Life on the frontlines and surviving the emergency department (with the help of social media)


In the midst of a global pandemic, COVID-19 has forced all involved with patient care to be innovative and adaptive. Deployed as an emergency department (ED) physician, on the frontlines of medicine, my team and I work tirelessly to take care of and research the COVID-19 patient. I have seen COVID-19, and I have seen the fear instilled in the eyes of my patients that receive this diagnosis, akin to a first-time cancer diagnosis. COVID-19 is undoubtedly here, with community spread, and will visit every hospital in the country at some point and at some capacity. While this pandemic unfolds, a trend is evolving within every hospital in the country. People are coming together as teams to help prepare for the evolving tsunami on the horizon.

There is a national trend for decreased ED censuses with more emergent pathology presenting as COVID-19 unfolds. That begs the question, what is an emergency? To a homeless patient suffering from uncontrolled schizophrenia with nowhere to go, nowhere to sleep, at below-freezing temperatures, well, that’s an emergency. Chronic back pain, asymptomatic hypertension, vaginal bleeding, stroke, myocardial infarction, cough, and fever? Well, those again are emergencies for the person that is suffering. We, as ED physicians, know this, and we take care of everyone irrespective of the complaint, without question. Questions are brewing among those responsible for patient care, however. Such as when there is no personal protective equipment (PPE) available for use in the ED, what will we utilize to protect ourselves and our families? While these questions constantly come up, I am finding solace in the ED. There is calm, and there is purpose.

Social media is one such avenue from which physicians gain assistance in treating COVID-19. As much as social media has contributed to the hysteria that is the COVID-19 pandemic, social media is also saving lives. Behind the scenes, leaders are utilizing social media outlets with the objective of unifying physicians in order to treat COVID-19. Some successes from this are:

Facebook emergency medicine groups sharing knowledge and experience. This is unprecedented in the history of medicine, and single-handedly is saving lives. It was from a Facebook colleague where I learned the skillset and precautions needed during intubation, so that at 2 a.m. I could safely, and successfully intubate my first “COVID-19-rule out”. Similar talks are ongoing on how to connect a single ventilator to 4 patients or how to devise your own PPE. #Covidhacks

EM:RAP live streams. COVID-19 have connected collaborators and viewers from all across the globe, sharing stories and experiences as to pass the knowledge of how to take care of the Covid-19 patient. One evening, I had the pleasure of listening to a lecture from an Italian physician’s experience with patients in the hot zone.

Twitter has provided case studies, reports, and even patient experiences regarding COVID-19. It was through this outlet that people were reporting diarrhea is their first symptom of COVID-19, which then influenced protocols for donning PPE for most patients.

It is thought that the most mainstream technological advances in medicine are in the literature, but instead, they are on social media. Physicians across the globe are saving lives because of social media.  For example, social media outlets have touted the hashtag #GetMePPE as our ED and ICU teams prepare for the surge of incoming critically ill patients. Currently, PPE is literally under lock-and-key, and it is much like telling our soldiers to give up their arms as they fight for their lives in times of war. From social media, we know that impending shortages will happen, meanwhile governmental agencies consciously are telling physicians to don bandanas or scarves as PPE. We, as ED physicians and providers, are sacrificing our livelihoods fully aware of the mortality and daily deaths occurring from this virulent virus. This is knowing full well our reserves in PPE are dwindling, and this has prompted officials and news outlets to run stories prompting national headlines in PPE shortages. Comparably, no guidance exists for how to ration other resources, such as ventilators, medications, or each other; however, social media is actively involved in creating informal policies to help mitigate these issues.

As my team enters the “COVID-Cabana” (restricted part of our ED for COVID-19-possible patients), we know we will diagnose COVID-19, irrespective of PPE, irrespective of the ability to test, irrespective of our families and home lives, and we dedicate ourselves to the cause. Every day for the foreseeable future, ED physicians will be responsible for making decisions on which patients have COVID-19, which patients can be safely discharged with COVID-19, as well as resuscitating COVID-19 patients that are on the brink of death. Our ED census is markedly reduced in this time of war, which through our social media collaborators, we know is the calm before the storm. Our peers from the coasts suggest that this lull in the patient census is to be expected just prior to the influx of patients that arrive in full respiratory distress or even multi-system organ failure. The videos on social media of physicians and teams of being overwhelmed and stretched thin are factual and palpable. This epidemic is nothing short of frightening, and in the wake of impending surge, know that physicians, nurses, technicians, custodians, interpreters, registration workers, are all working tirelessly in suboptimal conditions to ensure that the patient is cared for.

When the dust settles, we will emerge victorious, albeit with more gray hair. Regardless, this experience will allow us to become better individually, as a system, and as a global, unified, social team. Are we scared? Absolutely! Do we discover pride in working with our team to help our communities? Absolutely! Those of us on the frontlines serve proudly, with the opportunity to help those in need.

Nicholas Pettit is an emergency physician.

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