One for all – and all for one

So far, one positive element experienced during the COVID-19 pandemic has been the increased collaboration between colleagues from different disciplines; often driven by the obligatory new ways of working. For example, what some specialties find obvious from near-daily experience, such as ventilating patients in theatre or in ICUs, have suddenly become the focus and learning for other specialties seconded to the former. On the part of the experienced colleague, this produces a disorienting mixture of anxiety along the lines: ‘How do I exactly drive my car? Yes, I do it every day but without really thinking how. Now I have to teach and explain to a ‘novice’ quickly how to do it.’

This anxiety is compounded by the fact that training has to be completed as succinctly and quickly as possible (while wearing full PPE) as every minute spent training takes attention dangerously away from the patient, and, as realised at the end of the day, is so exhausting.

Still, consider all the poor people – key workers, wherever – who were not able to have the full PPE readily at their disposal!

We know that full PPE has been doing its job: colleagues worked out, with the restricted data available, that across the UK no casualties have been encountered amongst anaesthetists and critical care physicians working in the ‘danger zone’. How did they stay safe? In most cases by considering ALL patients potentially COVID-positive until proven otherwise, long before COVID could be detected.

Evidently, one can ‘overdo’ it with PPE, but amateur infection control and inappropriate risk assessment are a dangerous thing; as not only statistics have shown. A serious debate will have to take place on how we have sufficient and the right PPE available next time – and yes, there will be a next time. Will it rely on good-ol’ but expensive stock piling, or the newer, cheaper ‘just-in-time’ delivery? With the perceived end of the cold war, and reaffirmed more recently, plenty of countries in the world decided together, years ago, to adopt the latter, gradually getting rid of their PPE stocks. For many years, it is known, worldwide, that most PPE is (more cheaply) produced in China. With all of these counties in need of the same, at the same time, it turned out to become a rather ‘just-too-late’ delivery, and VERY expensive, both in money and lives – and we can’t blame the Chinese for that.

What are your thoughts? What measures can the UK take to ensure correct equipment is available during any future pandemics? 

Comments (5) Add yours ↓
  1. Hannah Warren Urology registrar

    Many of the items required for PPE (surgical masks, waterproof gowns, visors) are required for daily use in the NHS, albeit in vastly lower quantities than during a pandemic. Maintaining a national stockpile of non-expired PPE may be more feasible if items are routinely used from the stockpile outside of the pandemic and replaced with items with a refreshed shelf life.

    June 28, 2020 Reply
  2. Sophie Rintoul-Hoad Urology ST6 (deployed to ITU)

    The well known quote of your title – is part of the longer phrase (a letter between two armies in 1618) and actually reads: “we came to an unanimous agreement among ourselves that, regardless of any loss of life and limb, honor and property, we would stand firm, with all for one and one for all… we would not be subservient, but rather we would loyally help and protect each other to the utmost, against all difficulties”

    It is the sentiment that has stood the test of time and is apt for the exemplary inter-disciplinary teamwork that has been so been so evident amongst NHS workers during the last few months. Indeed this camaraderie is ever-present, but has been particularly needed recently. I’ve seen every specialty and healthcare worker imaginable within the walls of the ‘pop up’ ICUs. We have transferable skills and a willingness to learn, despite the difficulties of wearing PPE.

    As one of the ‘novices’ I was in awe of the intensivists and so grateful of their support and guidance. So THANK YOU Dr Wim – for your patience and acceptance of us non-intensivists into your difficult and stressful environment. I hope we were not a hinderance, that your ‘novices’ were good students and did you proud.

    June 28, 2020 Reply
  3. Eoin Dinneen uro research reg

    Surely stockpiling PPE for the short to medium term is a huge priority currently with the possibility of further surges either with increasing people’s liberty’s or autumn on the horizon.

    Another thought on ‘all for one and one for all’: what about the fact that some hospitals seemed to be desperately struggling for PPE whilst others had a surfeit only just up the road…? Should stocks of an essential piece of safety equipment like this be managed by a central organisation? Just a thought.

    June 29, 2020 Reply
  4. Tom Stonier Urology ST3

    One of numerous oversights in our ‘preparation’ (if you can call it that) for the pandemic was clearly PPE. Stockpiling does not seem like the best answer as the timeline for when we next will need it is so unclear (1 year, 5 years, 10 years) and it goes out of date – although how paper gown goes out of date I’m not sure!

    It’s interesting that during the pandemic I didn’t once not have the PPE I required to see a patient; yet I understand colleagues in other hospitals were cutting holes in the sides of bin-bags to make DIY gowns. Based on this I have to agree with Eoin that next time we need a central organisation to control distribution to make sure it is spread evenly. In my opinion tighter supply chains (that don’t just rely on China) are going to be more critical than stockpiling when this all comes round again.

    June 30, 2020 Reply
  5. Blancke Wim

    Thank you for all your reactions and recollection of history – very ad rem and humbling!
    Yes, we never seem to learn enough from history: PPE has always been associated with protection during warfare. Probably, our recollection has focused too much on pure military battles or terrorism. We tend to have forgotten that the ‘B’ in NBC warfare stands for ‘Biological’, exactly what we are facing now; this time with one common enemy. We have to realise that this battle can only be won, not only by perseverance but by collaboration. This means, as clinicians, all together, we have to show that we continue to stand together and what is required, for everybody, without discrimination and readily available.

    Hopefully, and soon, room is created to bring all parties (including trainees!) around the table, to enable an open, honest and frank, non-judgemental discussion on how to learn (our) lessons, to improve things, both for the near future – perhaps already the second wave – or the next threat, which can even be more localised. What would be the right platform to do so?

    July 1, 2020 Reply

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