Covid 19 FAQs: A&E Covid 19 Story Week 6

Week 6: Covid 19 FAQs and Myth-busting

Due to the amount of questions people ask me on a day to day basis, I have put together some Covid-19 FAQs.

Do you get a lot of people in the Emergency Department with Coronavirus?

This is classic question for Covid 19 FAQs. Yes. A large number of people who come into the emergency department right now may/have the Corona Virus. Everyone who presents with respiratory symptoms i.e. shortness of breath/cough/low oxygen saturations or fever are triaged as “suspected Covid”. These people are moved to isolation in separate cubicles in the ‘Covid’ side of ED.

What happens when an ambulance calls through a priority call for a covid patient

The Resus lead selects a ‘Covid Resus’ cubicl for the patient to go into. The ambulance crew communicate the CAD sign over the phone so the ambulance can be seen as a priority at the ambulance bay. This is incase there is a queue (of other ambulances). At least one doctor and one nurse prepare in ‘full’ PPE. This includes: Gloves, a long sleeved surgical/fluid resistant blue gown, (plus a normal plastic apron if the gown is not fluid resistant) a surgical cap, a FPP3 mask, a visor and then another pair of gloves where the opening of the gloves are taped down to the gown. 

What is PPE?

Personal Protective Equipment. PPE embodies masks, gloves, aprons, visors, and long sleeved gowns to protect staff members from contracting dangerous pathogens and virus’ such as the ones responsible for Covid 19, Hepatitis, HIV or TB. PPE also protects staff from harmful or offensive substances i.e. vomit, urine and blood. 

When do you use PPE?

Where I work mask’s are worn at all times when in the department. Gloves, apron and protective eye gear such as goggles/visor are used when interacting/caring for a patient (this could include recording observations or giving medication, taking bloods etc). When engaging in an aerosol generating procedure (AGP) such as swabbing a patient or ventilation we have to wear full PPE which consists of a long sleeved fluid resistant surgical gown, a surgical cap (which is basically a hairnet), two pairs of gloves, a visor and an FPP3 mask.

What is an AGP?

As mentioned above, an AGP is an ‘Aerosol Generating Procedure’. It is an activity that generates droplet particles that could transmit Covid such as CPAP or swabbing a patient with covid, the Resuscitation Council UK have stated they are as yet unsure if CPR is a AGP. The poster I have attached is useful for healthcare professionals who are unsure about resus scenarios regarding covid.

Why do people wear different types of PPE?

People employed in different professions and trusts have different PPE policies that seem to have been developed due to supply and what the professional may come across in their role. For example, many paramedics wear hazmat suits due to the potential exposure to a variety of things during a call. A nurse working in a place like intensive care where AGP’s are happening constantly may have different PPE practises than someone working in a care home. It would be reasonable to expect less AGPs to happen in a care home. Some wards made preparations for the Covid outbreak and could ensure their staff had fitted reusable FPP3 masks.

A Reusable FPP3 Respirator Mask

Do you always have access to it?

Where I work I luckily have access to the correct PPE at all times, however I understand this is not the situation many nurses are in. 

How long does it take to put on and take off?

It can all be put on in the space of a few minutes if you are in practice in doing it and if it is readily available to put on in an emergency. Taking it off involves tearing off the apron from the front by pulling it forcefully, putting in the bin, washing hands, wiping down the reusable visor, stepping out of the room and then changing your mask and rewashing/sanitising hands. 

Do you use fresh PPE for each patient?

Yes, apart from masks which we change regularly throughout the day but not between each and every patient. 

What happens in Intensive care?

In intensive care many patients with Covid are require invasive ventilation. This means they might be producing aerosols that can transmit the virus into the air in the form of droplets. In these areas the patients with Covid are in a cohort and the people working in those areas will have to wear the full PPE for long stretches of time.

What happens in these areas when nurses need breaks?

As wearing the full PPE is heavy, uncomfortable and hot it is important the professionals working in these areas have regular breaks as they are unable to have a drink or go to the toilet whilst wearing this PPE. This is where wards and Intensive Care Units are struggling with having enough staff to cover each others breaks. Every shift, 1 or 2 A&E nurses work on intensive care for the day to support the staff there. Additionally, the trust set up more intensive care units to cope with the increasing demand for ventilators/intensive care beds. These were in places like theatre recovery whilst there was temporary cancellations of elective theatre lists. 

Do you get breaks?

Yes. Where I work, staff nurses get 2 thirty minute breaks each day. We also get additional tea or coffee break in the morning. In A&E we cover each other’s break and if something comes up for one of your patients during your break (e.g., someone needs pain relief) someone is there to help.

I previously worked on an acute medical unit. If something needed doing during my break it was rare anyone would be able to step in to assist. Some of the time the nurse in charge/another nurse or support worker may have been able to help. However most of the times the other nurses were too busy with their own workload. This meant the task would be waiting for when you returned. This definitely wasn’t anyone’s fault. On the ward the ratio of nurses to patients was 1:8 whereas in A&E majors the ratio is 1:4. However in A&E there are different pressures, such as a quick patient turnover more critically unwell patients in need of stabilising. This means it would be difficult to keep track of what was happening to more than 4 patients. 

Social Distancing at work?

It is incredibly hard to maintain social distancing at work. Up until a week ago I could still be in a squeeze in a lift when 6 other people decide they would rather get in, than wait for the next one. There are now lift rules – which means there is a long queue in the morning for people needing to use it. Happily, A&E is on the ground floor. In the staff room at break times people don’t have space to suitably socially distance.

Further FAQs?

Thank you to the people who submitted Covid 19 FAQs to assist me in writing this post. If anyone would like to know anything further I would love to help answer your questions. Feel free to comment anymore Covid 19 FAQs. Thanks for reading.

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