The past few days things have got much harder. At the end of last week, I had a 24-hour shift. I did my normal day’s work – starting at 0730, working non-stop through both our ICU units, the second of which is now almost at capacity.
I got home at the end of a “long day” but remained on-call for emergencies. As I put my bag down in the hallway, I got a call and had to get an Uber back to the hospital immediately, then went straight out on a retrieval to put a patient on ECMO.
When we got back to the unit at 2am, other clinical work prevented me from going home to bed, so I didn’t eventually manage to leave until 6.30am. I then went in on Easter Sunday which is unheard of.
The perfusionist’s main role is with elective operations and so we normally just have an on-call team at weekends and overnight to deal with trauma and emergencies, with two or three of us on-call in an escalating order. But now our support is needed round the clock, due to the sheer volume of patients on life support, so we now have a 24/7 rota set up.
All of our ECMO circuits are now being used and we’re having to split equipment between machines in order to facilitate the number of patients we have on ECMO. We’re still waiting for more equipment to arrive.
At the moment, we’re ok for ventilators within our hospital and not having to split them (and hopefully won’t have to) but it won’t be very long until we reach full capacity. Hopefully the government’s work to increase ventilator supplies will pull us through.
If we get a call for a patient retrieval and we can’t help, the referral will be passed on to another hospital – there is a referral network. I don’t think there will be the equipment or specialist staff available for ECMOs at the Nightingale Hospitals – these I suspect will be used for housing patients who need less intense support and non-invasive ventilation.
The more intensive the support the more specialist staff required. But who knows? It’s an interesting and constantly evolving situation.
We are being very careful with PPE. You try to minimise waste under normal circumstances, but right now we’re definitely having to think very carefully about the number of times we have to don and doff – it’s all disposable except for types of visors.
I’m very worried about conversations both within the hospital and media about a shortage of surgical gowns. Although they’re disposable, there is talk of having used gowns washed for reuse, which is astonishing.
It’s difficult to describe the type of material they’re made of – a thin “papery” front with repellent backing – but it’s clearly disposable and how they intend to wash them and retain their integrity and function, I’ve no idea. It would be like trying to wash a disposable napkin.