Doctors and nurses will need treatment for post-traumatic stress disorder after working in harrowing conditions on wards during the coronavirus crisis, health leaders warn.
The strain on their mental and physical health is already unprecedented and the virus has not yet reached its expected peak, they say.
NHS staffing is at levels that were previously unthinkable as workers – forced to spend hours in hot conditions while wearing full protective gear – try to keep up with demand amid a lack of equipment.
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The increasing numbers of infections mean staff could be forced to work this way for many more weeks. Almost 2,250 patients have been admitted to more than 200 intensive care units across the country up to 3 April, with the NHS preparing for an expected peak in cases in the next seven to 10 days.
It comes as the head of intensive care at London’s Royal Free Hospital described in a memo how most units had already shifted from the usual one nurse to one patient ratio to one to six and were running out of key machines and equipment.
Dr Alison Pittard, dean of the Faculty of Intensive Care Medicine, told The Independent: “I am really concerned about the toll this is taking and will continue to take on staff.
“We are used to dealing with emergencies, but we have never been exposed to this sort of demand. We know staff are already struggling physically and mentally and that this will only continue.
“The government’s approach to flatten the peak will help to spread it out but what that means for staff is that we are in this for the long haul. We will get through this because that is what we do. But there will be some patients and staff who will suffer forms of PTSD and some staff with mild symptoms may not be aware and continue working and make themselves worse. We need to consider staff wellbeing in the future.”
Dr Pittard, a consultant at Leeds Teaching Hospitals NHS Trust, said critical care units had been forced to change in order to cope with coronavirus.
She said: “It is an unprecedented situation. In critical care, we are being forced to change how we work. Six months ago we wouldn’t have been able to cope, there is no doubt about that. We are pushing the boundaries of what critical care is in order to cope with demand.”
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She said this included weakening staffing ratios, which she said was “very uncomfortable” for staff, adding: “There is no doubt there will be situations where safety will be compromised. We have to do the best that we can.”
In a memo shared online, Dr Dan Martin, head of intensive care at the Royal Free Hospital, said: “Most centres now getting towards 1:6 nursing ratio with high level of support workers on ICU.” He added: “Training has largely fallen by the wayside as it is too large a task. People are being trained on the job.
“We need one support worker per patient. Other centres are using everyone they have. From med students to dental hygienists.”
Dr Martin revealed King’s College Hospital in south London was “running out of” blood filtration machines and another unit had “run out of pumps” for administering drugs.
He added: “We need to adapt fast to what we learn about this disease and learn from our colleagues at other centres. We are all in this together and joined up thinking is required.
“We desperately need to look at our own data to understand whether we are getting this right or not. Good luck, stay safe and be kind to one another.”
The latest data on intensive care patients with coronavirus reveals 2,249 patients were admitted to 210 intensive care units by 3 April. Of those, 346 have died and 344 have been sent home. The majority, 1,559 patients, were still in intensive care.
Around three-quarters of the 2,249 patients were male, with an average age of around 60.
Saffron Cordery, deputy chief executive of NHS Providers, said: “The NHS is facing the biggest challenge of its lifetime and staff are working extremely hard round the clock to ensure that patients seriously ill with Covid-19 get the care they need.
“Trusts are doing all they can to support staff health and wellbeing and there are well-established support systems in place.
“However, there is no denying that this extraordinary effort by staff will be extremely tiring, stressful and demanding. Staff will be dealing with physically and emotionally challenging situations every hour of every day.
“NHS colleagues, whether they are a clinician, nurse, porter, cleaner, or senior leader, are pulling out all the stops, sometimes at the expense of their own wellbeing, to look after others. The NHS has never been more under strain but also the evidence of the spirit of the NHS has never been more evident or valued.”
Beelzebutthurt on April 7th, 2020 at 05:02 UTC »
Here’s a NSFL story for you.
I’m a young medicine attending making my rounds in the hospital; a code blue is called over head. I’m not on the code team that day (there’s a dedicated team for that), but I’m a hallway away and the code team is probably on the other side of the hospital.... i would hope that if my dad/mom were in the hospital dying and a code were called overhead, that a doc a few meters away would just show up rather than continue walking away (even if it weren’t “his job”), so i go in. We’re on a gen Med floor, there’s not a whole lot around.
I walk in and anesthesia is already at the bedside with a young surgery resident; never a good sign at our hospital since anesthesiologists are rarely sighted outside the OR (we’re a very large hospital with a lot of other folks who usually respond to emergencies/do difficult intubations...anesthesia only comes for the really really bad ones).
The patient is definitely not dead, but he looks like he’s about to be- his face is turning blue and he’s holding his neck gurgling, he is definitely losing his airway. This is a rapid response call, not a code (yet) since clearly his heart is still beating. Surgery resident fills me in, patient had recent neck surgery and was about to be discharged when he suddenly started complaining of sudden difficulty breathing. Based on his neck size, he’s clearly bleeding into his neck space, so he called anesthesiologist and his chief - good move, but patient is now rapidly decompensating (hence the code call). We’re trying to bag him- not going well, lots of airway resistance. Anesthesiologist already wanted to intubate, meds are reportedly on the way stat from pharmacy, but we needed them yesterday. Guy is gasping, oxygen sats are dropping, running out of options.
