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I was given rare access this week to 2 critical care departments in South Wales – how they’re preparing for #Covid_19 ‘worst case scenarios’

What @c4marcus @daibaker & I found, of course, goes way beyond the realm of extra beds & ventilators…

Take @dr_mattmorgan for instance - critical care consultant in @UHWCriticalCare Cardiff. He agreed to record for us his @bmj_latest ‘open letter’ to the elderly (among others). It’s since had 2m views on Facebook

At the Prince Charles Hospital in Merthyr Tydfil – another critical care consultant Dave Jones @WelshGasDoc took us on a journey the most ill Covid-19 patients might take. At the end of which we discovered a whole day-surgery wing now co-opted for #Covid_19 critical care...

ICU beds ramped up from 8 to 22. Operating theatres empty of tables, ready for beds.
Anaesthetic machines (like this one pictured) are now being used as additional ventilators

Before patients are admitted into this wing, they’ve created a specific #coronavirus assessment area below.
The sign on this cubicle (one of 14) reads ‘Respiratory Isolation – apply Droplet/Airborne Precautions’.

Precautions centre around ‘donning & doffing’ PPE equipment, the careful choreography of which is being taught endlessly in the units we filmed – getting a ‘tight seal’ around the nose and mouth area was emphasised in this demo.

Everyone look energised – the emotion of what they’re involved in glimpsed, momentarily, when I asked senior nurse @cannied7, who’s devoted her career to the NHS, how proud she was to work for the NHS right now

In @UHWCriticalCare in Cardiff we filmed similar preparations – but the scale is on another level. In 2 weeks they’re training at least 600 staff to provide back-up support for the critical care teams

One of the most high risk procedures involves intubating a Covid-19 patient [simulation mannequin here & instructor watching on] due to medic/patient mouth proximity…

In an actual #Covid_19 intubation procedure, in this unit they’ll be wearing FFP3 masks – they’re using surgical masks in training here to preserve stocks of FFP3.

Here it’s a scenario of a patient in cardiac arrest who may have #Covid_19. Focus is on ensuring the crash team pause before entering to ensure all PPE is applied. One medic whispered to us how difficult that check will be when the usual instinct is to rush in to ‘save life’.

One training session we witnessed is just called ‘resilience’ – and it taps into the psychological challenge so many of these frontline health workers may encounter in a worst case scenario...

It involves, amidst imagined huge critical care demand, the scenario of telling the family of a patient with severe and chronic co-morbidities that further treatment would not improve their ‘life chances’...

‘Moral Distress as healthcare rationed’ is one of the issues highlighted by the unit’s consultant clinical psychologist @DrJulie_H in her ‘Advice for sustaining Staff Wellbeing in Critical Care during & Beyond Covid-19’.
She worries about long term impact this will have on staff

Dr Julie Highfield’s guidance is now being shared widely among Critical Care units – via Intensive Care Society @ICS_updates

https://twitter.com/ics_updates/status/1238180514823057408?s=21 https://twitter.com/ICS_updates/status/1238180514823057408

In Cardiff they’re grappling also with the issue of how to let relatives say goodbye to loved ones without risking infection themselves. PPE equipment training one option, but that depends on enough spare PPE supplies. ‘Virtual visits’ also an aim

We met a lot of health workers this week. Saw a health service being rapidly reshaped in the shadow of #Covid_19

Whether the NHS, across the UK, with its systemic frailties so often exposed in endless winter crises, can successfully withstand the extremes of Covid-19 is open to question.
But indisputably they are blessed with some of the most compassionate and professional people I’ve met.

This was our report (Tues) from the Prince Charles Hospital in Merthyr Tydfil @WelshGasDoc @CwmTafMorgannwg

Our report (Weds) from the University Hospital of Wales, Cardiff @UHWCriticalCare @dr_mattmorgan

Both pieces produced by @c4marcus filmed & edited by @daibaker

Last word to @dr_mattmorgan

I asked him:
When in a year's time, we're hopefully through this and I might be interviewing you again, what shape do you think you and your colleagues here in @UHWCriticalCare will be in?

His reply...