At the time of the stressing epidemics and pandemics, it is crucial to to stick to the team solutions in coping with the problem.
We introduce Dr. Kevin Roush, who is the first pharmacist to lead The Society of Critical Care Medicine (SCCM) and who is discussing the importance of the team approach in the field of critical care medicine.
How is your team managing the response to the current epidemic?
It is obvious that pharmacies across the country are essential link to the efficient management of the current epidemic. You cannot battle the epidemic successfully if you don’t have enough basic medical devices at hand at all times. So we are working closely with hospitals in our vicinity on one hand, and with the suppliers of the medical devices, on the other hand, on order to have sufficient amount of medical equipment to meet the ever-increasing demand for these.
Is there any pre-planned model that your work is based on in order to organise it efficiently?
Indeed, there are such models. While the current epidemic is the first one of this scope, there have been a number of cases throughout the history, and even in my lifetime, when the work we are doing now was crucial. The Society of Critical Care Medicine (SCCM) is describing both disaster models and search models for increasing the efficacy of critical care teams. These models are available and are very handy in critical times like we are living through now.
What are some of the main aspects of these models?
To touch on some of the useful and practical team-working aspects, I would mention the specializing methods. Which is, each team is having one specialist with the relevant experience for each specific field of care. These would include: a professional pharmacist, a nurse with critical care skills and training, a specialist in respiratory deceases including severe cases, an immunologist, a bacteriologist, and others. The difference between the critical care and the regular care, is that the ratio of those practitioners are different for critical care cases. For instance, in typical cases, a nurse responsible for critical care is usually working with only two patients at a time. When we have situation like ours, the same nurse can be assigned for up to six patients and to do the most critical issues serving all those patients attached to her. Obviously, there is no time for the critical care nurse to perform all aspects of nursing with those six patients simultaneously. For that reason, a nursing specialist without the critical care training would take on typical routines for all those six patients. They will be working together as a team.
Are there any other personnel that might working in the team like this?
Exactly, I just wanted to discuss it. The specialists who are usually not involved in critical cases can be taken into the team and to do a number of tasks: drawing blood from the patients, starting IV-lines, taking care of medications administering routines, or adjusting infusions. The critical care nurse we discussed will be strongly supported by the newly added personnel, provided their roles and tasks will be polished and implemented efficiently. That is the reason we have a thorough person-to-person training with each specialist taken into the team.
How hard is it to achieve the proper coordinating inside the team?
As I said, we are having personnel training with each doctor and specifically train him to perform his task efficiently regardless of the team work, but considering at times chaotic distribution of patients in the hospital. After the training is polished, we introduce multiple-specialist training and start the teamwork routines polishing. After we are sure the team is working efficiently and smoothly, we are ready to send the team in the real field for work with actual suffering patients. In general, the overall training can take up to 3 sessions, and if necessary can be performed in one day.
What is the current situation with available beds for patients in the US?
The United States of America is prepared better than other countries across the globe, with 35 hospital beds per 100000 citizens. It is almost ten times higher number than that of, for example, China.
Are there any deficiencies in equipment and overall preparation of hospitals for the existing epidemics?
Indeed, we have a number of things we must have had prepared. If we only knew what we had coming! Those things include the numbers of Intense Care Unit beds and mechanical ventilators used currently in hospitals. If the numbers of patients reported at the Society of Critical Care Medicine report will become reality, and the deadly virus will be spreading as predicted, we will have as many as 4.9 million patients who would need to be hospitalized. At the same time, close to 2 million patients would need to be admitted to Intense Care Unit. The mechanical ventilation will be needed to as many as 970000 patients.
Based on our numbers, it is only 5 patients for each ventilator unit that is possible to put into the service.
What is the current situation with existing ventilator units ready for use at the hospitals?
We, at SCCM, have established special Ventilator Task Force specifically to ensure we are focusing on the needful ventilator units. As of now, it is estimated that 63,000 completely functional ventilators are ready to be used in the country, while around 110,000 of out-of-date ventilators that can be however used if nothing else is available. These include 23000 non-invasive ventilators, 33000 auto resuscitators, and 9000 C-P-A-P units.
Besides these older-version hospital ventilator equipment, we could have used stock-piled ventilators from the CDC as well as anesthesia machines, while totaling the possible amount of devices at around 200 thousand units. Obviously, not every unit out of older stock will be 100 percent functioning, and hardly all of them will be able to help patients with severe respiratory failure. Another possible hindrance of supplying ventilators of any kind, either brand new or older versions is current interruptions and delays in international supply; again, due to the overall halt caused by the virus.
Are these the number for the worst case scenario?
No, these are very positive prognoses, close to the best case scenario. If you are asking me about the worst case scenario, we would look at the numbers at as many as 21–23 million of all the US population.
What will be required to make hospitals and all of us prepared better for the peak of the epidemics?
As of now, it is clear that, despite all the team work and efforts on the part of our organisation and on the part of the local authorities, we are far from being fully prepared. It will take a serious and determined collaboration. The general population must gain skills in social distancing, enhance testing of the virus to trace the contract in order to limit the virus transmission speed and efficiency, while hospitals must put their best effort to maximize the availability of ventilation. The necessary equipment we must concentrate on providing at the moment is the testing equipment and installation in hospitals as well as establishing stand-alone testing centers with 24/7 admittance.