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| From ambulance to physio: what a Covid-19 NHS patient should expect | |
| (about 1 hour later) | |
| Hospital and ambulance staff from paramedics to radiographers share their experiences | |
| Patients that need hospital treatment for coronavirus may need a team of NHS staff to help them through. | Patients that need hospital treatment for coronavirus may need a team of NHS staff to help them through. |
| Jessica Murray talks to the people who are key to such treatment – from first responders to intensive care consultants to physiotherapists. | Jessica Murray talks to the people who are key to such treatment – from first responders to intensive care consultants to physiotherapists. |
| Mark, 36, a paramedic | Mark, 36, a paramedic |
| We’re informed by the control centre whether the patient is query Covid-19, but we’re wearing protective equipment - mask and protective eyewear - for pretty much all jobs now. We’re going into people’s houses and it’s an enclosed space so we’re not able to social distance. | We’re informed by the control centre whether the patient is query Covid-19, but we’re wearing protective equipment - mask and protective eyewear - for pretty much all jobs now. We’re going into people’s houses and it’s an enclosed space so we’re not able to social distance. |
| Because people can’t visit Covid patients in hospital, we facilitate the conversation so people can say their goodbyes, without being too explicit about it. We then advise them to take a phone with them if they’re able to, make sure they’ve got a charger and if they don’t know how to video call, we might quickly teach them how to use it before we set off. | Because people can’t visit Covid patients in hospital, we facilitate the conversation so people can say their goodbyes, without being too explicit about it. We then advise them to take a phone with them if they’re able to, make sure they’ve got a charger and if they don’t know how to video call, we might quickly teach them how to use it before we set off. |
| We then take them to A&E but through a different door for Covid patients - although we’re finding the Covid side is busier than the normal side. | We then take them to A&E but through a different door for Covid patients - although we’re finding the Covid side is busier than the normal side. |
| Then we’ll deep clean the ambulance. We have to clean inside of our cab, around the steering wheel and all the stuff that we would touch, and it’s difficult because there’s a lot of equipment and crevices in an ambulance. | Then we’ll deep clean the ambulance. We have to clean inside of our cab, around the steering wheel and all the stuff that we would touch, and it’s difficult because there’s a lot of equipment and crevices in an ambulance. |
| Astrid, 28, healthcare assistant | Astrid, 28, healthcare assistant |
| We have the most patient contact out of any healthcare workers. [We] help the nurses with the really basic but essential tasks, such as washing and changing patients, helping them go to the toilet and helping them eat. | We have the most patient contact out of any healthcare workers. [We] help the nurses with the really basic but essential tasks, such as washing and changing patients, helping them go to the toilet and helping them eat. |
| With the current coronavirus crisis, that role has expanded because we are so short-staffed - our ward is down 60% of staff at the moment. We’re doing the Covid testing swabs and transferring positive patients around the hospital. I work on a trauma and orthopaedic ward, which is now on lockdown because we have so many confirmed cases. | With the current coronavirus crisis, that role has expanded because we are so short-staffed - our ward is down 60% of staff at the moment. We’re doing the Covid testing swabs and transferring positive patients around the hospital. I work on a trauma and orthopaedic ward, which is now on lockdown because we have so many confirmed cases. |
| With both suspected and confirmed patients, we are only wearing surgical masks, sleeveless, plastic aprons and gloves, so there’s no eye protection and no arm protection. Today I worked a 13-hour shift with a patient who is confirmed positive, and I’m still going in with basically nothing. | With both suspected and confirmed patients, we are only wearing surgical masks, sleeveless, plastic aprons and gloves, so there’s no eye protection and no arm protection. Today I worked a 13-hour shift with a patient who is confirmed positive, and I’m still going in with basically nothing. |
| We also get a lot of the stress and abuse from patients who are scared and confused and don’t know what’s going on, because we’re the people they see most. | We also get a lot of the stress and abuse from patients who are scared and confused and don’t know what’s going on, because we’re the people they see most. |
| Tom, 31, radiographer | Tom, 31, radiographer |
