A COVID-19 patient is in respiratory distress. The Army nurse knew she had to act quickly.

It’s the peak of this year’s omicron surge, and an Army medical team is helping at a Michigan hospital. Common hospital beds are full. The same goes for the intensive care unit. But the nurse heard there was an open space in the overflow treatment area, so she and another team drove the gurney across the hospital to grab the space first, hitting a wall in a hurry.

When she saw the dent, Army squad leader Lieutenant Colonel Suzanne Cobre knew the nurse had done her job. “She’s going to damage the wall on the way there because he’s going to get that bed,” Cobley said. “He’ll get the treatment he needs. That’s the mission.”

That nurse was tasked with providing emergency care to her patients. Now, the U.S. military’s mission is to use the experience of the Cobleigh team and other forces in combating the coronavirus pandemic to prepare for the next crisis that threatens large populations, whatever its nature.

General Glenn van Herck said their experience will help shape the size and staffing of the military’s medical response so the Pentagon can deliver the right type and number of troops needed for another pandemic, global crisis or conflict.

One of the key lessons learned is the value of small military teams to large-scale movements of people and facilities in a crisis caused by COVID-19.

In the early days of the pandemic, the Pentagon, at the request of state leaders, sent hospital ships to New York City and Los Angeles and built massive hospital facilities in convention centers and parking lots. The idea is to use them to treat non-COVID-19 patients, allowing hospitals to focus on more severe pandemic cases. But while the image of the warship is strong, many of the beds are often left unused. Fewer patients need non-coronavirus care than expected, and hospitals remain overwhelmed by the pandemic.

A more flexible approach has emerged: having military medical personnel step in or work with exhausted hospital staff, or in additional treatment areas in unused spaces.

“Over time, things have changed,” Van Heck, who oversees U.S. Northern Command and is in charge of Homeland Defense, said of the response.

Overall, about 24,000 U.S. troops have been deployed to the pandemic, including nearly 6,000 medical personnel to hospitals and 5,000 to help administer vaccines. Many went on multiple tours. That mission is over, at least for now.

Cobleigh and her team members were deployed to two Grand Rapids hospitals between December and February as part of the U.S. military’s effort to relieve civilian medical staff. Just last week, the last military medical team deployed for the pandemic wrapped up work at the University of Utah Hospital and returned home.

Van Heck told The Associated Press that his command is rewriting pandemic and infectious disease plans and planning war games and other exercises to determine whether the U.S. has the right balance of military medical personnel in active and reserve duty.

The team’s makeup and equipment needs have changed during the pandemic, he said. He has now put teams of about 10 doctors, nurses and other staff (or about 200 soldiers) on a ready-to-deploy order by the end of May in case infections surge again. Teams vary in size from small to medium.

Dr. Kencee Graves, chief medical officer of the inpatient department at the University of Utah Hospital, said the agency ultimately decided to seek help this year as it was delaying surgeries to care for all COVID-19 patients and closing beds due to staffing shortages.

Graves said some patients had surgeries delayed more than once because of urgent needs for critically ill patients or others. “So before the military came, we were dealing with a backlog of hundreds of surgeries, and we were understaffed. We had exhausted staff.”

Her mantra became: “All I can do is show up and hope it helps.” She added, “I just did it day in and day out for two years.”

Then came a 25-man naval medical team.

“Many staff were overwhelmed,” said Dr. Ariel Atienza, chief medical officer for the Navy team. “They were burned. They couldn’t take sick days. We were able to fill some gaps and needed shifts that would otherwise remain unattended and the patient burden on existing staff would be very demanding.”

Atienza, a family doctor who served in the military for 21 years, was dispatched to a hospital in New Mexico over the Christmas break before heading to Salt Lake City in March. Over time, he said, the military “has evolved from things like makeshift hospitals” and now knows how to seamlessly integrate into local health facilities in just a few days.

This integration helps hospital staff recover and catch up.

“We’ve completed about a quarter of the backlog of surgeries,” Graves said. “We didn’t call back up doctors for the hospital team this month…the first time that’s happened in months. Then we didn’t call patients asking them to reschedule procedures for most of the past few weeks. .”

The pandemic has also highlighted the need to review national supply chains to ensure the correct equipment and drugs are stocked, or to see if they are coming from foreign distributors, VanHerck said.

“If we rely on getting these products from foreign manufacturers and suppliers, then this could be a national security hole that we have to address,” he said.

The U.S. is also working to better analyze trends to forecast demand for personnel, equipment and protective gear, Van Heck said. The military and other government experts have watched the progress of COVID-19 infections across the country and used the data to predict where the next outbreak will be so workers can prepare to go there.

The need for mental health care among military personnel has also become apparent. Team members working through tough shifts often need someone to talk to.

Cobleigh said military medics are not used to caring for so many people with multiple health problems because it’s more common among civilians than among rank-and-file individuals. “There are more levels of illness and death in the civilian sector than anyone has ever experienced in the military,” said Cobley, who is now based in Fort Riley, Kansas, but will soon be moving to Aberdeen, Maryland, for the trial field.

She said she found her staff needed her and wanted to “talk to them about stress and stress before they go back to their shifts”.

For civilian hospitals, the lesson is knowing when to seek help.

“It’s the bridge that helps us get rid of omicron and allows us to take good care of our patients,” Graves said. “I’m not sure how we would have done this without them.”