The Paramedic experience of COVID-19 is completely counter to what I initially expected

Not to discredit the work of our incredible in-hospital colleagues, but the prehospital management of COVID feels ‘simple’

Well enough to stay*?
Sick enough to go?
How much O2?

*caveats
/1

We have some pretty robust decision making guidelines and though it’s been dynamic and changing daily, I feel pretty confident about the clinical decisions being made and the core ‘ambulance work’ that we’re doing... which is actually what I feared being difficult

/2

The challenges are human

They are moral

They are ethical

They are harder wearing PPE (albeit safer)

/3

These will be hugely bleached of detail as they are not clinical reflections and none are attributable to any particular patient:

/4

Attending an elderly couple isolating away from their family; both symptomatic. One well enough to stay home, one catastrophically unwell

Simple to “manage”; oxygen, chair, diesel, hospital.

The challenge? I genuinely believe they’ll never see each other again.

/5

To my prehospital colleagues who have or will be in that same living room.

Give people their chances to say goodbye.

I’m not saying write everyone off, this isn’t a 100% mortality diagnosis.

But recognise that contact & comms only worsens when those ambulance doors close.

/6

I don’t want anyone left regretting not taking the chance to say what they wanted to say

We might be the ones hosting that last chance. So I believe it’s our responsibility to do it to the best of our ability.

Inform. Empower. Support. Enable.

/7

“How long is he going to be in?”

“I’m not entirely sure. Hopefully not too long at all. However, he’s really quite poorly at the moment and this virus can be really dangerous, especially for someone his/her age. Before we leave make sure to take the chance to...”

/8

A simple way to create the opportunity to say “I love you” or “goodbye” or “I’ll see you soon”

Now is not the time to pretend everything will be ok, because unfortunately it might not be.

The challenge is creating the opportunities for humanity in the chaos

/9

All too often I’m faced with the phrase “I never got the chance to say goodbye”

I don’t want to be part of that problem

/10

I don’t want to look back at my role in this crisis and regret a single interaction... I want to know I afforded every family the chances I could

/10.5

The next challenge COVID has brought is one of PPE

And this again, is multifaceted... practical and human

Practical? This is easy enough, practice with the right kit, know it inside out and it’ll all be fine. Confidence and competence... blah blah blah

/11

The real issue for me is being human in it... twitter has shown us some incredible solutions: names on the tyvex, printed stickers, boards in the corridors, colours etc

Hard/impossible during the fast paced acuity of a CAT1 999 call, donning at the boot of a car

/12

And then walking into a house, dressed like an identity-less forensic examiner... In the world of COVID, frequently informing people that their loved one has died

/13

PPE guidelines exist for a reason - to keep us safe. Good. Adhere to them.

But, what are the marginal gains here. How do I be more human. How can I make this any less awful.

Currently, I swear by the withdrawal back to the car and downgrade away from the L3 PPE ASAP

/14

Breaking bad news is not an AGP

/end