Thread by @DrSimonAshworth

If you have to ask, it’s disappointing.

But the answer is none of the staff who we need to care for critically ill patients have quite mastered the art of being in two places at once…

https://twitter.com/johnredwood/status/1314268776066617344

I realise my reply may seem facetious, so I will give more details. Initially COVID was presented as a simple disease and a bit of ventilation was all that was required. In fact it isn’t.

COVID is a multisystem disease that causes pneumonia skewed towards the highest severity of illness with terrible lung disease, kidney failure, brain involvement and very abnormal blood clotting. Some patients get poor cardiac function too. Treatment is rapidly evolving.

As a result patients are not suitable for care by someone who isn’t an experienced critical care consultant, or nurse. Things happen very fast and experienced clinicians are needed to respond if good outcomes are to be possible.

We used a lot of non-ICU staff to support, and they did a great job, but this was highly stressful for them and for us, and not sustainable given the impact on other services. Nobody was working in anything resembling a comfort zone, and you can’t do this for long.

At the same time our normal business of trauma, cardiac arrests, aneurysms, bleeding, kidney failure, stroke, liver failure, pneumonia, cancer surgery, cardiac surgery, bowel surgery, transplants, sepsis and other conditions keep coming. These people too need specialist care.

The fact is Critical Care tripled its capacity during the surge, at least in my hospital. This was a massive effort and achievement.

We face the potentially same again or worse whilst being asked to provide a full “NHS worth” of critical care at the same time.

ICU nurses take a couple of years to train, airway skilled registrars perhaps five years post qualification (ie 10 years), and consultants like me roughly 15 years from school leaver to consultant.

So we can’t turn on a dime. We did second a lot of people into ICU, but this is a transformation unprecedented in peacetime healthcare, and the necessary permanent expansion of critical care will take a lot of resources.