Surgery resident and i hold patient’s arms down. We tell him to stay calm and try to cooperate, we need to get the tube in now or you’re going to die. His eyes are panicked and wide, but he gives a quick nod.
Anesthesiologist tries to intubate him while he’s awake, we’re out of time. Can’t see anything, patient retching and writhing. Typical, that’s why we usually need meds. Abort first attempt, O2 Sats are down in the 60-70s. RT starts bagging again, Surgery resident is calling trauma chief, he’s stuck in a surgery with attending (surgery doesn’t routinely come to codes), i got a hand on his pulse. Sats are back up to low 80s, anesthesiologist tries one more time- gets a view of the cords, but there’s too much swelling past the vocal cords and he can’t get the breathing tube through.
By now patients face is a deep shade of purple and his heart rate is in the 50’s, this dude’s about to fuckin die. Bagging getting harder. I tell the surgery resident we need to prepare to do cricothyrotomy or something- this guy is going to be toast. First year critical care fellow shows up with the code team. Somehow still no meds here...it seems like an eternity, but it’s probably been <5 minutes at this point since all this started. Someone runs to the ICU to pull meds from a Pyxis machine, but that’s on the otherwise of the hospital, and these other meds are getting tubed over from the pharmacy which takes time....more than the 5 min we’ve already had.
Guy’s neck is huge now, we can’t bag anymore, still no meds, we’re beyond fucked here. Surgery intern is still the only surgeon here and the critical care fellow is new- no one has ever done a cric in this room.
No time to worry about that- we have to make a move or he’s dead. Somehow this poor bastard is still conscious- we each take a limb (there’s a lot of people here now) and hold him down. Surgery resident cant find cricothyroid space- too much swelling, we just need to evacuate the hematoma. Patient loses consciousness. Surgery resident looks confidently terrified (I’m sure we all do), he fuckin bibs this guy to evacuate the hematoma and find cricothyroid space- suddenly he’s awake again and thrashing on the bed, me and three large dudes are struggling to restrain him. His eyes are so wide- panicking, crying. He’s trying to scream but he has no air to scream so it sounds like a raspy squeak. Those eyes man. I can still see him staring, pleading. There’s blood everywhere, whatever was bleeding was (or now is) arterial. Coming out in spurts. Critical care fellow gets a finger in and clamps what’s bleeding; hematoma evacuated. But this guy is super fat, there’s blood everywhere, and he is still moving- no way to safely do the cric, not now at least.
Meds from pharmacy getting in- somehow only succinylcholine (a medication for paralysis) here at the moment. No sedative or pain meds here yet. FUCK.
Patient is going ballistic on the bed, can’t get a seal to try and bag, there’s blood everywhere. Sats still low, i can’t believe he hasn’t coded. I can’t believe he’s still conscious! Anesthesiologist orders to paralyze or he’s going to die just from inability to vent. He stops moving. Before we try cricothyrotomy with hematoma out, anesthesia wants to try and intubate again. Swelling less with hematoma out, he gets tube through. RN back from MICU, we have sedatives. Get the guy comfortable. Meds from pharmacy here. Sats are better, still bleeding like a stuck pig. We run him down to OR and vascular surgery meets us there, i leave him in the hands of my colleagues.
All that happened in like 15 minutes or less. All this happened at about 9AM, i still had another 10 hours of my day left to pretend like i didn’t just see some guy get his throat slit while i held him down.
Dude lived. Was very grateful. Remembered everything. I can still see his face as i held down his arms as they cut his throat to this day. I’m sure he has nightmares.
The point is this: if you work in medicine odds are you’ve been traumatized already, several times. I have a handful of fucked up stories just like this one, and I’ve only been practicing for 5 years. The difference with COVID is the added stress of self preservation and the threat to my family. That on top of the stress of people dying and not being with their families with the visitor ban has made it all the more difficult. But let’s not pretend like most of us weren’t already carrying some baggage, we just don’t talk about it.
ByteVenom on April 7th, 2020 at 04:38 UTC »
My buddy is an EMT. Relatively new to it too. Had to help evacuate an old folks home that was infected.
He said the things he saw didn’t bother him in the moment, but after processing what he saw, they do. Unfortunately whatever EMT company he’s working for doesn’t offer counseling.
Church_of_Realism on April 7th, 2020 at 03:59 UTC »
My wife's been traumatized. She's a nurse in a geriatric rehab/living facility where COVID-19 has killed six of her residents in long term care, so far. Her test results just came back positive for it. This after pulling two 16 hour shifts after some of the other nurses who refused to report. She now has symptoms and had a panic attack today because of it. She's never had one before and required medical intervention because it made her feel like she was dying in that moment. She's better now, but holy shit this is fucking terrible and terrifying.