As a hospitalist in Minnesota, my colleagues and I are busy preparing for the coming viral storm. It is starting to rain. We read the harrowing front line stories from overwhelmed hospitals in China, Italy, and now here in the U.S., and reach for a sublingual Zofran tablet to calm the nauseous dread.
The smart and intuitive “flatten the curve” graphic has made a strong case to the public for why stringent social distancing is our best chance of keeping our hospitals from becoming an apocalyptic scene. We hope to be spared, but prepare as though we won’t be.
Like many other hospital-based health care workers, I have received numerous heartfelt messages of support from friends and family who anticipate what we are likely facing. And the media is now focusing on hospital preparedness in terms of personal protective equipment, ventilators, respiratory isolation rooms, but also adequate staffing. As other countries have already experienced, inadequately protected hospital staff can end up getting sick themselves, and then you have some really serious staffing problems.
Thank you, America. We deeply appreciate your concern and support; we really do. And we’re praying that it translates into more gowns, gloves, masks, ventilators, etc. Because unfortunately, studies have shown that the sincerest concern and emotional support, even when donned correctly and worn vigilantly, provide little to no protection against aerosolized respiratory particles.
But the media coverage of potential doctor and nurse shortages leaves out one small, very large detail.
If you haven’t spent time in a hospital, you understandably might think it’s run by just doctors and nurses, like we look at NASA and figure it’s staffed entirely by astronauts and rocket scientists. But a modern hospital—and particularly those that take care of the sickest, most complex patients—is staffed by a staggering array of highly trained professionals who do not have an MD or RN behind their name. There are pharmacists, physician assistants, radiology technicians (the people who actually get CT scans done), nurse practitioners, physical and occupational therapists, laboratory staff, and respiratory therapists (who are absolutely critical in a respiratory virus pandemic) just to name a few.
If you would ever watch a surgery, or an unstable patient in the ICU, or a medical procedure like a coronary angiogram, you would see that the room is filled with what appears to be a NASCAR pit crew: a whirling dervish of smart, highly trained, highly skilled staff members, each of whom plays a vital role in how things turn out. ‘Vital’ as in life or death. Even cleaning up a respiratory isolation room for the next patient is no small or simple task: it must be done correctly, with diligent attention to hygienic detail. Likewise, the complicated mechanical infrastructure of a modern hospital—particularly when it is running at full tilt—requires so much more than a pipe wrench and a pair of pliers.
Some of these highly skilled hospital staff members will be working face-to-face with the coronavirus, perhaps none more so than respiratory therapists. We know that when they give a patient a nebulized breathing treatment, or suction out the tubing of a ventilator (the machine which can keep a patient breathing), a lot of aerosolized respiratory droplets are created. It’s a highly infective brew that makes wearing the correct protective gear a must.
America, doctors, and nurses deeply appreciate your declarations of support and admiration. But please share that love with all of our highly skilled colleagues who work shoulder to shoulder with us, or sometimes quietly behind the scenes. Without these essential (and too often unrecognized) hospital staff members, doctors, nurses, and patients would be left idling in pit row, waiting for something to happen. If hospitals get to take a victory lap at the end of all this, it will be because of the mutual efforts of everyone who makes a hospital work, and because social distancing efforts gave us a fighting chance.
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