Of all the shortages hospitals face, the most avoidable and prevalent may be of staff trained and available to prone patients. (Thread) 1/

Proning - turning a patient onto their stomach - has long been used for Acute Respiratory Distress Syndrome. It's too early to know its impact on COVID, but there's enough confidence in its potential efficacy that it's commonly used pre- and post-intubation. 2/

But proning is a surprisingly complicated procedure for an intubated patient. They need to be carefully flipped onto their stomach without dislodging the breathing tube/IV lines, continually repositioned to prevent pressure sores, and then flipped back. Then the cycle repeats. 3/

This requires training a set of health care workers to work as a team to do something new - not a strong suit for a siloed health care system. It does not happen if you try to assemble an ad hoc team out of whichever nurses/PAs/MDs happen to be around doing other patient care. 4/

As long as a trial of proning is considered standard of care for some COVID patients, hospitals have an obligation to proactively assemble and train *dedicated* teams to do this work. /5