As the medical director of a Midwest community emergency department that has yet to see the New York City-levels of devastation, I am begging hospital administrators across the country to begin leading their front line health care workers in preparation to meet the enemy head-on.
It has become painfully clear in our hospital daily incident command briefings and discussions with our hospital leadership that no one is making decisions. The decisions come from people with unknown voices and faces, and their decisions are based on what will most absolve them of liability and blame when the war is done, and the casualties are laid before them.
As we wait in the battle line and watch the enemy march towards us, hospital and system leadership are nowhere to be found. Instead of communicating via telephone calls and Zoom meetings, they are telling us that the enemy troops are smaller-numbered than they seem. They are telling us to do our jobs with fewer tools and fewer supplies. They have locked up our masks and asked that each use be justified. They tell us this with printed, small-font policies and guidelines taken from the CDC website, leaving no room for innovation.
Last week, our great nation’s leading health care organization, the CDC, told clinicians and front line health staff that when we run out of n95 masks, that we can protect ourselves with bandanas and scarves. Meanwhile, it has given zero guidance to hospitals on processes to sterilize masks for reuse. The CDC effectively said it would rather doctors and nurses and respiratory therapists wear bandanas and scarves than offering solutions on how to clean their protective equipment. The CDC also recently changed their recommendations for n95 mask use, stating that it is not necessary for all patient encounters and that a simple surgical mask will do. The restrictions were loosened because the supply chain of respirators cannot meet demand, not because it is in the best interest of the health care workers or good data.
There are no generals leading this battle; the captains are nowhere to be found. The physician leadership in the front lines, as a result of decades of power being slowly stripped away, has no additional weapons to offer our staff who bravely don trash bags, reused masks, and hardware store purchased goggles to march into battle. The staff looks to physicians for leadership, and we are largely powerless to help them. The unnamed, unseen leaders tell physicians that if they don’t follow their guidelines, there will be disciplinary action. A physician in Washington state was fired last week for questioning the hospital’s policies to protect its staff from COVID-19. Social media is overwhelmed with health care workers recounting threats from hospital administrators for using too much PPE or inciting hysteria by protecting themselves.
When the smoke clears from the battlefield, the health care workers who survived will remember what their administrators did to protect them. They will remember the good. They will remember institutions who acted instead of talked. They will remember institutions who scrutinized CDC policies and recognized that more guidance and protection was needed. They will recognize governors like Andrew Cuomo, who said: “If the guidelines don’t sufficiently protect our health care professionals, we’ll put our own guidelines in place.” They will recognize who stood up for them.
They will never forget hospitals and organizations that threw their employees to the wolves, knowing that the CDC guidelines were insufficient and incomplete but covering their own tails. To the administrators of these systems, though you are not in the front lines, you will still have blood on your hands at the end, and your staff will remember.
To hospital administrators and policymakers:
1. We want you to examine every possibility at all waking hours for purchasing adequate supplies to protect your staff. We don’t want to hear that we are running low; we want to hear that we will have enough. We want you to go on social media or call construction companies begging for donations of supplies, and work with other companies to change their manufacturing for PPE.
2. If you have a problem with the PPE that your staff is wearing to protect themselves and their families, please don the appropriate available PPE and help us evaluate the patient. Lead by example and show your staff how it’s done.
3. We want you to explore new ways to help your staff stay safe and take action without a six-month study or CDC guidance. We want to know that you have examined the risks and benefits and decided the benefits of protecting your staff outweigh the risks to your own liability.
4. We want you to stop threatening your staff and your doctors. You know that they are a more irreplaceable resource than any n95 mask or gown. We need you to say, “We know you are scared and don’t feel safe. We support you and are doing everything we can to protect you.”
5. We want you to be visible in leading your troops into battle, understanding that you have examined every possibility to equip your staff in the best way possible.
6. If you are not going to help, we want you to at least stay out of our way. Your indecision, vacillation, and obstruction will cost the lives of frontline health care workers and patients.
Health care workers want nothing more than for you to succeed in protecting us, our patients, families, and communities. We want to emerge from this fight convinced that our leadership did everything they could. Better late than never.
The author is an anonymous physician.
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