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James Goss at a test emergency response center.

Emergency Response Expert James Goss on Responding to COVID-19

  • James Goss, DHA, MICP was at Ground Zero. He was there in the aftermath of Hurricane Katrina. He was in Haiti after the earthquake in 2010. He knows what disaster is and what recovery takes. And it’s the health system, he says, that “is the primary response mechanism by which we respond to disasters that involve human beings.”

    Dr. Goss, new Assistant Professor of Healthcare Administration at the MCPHS School of Healthcare Business, brings a wealth of extraordinary experiences to the university. He spent 26 years in FEMA’s National Disaster Medical System and is a retired Air Force reserve medical readiness officer. He also loves teaching. As a first-generation college student, Dr. Goss knows how important getting the right education can be. Goss says that when he saw that MCPHS was ranked highly for student return on investment, he thought, “That’s where I want to work. I want to work at a place where I can use my emergency response background knowledge, my healthcare administration knowledge, and provide a good return on investment to students.”

    One of five alternate care sites we set up around Ground Zero.

    The expertise he brings is especially relevant now, in the time of the coronavirus pandemic. His work at the aforementioned disaster areas involved establishing alternate care sites—places for the treatment of those in medical need in spaces not ordinarily designated as treatment centers. While 9/11, Katrina, and the Haiti earthquake might not have been diseases, the majority of Goss’ research for the past ten years has been on preparing for pandemics; he not only has first-person experience in disaster zones but extensive knowledge of pandemic preparation and response. He and his colleagues Steven Berkshire, Asa B. Wilson, and Kathleen M. Jordan recently coauthored a paper on just that. Goss says that the paper, entitled, “A Systems Approach and Notional Response Model for Preserving the Health System during the COVID-19 Pandemic,” aims to provide “conceptual models on how to respond to a surge of patients who you might not necessarily want inside of a hospital. Hospitals in the past have magnified diseases….I wanted to pull together everything we had learned from ebola, from SARS, from MERS, and other outbreaks and combine those lessons to create a notional response model to equip emergency managers with a basic structure in their minds.”

    The research found that intelligent response involves keeping people who don’t need to be in hospitals out of them. This both helps prevent disease spread and saves hospital resources for the truly sick, whether from the disease in question or something else. Goss and his coauthors found that during the 2013-14 outbreak of ebola, the use of community care centers prevented hospitals being contaminated and saved hospital beds. In 1918 people turned their homes into care centers to help prevent spread of that year’s flu. Developing “surge capacity,” Goss writes, is essential “to preserve medical resources for the duration of the outbreak while continuing to deal with causes of morbidity and mortality unrelated to the SARS-CoV-2 virus.” During some previous pandemics, mortality rates from all causes have doubled; in some outbreaks, overwhelming the health system leads to death totals from other causes as high as the deaths from the outbreak itself, due to lack of medical resources. Goss writes

    Recognized strategies enable facilities to increase care capacity by up to 30% while surging-in-place. Such strategies have included canceling elective procedures and admissions, reverse triage, and providing care in flat spaces such as parking lots, hallways, entry lobbies, classrooms, and cafeterias.

    “They’re sites of opportunity. They’re not hospitals. During 9/11 we converted a deli into an emergency clinic. We converted the lobby of the American Express building into a clinic, he says. “Our job there was to stabilize people and then evacuate them [as needed] to the local hospitals” that were still functioning, so a deli worked. “With a disease model, you have to be able to receive the patients, sort through to see who needs care and who can be sent home, and hold the patients who need to be held for their recovery. So a deli wouldn’t work for a disease,” but a whole host of other places might. If you fit the needs of the response with the right equipment and personnel, you can find spaces to provide treatment and lessen the burden on hospitals and other facilities.

    Goss and his colleagues plan to examine the issue further and write a follow-up paper. One thing that has not surprised him is the struggles with federal vs. local responses in the United States. “We have long predicted that the federal government wouldn’t be able to respond. We’ve long predicted that localities would need to be self-sufficient.” He’ll be keeping a close eye on how it all plays out and providing guidance where it’s needed.