Sarah L. Carnes, MLIS, AHIP
Clinical Librarian/Acting Emergency Manager
Bedford VA Medical Center

Editor’s note: The health sciences librarians and healthcare professionals we work with are responding to the COVID-19 pandemic in unique ways. We are honored to bring you their accounts of what those efforts look like. This month, we share with you the experience of Sarah Carnes, clinical librarian and acting emergency manager of the Bedford VA Medical Center, who curates weekly COVID-19 literature alerts and maintains a resources list for the Veterans Affairs Library Network (VALNET).  

As a privileged member of the Veterans Affairs Library Network (VALNET), we work throughout the United States at Veterans Health Administration (VHA) locations with access to a robust collection of resources. We frequently share best practices, assist each other, and work together to provide a series of topic-focused literature alerts on subjects such as Patient Aligned Care Teams, Lean Six Sigma, Women Veterans, Post-Traumatic Stress Disorder, and Transcranial Magnetic Stimulation.

Like many medical librarians, I monitor a variety of sources to remain up to date on new research that is relevant to the clinical and research staff I support. I tend to pay particular attention to information related to infectious diseases and emergency management as a result of my previous experiences. I was a Medical Service Corps Officer in the U.S. Army and conducted training and real-world operations in a variety of countries. My last position as the Chief of Security, Plans, and Operations at the Landstuhl Regional Medical Center in Germany had a focus on emergency management in a hospital setting. When the USS Cole was bombed, I managed an incident command center to coordinate the evacuation and treatment of sailors from Yemen to Germany and ultimately home to the United States. After I left military service, I managed strategic emergency preparedness for a hospital system in northern New Jersey. This was just post-9/11, so we were very motivated. During this time, we experienced a regional brownout affecting critical utility infrastructure, a SARS outbreak, and concerns about natural or terrorist related outbreaks. In collaboration with hospital associations, public health departments, and emergency management throughout New Jersey and New York, we conducted pandemic, mass casualty, and mass vaccination planning and training. I later became an adjunct instructor at the National Emergency Response and Rescue Training Center based on the Texas A&M extension service’s campus and trained local, state, federal, and military entities in emergency management with a focus on Emergency Medical Services (EMS), hospitals, and public health.

A large part of my jobs during and following my military service was keeping up with potential threats my unit or organization might face. This required an extensive amount of research and information monitoring, which I incorporated into my training and planning. For example, knowing what diseases were in a country helped me determine what medications my unit needed to bring as well as what vaccinations we needed prior to arrival. Knowing that a community had a high flood or tornado risk, zoonotic disease prevalence, or concerns about old, failing water systems helped us create informed and effective plans. I became a clinical librarian because I wanted to get back to supporting clinicians, patients, and researchers more directly. Whether through a reference interview, reading reports, attending meetings, participating in rounding and case conferences, or surveying my patrons, I find ways to refine my work to not only respond to requests but to also provide relevant information as it emerges.

In early January, I began hearing and seeing reports about a novel coronavirus outbreak in China. By mid-January, there was a noticeable uptick in information related to this novel coronavirus, so I set up email alerts. The last week of January, I saw a flurry of activity in popular, medical, librarian, and other listservs and alerts. I pulled together a handful of this information to share with my staff at the Bedford VA Medical Center on January 30.

The next day, I wrote to VALNET director Nancy Clark and offered to share this information with my colleagues. With Nancy’s support and assistance, I began a weekly literature alert about the “2019 Novel Coronavirus,” as SARS-CoV-2 was initially primarily known.

In the alert, I include a collection of the articles that were added to PubMed the week prior. The search string has evolved multiple times. It now incorporates an amalgam of terms suggested by NCBI, Expert Searching and MEDLIB listserv participants, and my own experiments. Not surprisingly, the volume of articles published has exploded. For my February 7 alert, I retrieved 50 articles in PubMed. On July 6, I retrieved over 4,000. And in the following seven days, another 4,000 articles had already been added.

We all know volume is not always our friend, especially when seeking to be useful and relevant. Therefore, I curate information from a variety of sources, which I highlight at the top of my alert. I lead with information from the Veterans Health Administration (some of these articles are only available to my colleagues in VALNET, but others are freely available to the public) and follow with information selected from the innumerable email updates I receive from the CDC, NEJM, McMaster Plus Evidence Alerts, the Disaster Information Management Research Center of the National Library of Medicine, the Public Partners alerts from the Department of Health and Human Services, and Medscape.

I’ve also put together a list of resources that provide reliable and convenient means of focusing an information search. For example, there are training sites and toolkits to help clinicians improve their skills to medically manage COVID patients; specific journal and publisher websites that are freely accessible; sites with conducted reviews of the abundance of literature to help discern which articles are most useful; and sites that provide visualized data about infections, deaths, hospitalizations, and testing. When I add new items to the list, I often highlight them in the alert as well.

As with every good project, this is a collaborative effort. My VALNET colleagues across the country and staff members receiving the alert regularly send me resource and article recommendations. I glean a lot of information from academic and hospital-based medical librarians thanks to our listservs and friends I’ve met at conferences. This assistance has been especially important in the last four months while I have additionally served as the acting emergency manager at the Bedford Veterans Affairs Medical Center. Many times, this alert has been exceptionally useful to me as I help coordinate our response to COVID-19. I am extremely grateful to all who have contributed!

The alert is sent to over 780 people within the Veterans Health Administration and around the world. I would be happy to share it with any of you. Please feel free to send me an email at Sarah.Carnes@va.gov to request the alert or to share a resource.