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From the Red Zone: ‘We’re seeing a worrying number of younger patients being admitted’

From The Red Zone illustration
From The Red Zone illustration
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I had a day off this weekend, and went for my only exercise this week (I don’t get to exercise every day because I’m doing such long hours in the red zone). I cycled along the Thames and was seething and insulted to see – and later to hear on the news – that people were out sunbathing. Things couldn’t be clearer and I can’t understand it.

At work, things are hotting up: our adult intensive care unit is now full and patients are spilling over into the paediatric ICU, which has of course been cleared of patients some time ago in preparation – we don’t have any children in the hospital, yet.

The number of calls we’re getting for ECMO retrievals per day matches what we’d ordinarily have in a normal week. Not all are answered though: of the first two we had today, one patient was showing signs of improvement and the second was unsuitable for ECMO because of their age and profound underlying health conditions that made them unfit for this form of life-support.

ECMO is used when a patient’s respiratory (and/or cardiac) function is no longer manageable by the ventilator or other interventions, and is often a last-change saloon for recovery.

The system of life support is not suitable for anyone aged 65 and over; and although doctors will sometimes push this limit if they think patients will do well; right now we are sticking to guidelines because of the volume of people coming through.

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With a shortage of ventilators being forecasted if stocks aren’t greatly increased, there possibly will come a time when there will be a shortage of ECMO devices.

We have 15, and can get more, but as capacity becomes stretched it will have a knock-on and affect other patient groups who don’t have Covid-19 but are unwell and need this vital life-saving equipment.

I went out for my third retrieval of this crisis late afternoon yesterday, to a hospital in Berkshire.

Our retrieval team – an anaesthetic intensivist, perfusionist and a scrub nurse – blue lighted in a specialist ambulance with our equipment and portable ventilator.

We donned our PPE outside their ICU, walked straight in and after quickly assessing the patient, I set-up and primed the ECMO circuit, we put the patient onto the machine and portable ventilator, put in new drug lines and promptly transferred them into the ambulance. It was an easy journey there and back because of the empty streets.

As our teams are now regularly visiting other hospitals, we are occasionally shocked at the slack way in which PPE is being worn and the way in which ICU protocols are being managed, with sometimes very low standards of isolation and no staff checking nor challenging who is walking up to the intensive care areas containing Covid patients.

From the Red Zone
From the Red Zone

I saw staff not wearing hats, nurses with hair drooping down over the front of their gowns, which may have touched patient sheets, gaps between gloves and gowns that exposed skin.

In one unit, the ICU door kept getting stuck open and I had to push it shut with my foot – the door is the only barrier between a clean area and a dirty one and it’s quite an extraordinary thing, not to mention careless.

I believe it’s down to the way hospitals are managed locally, and how they are disseminating and adhering to government advice; being slack is likely to mean a lot of unnecessary contamination which could be avoided!

We’re still seeing a worrying number of younger patients being admitted, and there are discussions in the global medical/scientific community that there could be a sub-set of patients who are particularly susceptible to the effects of Covid-19.

It’s not yet known whether this susceptibility is largely down to environmental or genetic factors, but genetic studies are currently being established to look into this – and there’s sadly no shortage of mortalities on which to base this work.

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