The Covid-19 Pandemic

Lessons Learned for Sustained Trauma Preparedness and Responses

Joseph Cuschieri, MD; Bryce Robinson, MD; John Lynch, MD, MPH; Steve Mitchell, MD; Saman Arbabi, MD, MPH; Chloe Bryson, MD, MPH; Michael Sayre, MD; Ronald V. Maier, MD; Eileen Bulger, MD


Annals of Surgery. 2021;273(6):1051-1059. 

In This Article

Abstract and Introduction


The emergence of coronavirus disease 2019 (COVID-19) that is caused by the SARS-CoV-2 virus has led to an overwhelming strain on healthcare delivery. This pandemic has created a sustained stress on the modern healthcare system, with unforeseen and potential drastic effects. Although the initial focus during this pandemic has been preparedness and response directed to the pandemic itself, traumatic injury has continued to remain a common problem that requires immediate evaluation and care to provide optimal outcomes. The State of Washington had the first reported case and death related to COVID-19 in the United States. Harborview Medical Center, which serves as the sole Level-1 adult and pediatric trauma center for the state, was rapidly affected by COVID-19, but still needed to maintain preparedness and responses to injured patients for the region. Although initially the focus was on the emerging pandemic on institutional factors, it became obvious that sustained efforts for regional trauma care required a more global focus. Because of these factors, Harborview Medical Center was quickly entrusted to serve as the coordinating center for the regions COVID-19 response, while also continuing to provide optimal care for injured patients during the pandemic. This response allowed the care of injured patients to be maintained within designated trauma centers during this pandemic. This present report summarizes the evolution of trauma care delivery during the first phase of this pandemic and provides informative recommendations for sustained responses to the care of injured patients during the pandemic based on lessons learned during the initial response.


As with all other components of healthcare, trauma centers have had to alter and reconfigure care delivery in response to the challenges of the COVID-19 pandemic. This devastating pandemic originated in Wuhan, China, in late December 2019.[1] Rapid worldwide spread occurred with the first case in the United States diagnosed in Washington State.[2] Despite isolation of the first case, subsequent cases were found in the community. An outbreak was detected in late February in a long-term care facility in King County affecting 129 individuals.[3] This outbreak was followed by a number of public health measures to limit further spread and maintain public healthcare infrastructure for the 2.2 million residents of King County. However, it became evident that the SARS-COV-2 virus had been circulating throughout Western Washington for at least 3 to 6 weeks before the first documented case in late January.[4]

Despite this pandemic, trauma and emergency care needed to continue. As the sole Level I trauma center located in King County and supporting the states of Washington, Idaho, Montana, and Alaska, Harborview Medical Center (HMC) needed to create a rapid and nimble process to treat COVID-19 patients and still maintain the essential care of severely injured patients for the region.[5] The following report focuses on the initial and sustained responses developed to manage injured patients during the evolution of the COVID-19 pandemic.