The lack of adequate supplies of PPE is deplorable, inconceivable. This has been made abundantly clear through both social media and traditional media. Post after post on various social media outlets have exposed the appalling shortages and, at times, blame and attack those that are obliged to provide us the PPE. Those posts, in part, have spurned movements among nonmedical personnel to donate and make masks. Heartwarming, and it feels good to have widespread sympathy for our plight.
Thinking rationally, it is unlikely that those actions will solve this problem on a widespread scale. Hospitals and other organizations have entire teams of experts that deal with supply chains daily. Terrible mistakes were made with horrific consequences. The mistakes were in the design of the system. The process of just-in-time ordering from group purchasing organizations is designed from a financial perspective. It makes perfect sense to those making the decisions. We use X amount of PPE every week (the burn rate), and if the supply of PPE matches the burn rate, there is no warehousing and warehouse management needed, and thus costs per unit of PPE go down. Now, faced with a burn rate of many multiples of X, the supply chain can not meet the demand. This process is reproduced all the way back to the manufacturing and importing of PPE. There is no surplus in the system. That was the mistake. Based on affective decision-making principles, should we conclude that these organizations are now incapable of ramping up acquisition and maximizing supply and that we can do it better? Or should we do our part to raise awareness, coordinate donations, and then rely on the hospitals and organizations to manage the supply?
Again, the lack of PPE is appalling. We are asked, expected, to care for patients in uncertain times with what is felt to be inadequate protection. The lack of equipment should be made known to the industry and to the public to pressure industry leaders to ramp up supply. That has happened. The time for changing the system to prevent this from occurring again is in the future. Now it is time to step back and balance the emotion with the reason. Will continuing to emotionally appeal for more PPE or attack the organizations whose duty it is to supply it help? Rationally, does it make sense that our hospitals and supply chains do not want us to have the necessary PPE? Is it more likely that the conservation strategies (which emotionally seem ridiculous) are necessary to prevent running out of supplies completely? Using the affective decision making model, let us ask: How much more does and N95 mask protect us than does a surgical mask and contact precautions? The answer is incredibly complex and depends upon so many variables including droplet size, chances of infection after exposure to an unknown amount of viral particles, air currents in the room, time in the room – the list goes on and on. My job as a scientist and a leader is to postulate that an N95 mask reduces my chance of becoming ill more than a surgical mask, but likely by a very small amount. So we must weigh this slight increase in benefit with the desire (emotion) to eliminate all risk while understanding the supply chain issues. So a strategy to conserve equipment and protect us must be developed based on reason balanced with the fear of becoming ill.
My job as a physician leader is to form my opinion about PPE based on a balance of emotion and what is rational. This is perhaps the most difficult decision we will make because the emotion is so strong as we literally put our lives on the line. We have done a fantastic job of raising awareness of the issue of inadequate PPE. It has primed the system to now obtain as much PPE as possible. It will soon be time to start having rational conversations when emotion is lower about how to prevent this scenario in the future.
Robert Frolichstein is an emergency medicine physician.
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