Ascension Texas’ Infectious Disease Response Unit has been training for a pandemic like the COVID-19 outbreak for more than two years. Officially formed in 2018, the team grew out of the Ebola crisis in 2014, which had confirmed cases in Dallas as well as four people in Austin who were being monitored but later confirmed to not have Ebola.


The state built its infectious disease team, and two years ago, Ascension Texas created its own, which the staff says is the only hospital-led team in the state.


The team trains for different disease emergencies. That includes developing protocols for required personal protective equipment for each disease and for how medical staff can be most efficient in treating sick people while minimizing their own risks of contracting the disease.


Toby Hatton, the regional emergency management officer, leads the team at Ascension Texas along with fellow nurses Anna Steinhauser and April Burge. Although Hatton is a nurse, he says if he’s pulled into patient care, "it’s really bad."


So far he has not had to step into patient care during this pandemic.


The Ascension Texas team has grown from six nurses to 32 nurses who have completed the two-day special training, and they also have trained others throughout Texas, including in Dallas, Amarillo, El Paso and San Antonio.


Hatton expects the next training will have even more people and he’ll get more requests to train people throughout Texas.


Though they work with doctors and specialists, the team is all nurses, and they are in charge of making sure protocols are being followed.


Some of those protocols are as simple as always asking whether a patient has traveled outside the U.S. in the last 21 days. That helps the team narrow down what diseases to look for. If someone comes in and says they are a petroleum engineer who has been to Saudi Arabia, Hatton says, that lets the staff know to consider MERS, Middle Eastern Respiratory Syndrome, which is a coronavirus that is more deadly than COVID-19.


Even before this pandemic, "we’re constantly screening for highly contagious infectious diseases," Hatton said.


COVID-19 isn’t the scariest thing they screen for. Far worse are diseases like Ebola, MERS, SARS 1, Crimean-Congo hemorrhagic fever and monkey pox.


"The team is trained for the worst," he said. The worst includes diseases that kill 65% to 70% of the people who contract them and diseases that spread very easily.


The nurses who have been trained, he said, understand the pathology of infections, what protocols they need to follow and what kinds of equipment they need to wear.


COVID-19 does not require the highest level of protective gear, what they call a bunny suit, which is fully contained and has its own breathing apparatus.


Because they are trained, "our nurses are stone-cold calm," Hatton said. "They don’t stress. They’ve assumed the position of subject matter experts. They are the ones leading by example."


For two years, they’ve trained quarterly on such things as how to put on and take off the personal protective equipment, and how to get the most done while minimizing the amount of time they are exposed to patients with infectious diseases. They also learn how to be aware of their surroundings — to avoid tears in their gear — and how to slow down their movements to be more careful.


"Sometimes my only job is to say, ‘Slow down. This is not a race. This is for your safety. Go slower,’" Hatton said.


The team members also learn how to control the environment, to think ahead and to keep themselves and their patients safe.


They work in teams, with one person watching the nurse who goes in the room with the patient. That person watches the nurse as they put on gear, as well as what happens in the room. They also watch as the nurse exits the room and takes off gear. A third person is there as backup to step in if the nurse in the room needs help.


The nurse who is watching will stop the nurse inside the room and say things like "there’s a lot of bio burden on that bed rail ... let’s wipe it down so we can lean across it."


When they are training, they are in full gear because part of learning how to manage infectious diseases is not freaking out about being in full body gear. They also get used to breathing through a mask or respirator. The N95 masks that are being used with COVID-19 require a lot of lung power to breathe through them, so nurses are having to change out after about 45 minutes, Hatton said.


Through training, they learn how many minutes or hours they can be in that gear before they need a break. By practicing, they learn the rate at which they will burn through their personal protective equipment. They also know in which situations they need teams of three people rotating in and out and in which situations they need more people.


They also train with emergency medical service folks about how to transfer a patient from an incoming ambulance to the specified unit in the hospital; that’s the time of most risk for the health care professional.


Before COVID-19 hit Austin hospitals, Ascension Texas’ team was sent to San Antonio to treat people who had been on the Diamond Princess cruise ship and tested positive for COVID-19.


Hatton said they would group tasks, going into the patients’ rooms only three times a day for 30 minutes to an hour each time. Those patients were not the sickest of the sick. For patients in the intensive care unit, nurses would have to go in more often, which means they have to change out team members more often and go through more personal protective equipment.


They also learn to clean the room’s surfaces on their way in and their way out, as well as to be aware of what they touch and to be careful not to touch themselves.


All the practice has really paid off, Hatton said. "We're cool as cucumbers," he said. "We don't stress. We go into the unit where nurses haven't done this, and it brings a calm over rest of the unit. Everyone sees and learns from them."


Hatton said he knows his hospital has not been hit as hard as it could have been. "Social distancing gave us the opportunity to ramp things up to another level than we would have," he said. "It’s controlled chaos. It has given us the opportunity to spread out the positive patients and rule out patients so they didn’t all come at once."


Hatton did his 2013 master’s thesis on how prepared our health care system was for dealing with a pandemic, after studying the 1915-18 Spanish flu. He predicted that we didn’t have enough ventilators, we didn’t have enough hospital beds, and we didn’t have enough trained people.


That’s helped him inform his work with the Infectious Disease Response Unit.


"Some of us expected this," he said, "and our team, we’ve been expecting this. This is why we’ve trained."