| We’re not classed as frontline workers even though we are very much on the frontline because every Covid-19 patient is coming to us. Medical staff don’t know what they’re dealing with unless the patient comes through radiology. | We’re not classed as frontline workers even though we are very much on the frontline because every Covid-19 patient is coming to us. Medical staff don’t know what they’re dealing with unless the patient comes through radiology. |
| You don’t see Covid-19 in the lungs, so I’m using the chest X-rays and CT scans to look for patches, mainly on the edges of the lungs, which suggest infectious changes. We’re looking for pneumonia and fluid. | You don’t see Covid-19 in the lungs, so I’m using the chest X-rays and CT scans to look for patches, mainly on the edges of the lungs, which suggest infectious changes. We’re looking for pneumonia and fluid. |
| For ICU patients who are on a ventilator and not looking well, we’re likely to be down there at least daily, if not a couple of times a day, for chest X-rays. We have portable X-ray machines on wheels so we can go direct to the patients on the wards, but the CT scanner is a huge machine so they have to come to us for that one, which poses quite a logistical nightmare. | For ICU patients who are on a ventilator and not looking well, we’re likely to be down there at least daily, if not a couple of times a day, for chest X-rays. We have portable X-ray machines on wheels so we can go direct to the patients on the wards, but the CT scanner is a huge machine so they have to come to us for that one, which poses quite a logistical nightmare. |
| We’re needed in A&E, across the wards and, in the ICU we’re used all the time. We’ve also got a postmortem CT scanner so we’re anticipating Covid patients coming to us that way as well. | We’re needed in A&E, across the wards and, in the ICU we’re used all the time. We’ve also got a postmortem CT scanner so we’re anticipating Covid patients coming to us that way as well. |
| Chris, 35, intensive care consultant | Chris, 35, intensive care consultant |
| I care for some of the sickest patients in the hospital who have a chance of getting over their illness. If someone is in hospital with Covid-19 and their oxygen levels continue to deteriorate, they will often be transferred to intensive care as they might need a ventilator. | I care for some of the sickest patients in the hospital who have a chance of getting over their illness. If someone is in hospital with Covid-19 and their oxygen levels continue to deteriorate, they will often be transferred to intensive care as they might need a ventilator. |
| If that happens, a team of three or four of us will drift them off to sleep and put a breathing tube through their mouth into the airway. In some cases, we also turn them on to their front, for about 16-18 hours a day, because some Covid-19 studies suggest this can help with oxygenation. That takes at least five people. | If that happens, a team of three or four of us will drift them off to sleep and put a breathing tube through their mouth into the airway. In some cases, we also turn them on to their front, for about 16-18 hours a day, because some Covid-19 studies suggest this can help with oxygenation. That takes at least five people. |
| We wear full PPE to go in and see patients, meaning a mask and either a visor and goggles or a full respirator helmet, as well as a gown, apron and three pairs of gloves. But we try to spend as little time in with them as possible to minimise our exposure. | We wear full PPE to go in and see patients, meaning a mask and either a visor and goggles or a full respirator helmet, as well as a gown, apron and three pairs of gloves. But we try to spend as little time in with them as possible to minimise our exposure. |
| I lead the ward rounds, and manage the whole patient - not just the lungs and the right amount of oxygen, but also the heart, the kidneys, and all the other organ systems. Covid-19 can affect the whole body, and many organs may need supporting. | I lead the ward rounds, and manage the whole patient - not just the lungs and the right amount of oxygen, but also the heart, the kidneys, and all the other organ systems. Covid-19 can affect the whole body, and many organs may need supporting. |
| We’re seeing many patients stay on a ventilator for about seven to 10 days. After that, the hope is the oxygen levels have returned close enough to normal that patients can breath sufficiently on their own. | We’re seeing many patients stay on a ventilator for about seven to 10 days. After that, the hope is the oxygen levels have returned close enough to normal that patients can breath sufficiently on their own. |
| It’s quite an invasive process coming to intensive care. You have quite a lot done to you. But that’s because you need it. | It’s quite an invasive process coming to intensive care. You have quite a lot done to you. But that’s because you need it. |
| Carol*, 57, critical care nurse | Carol*, 57, critical care nurse |
