Investigation reveals pressure on paramedics during the pandemic winter wave

New research published in anesthesia (Journal of the Anesthesia Society) shows that the number of newly admitted infected patients has skyrocketed and the UK anesthesia and critical care staff are receiving a large amount during the winter wave of COVID-19, including the most planned surgery. Shows pressure. A significant number of serious cancer surgeries have been cancelled.

“These findings have important implications for understanding what happened during the COVID-19 pandemic, planning a recovery, and building a system that responds well to future waves and new epidemics. “We are,” explains co-author Tim Cook, an anesthesia and intensive care consultant. Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK, and Professor Emeritus, School of Medicine, University of Bristol, UK.

Between October 2020 and January 2021, the author conducted three national surveys to track anesthesia, surgery, and critical care activities during the second COVID-19 pandemic wave in the United Kingdom. The final survey in February 2021 immediately after the peak of the New Year’s surge caused by the lifted restrictions in 2020 and the new Kent (UK) variant of SARS-CoV-2.

They surveyed all NHS hospitals where surgery was performed. The response rates by round were 64%, 56% and 51%. Studies have shown increased systemic pressure on anesthesia and perioperative services due to the need to support critical emergency pandemic demands.

There was evidence of significant stress in the system in October, which increased in December 2020, including the relocation of one in six doctors from anesthesia to critical care, and by December of the critical care unit. Approximately half expanded and the planned surgery became unsafe. During this period, nearly one-fifth of the operating rooms were closed, but many hospitals were able to move surgery elsewhere. The overall surgery rate was reduced by about a quarter compared to a similar period last year.

Then, at the peak of the second surge (January 2021), the situation deteriorated dramatically and there was a response indicating that the system was approaching its limit. Almost half of all operating rooms were closed, and the open theater was run with nearly half the normal activity. Due to the lack of staff, the hospital was unable to move its activities elsewhere.

“Part of the impact on surgery was due to the space acting as the operating room being used as an extended ICU, but the most important factor was care when relocated to the critical care unit. There was a shortage of anesthesiologists to provide. At peak January, one in three anesthesiologists was unable to participate in the anesthesia work because the relocation more than doubled the workforce in the critical care unit. “I did,” explains Professor Cook. “All but a quarter of the critical care units have been expanded to the point where planned surgery cannot be performed safely. As a result, surgical activity has been significantly reduced and all types of surgery have been affected. There were significant regional differences and it was a tough region. Pediatric and non-cancer surgery dropped to 12-20% of normal activity, even cancer surgery, which is usually considered an urgent priority, is normal It has dropped to less than half of the activity. “

As long as the UK continues to break out of blockade restrictions and vaccination rates keep COVID-19 infection low, rapid decompression is likely to occur, critical care units rapidly diminish their capabilities, and the rest of the medical system Resume selective and other surgical care. However, working on a surgical backlog requires years of work far beyond normal capacity and can even be difficult to return to normal. Co-author Dr. Emira Krsmovic said: “Our data show very clearly that anesthesiologists, and perhaps other healthcare providers working in the operating room, are at the heart of the pandemic’s critical care response and are affected as well. Staff had increased workload and concentration, reduced vacations, and psychological burdens, including moral injuries. Workers’ physical and psychological burdens when planning a recovery of non-COVID medical services. Needs need to be considered. “

The author adds: “Surveys show pressure points in the current system. These include space, especially staff. The fact that a significant number of anesthesiologists need to be relocated to expand critical care is at least It can have important implications for the next stage as a year. Critical care Services are flexible, adapt to changing demand, and scale as needed. This, in turn, has important implications for dealing with the surgical waiting list. Expanding both space and the anesthesia workforce can be an unavoidable requirement. “

Dr. Mike Nathanson, President of the Association of Anesthesiologists, said: “These important studies show the pressure on anesthesiologists and anesthesiology during the pandemic surge. The impact on the mental and physical health of colleagues is still felt. About national health in terms of expanding the waiting list for Surgery, A big concern. The lack of workforce and the inability of many trainee anesthesiologists to advance their careers due to lack of proper work will emphasize this backlog, even without further spikes. “

Professor Ravi Mahajan of the Royal College of Anesthetism, who funded the study, said: “These findings confirm that anesthesiologists played a central role in treating critically ill patients with and without COVID during a pandemic. Successful recovery is evident. The right staff in the right place. It depends on placing it at the right time. “

He adds: “But don’t forget the enormous physical and psychological sacrifices that working in a pandemic has made to anesthesiologists in a hurry to reduce the backlog. Overall, it jeopardizes the sustainability of the NHS. It is important to take lessons from last year to identify areas for improvement, plan a sustainable NHS recovery, and be more effective in responding to future pandemics. ”

Provided by AAGBI