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& #39;s too early to know its impact on COVID, but there& #39;s enough confidence in its potential efficacy that it& #39;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