| In critical care there’s a nurse by the bedside 24/7 - although obviously not the same nurse or we would burn out pretty fast. Other medical staff, like the consultants, physiotherapists and nutritionists, tend to go from patient to patient, so they rely an awful lot on the bedside nurses’ insight. | In critical care there’s a nurse by the bedside 24/7 - although obviously not the same nurse or we would burn out pretty fast. Other medical staff, like the consultants, physiotherapists and nutritionists, tend to go from patient to patient, so they rely an awful lot on the bedside nurses’ insight. |
| If someone is having breathing difficulties, we can reposition them, administer medicines, use oxygen masks, or maintain their ventilator. With breathing, you need to be pretty damn quick at reacting. If five or 10 minutes go by, bad stuff can happen. | If someone is having breathing difficulties, we can reposition them, administer medicines, use oxygen masks, or maintain their ventilator. With breathing, you need to be pretty damn quick at reacting. If five or 10 minutes go by, bad stuff can happen. |
| We also do the things for the patients that they cannot do themselves. So we’ll wipe their eyes, lubricate them, make sure their eyelids are shut, we’ll brush their teeth, suction out any buildup of saliva and apply lip balm. We’ll use bedpans, we’ll put in catheters and monitor those, we’ll wash the patients, change their bedding and we’ll regularly reposition them. We’ll also talk to them because we’re never quite sure what level of consciousness they have. | We also do the things for the patients that they cannot do themselves. So we’ll wipe their eyes, lubricate them, make sure their eyelids are shut, we’ll brush their teeth, suction out any buildup of saliva and apply lip balm. We’ll use bedpans, we’ll put in catheters and monitor those, we’ll wash the patients, change their bedding and we’ll regularly reposition them. We’ll also talk to them because we’re never quite sure what level of consciousness they have. |
| When the bedside nurse is in full protective equipment, they can’t just nip away to pick up the medicine or a new set of linen. So you have someone who stays in the amber zone away from the patients, who can fetch stuff. | When the bedside nurse is in full protective equipment, they can’t just nip away to pick up the medicine or a new set of linen. So you have someone who stays in the amber zone away from the patients, who can fetch stuff. |
| Another big part of my job is supporting family and friends, giving them updates and providing emotional support. In this current situation, we’re also exploring using FaceTime for patients to talk with their loved ones. | Another big part of my job is supporting family and friends, giving them updates and providing emotional support. In this current situation, we’re also exploring using FaceTime for patients to talk with their loved ones. |
| Ema, 38, respiratory physiotherapist | Ema, 38, respiratory physiotherapist |
| We help identify patients who need extra help breathing, and then help to maintain their chest and keep it clear of secretions. We are the people who are actually asking Covid patients to cough. | We help identify patients who need extra help breathing, and then help to maintain their chest and keep it clear of secretions. We are the people who are actually asking Covid patients to cough. |
| As they’re breathing out on the ventilator, we give their chest a really good shake with our hands. It just helps to clear the phlegm, because they can’t cough as they’re paralysed and sedated. We do the cough for them, using our hands on their chest and tummy. It’s a lot of very hands on treatment. We’re then working with the nurses and medics to ultimately wean them off the ventilator. | As they’re breathing out on the ventilator, we give their chest a really good shake with our hands. It just helps to clear the phlegm, because they can’t cough as they’re paralysed and sedated. We do the cough for them, using our hands on their chest and tummy. It’s a lot of very hands on treatment. We’re then working with the nurses and medics to ultimately wean them off the ventilator. |
| We also do physical rehabilitation. It might be just sitting on the edge of the bed, but for somebody who’s been tubed on intensive care, that is like running a marathon. | We also do physical rehabilitation. It might be just sitting on the edge of the bed, but for somebody who’s been tubed on intensive care, that is like running a marathon. |
| Covid-19 patients are probably going to be in intensive care for a little bit longer than we’re used to, so I think then we will also play a big role in rehabilitation. I think there’s going to be a lot of post traumatic stress, and probably a lot of breathing pattern disorder. | Covid-19 patients are probably going to be in intensive care for a little bit longer than we’re used to, so I think then we will also play a big role in rehabilitation. I think there’s going to be a lot of post traumatic stress, and probably a lot of breathing pattern disorder. |
| *Name has been changed | *Name has been changed |
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