAs, arrived at my time at the civilian hospital. One of nected to windows with plastic curtains/ in a similar situation to the previous
the hospital, we were greeted by a grate- the first patients I was assigned was the seals separating the rooms and units patient, requiring HiFlo nasal cannula
ful, yet exhausted, nursing staff. perfect example of this. from non-COVID areas. with NRB mask maxed out O2 delivery
The reality of what we had walked into The patient was in his late 60s with This reminded me of a scene out of an and a CPAP. This patient decided it was Col. Sean Carpenter, 926th Wing commander, takes his final flight as wing commander, May 13, 2021, at Nellis Air Force Base, Nev. Carpenter has served as wing commander since
became obvious when we received the diabetes and a long history of smoking. apocalypse movie, where the character best to be DNR/DNI and chose to fight August 2019, and will be moving to Joint Base Langley-Eustis in Virginia.
tour of the hospital. I asked one of the When I first met him he was cycling be- walks into the hospital every day, masks the virus head-on.
nurses how many people were actually tween a HiFlo nasal cannula and a non- up with an N-95 and dons PPE before When I rounded on this patient and ____________________
dying and was shown a freezer truck full rebreather (NRB), requiring a CPAP to entering every COVID unit. asked how he was doing he always re- COMMANDER, from Page 1 Family, friends
of the deceased and told another would keep his O2 saturation in the 80s. Performing a simple physical exam plied, “Bien, I’m bien.” and members
come the next day as the morgues could Every day, we discussed whether or and communicating with a patient was Despite his shortness of breath and the great leadership, and that is just what they will get with Col. of the 432nd
not accommodate all the bodies. not to intubate this patient, but we saw extremely difficult, and multiple loud limitations of his thick accented Spanish, Eric “OH” Schmidt as he takes the reins of this amazing wing,” W G / 4 3 2 n d
The broad scope of our training as PAs intubated patients pass every day, only devices such as negative pressure pumps, he always had a way of expressing his Franks said. “OH comes to us with an impressive resume filled AEW took part
allowed us to integrate with the hospital to see newly intubated patients take their combined with the muffling of masks determination to fight. with experience in the special operations and flying commu- in a change
medical team quickly. We were each as- place. This patient initially decided to be and language barriers all served as yet One morning, I quickly noticed his O2 nities with accomplishments that have prepared him well for of command
signed a supervising internist to oversee do not resuscitate (DNR/do not intubate another obstacle to overcome. was in the 60s, so I ran to the head nurse this challenging and prestigious position.” ceremony at
us, who inquired about our background, (DNI). However, he slowly deteriorated Additionally, the inability for patients Schmidt has logged more than 2,900 hours in the F-15C, C r e e c h Air
consisting of primarily outpatient care to the point his mental/medical decision- to see emotion through facial expres- ______ See pANDEMiC, on Page 9 MQ-1B, and the MQ-9. He was also an instructor pilot with Fo rce B as e,
the 425th Fighter Training Squadron and taught Airmen to Nev., May 20,
fly the AT-38C. 2021. During
As the 432nd Wing/432nd Air Expeditionary Wing com- the ceremony,
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