Thread by @DarylTractor

An interesting thing happened last week. 

Here’s a brief 🧵:

While the media was fixated on freedoms and roadmaps, Australian ICU experts made an eye-opening call to the government:

Indemnify healthcare workers who’ll be forced to deny people admission to overflowing ICU wards.

Lots has been said about the fact hospitalisations have not yet peaked, and capacity “will be stretched” from Oct onwards.

But in many hospitals across Sydney and Melbourne, the situation is already dire.

Have a look at some of @squigglyrick’s reporting about how untenable the situation already is for paramedics -  including leaving a seriously ill mum at home in the care of her small children - all battling Covid.

Take it from those who are living this crisis. Ie this Sydney doctor who told me, a stranger:

“We’re overloaded. We can’t offer surgery to people who need it. It’s evolved slowly - so there’s no threshold to say it’s failed.”

Of the weeks ahead, the doctor says:

“Usually we won’t admit people because it’s cruel and futile. Not because we don’t have a bed.”

In the Victorian presser today a journalist complained that Premier Dan Andrews hadn’t told him exactly how many hospitalisations Victoria can handle.

The answer isn’t that simple.

Last week @RealOzSAGE, an independent group of Aus experts on infectious diseases, public health, emergency medicine, policy, economics and more, released the recommendations of its ICU Working Group.

(This group contains some of the most respected experts in their field - people like @MarylouiseMcla1, @Globalbiosec, @TonyBlakely_PI @enenbee @lidiamorawska, to name a few.)

The ICU Working Group’s analysis is confronting.

And it provides some important background to the “we’ve been working on our surge capacity for 18 months” rhetoric.

“When baseline ICU capacity is exhausted (also known as “code black”), plans have been created to extend ICU care outside the designated ICU physical environment,” the report states.

“In reality surging ICU is a continuum, with progressive dilution of resources and expertise and an increase in risks and likelihood of adverse outcomes.”

As well as ICU wards spilling into non-designated areas, patient/staff ratios being reduced and non-ICU staff being expected to step up to fill shortfalls, there are many other issues.

It’s a new disease, known for causing rapid deterioration in previously well people. Add sweaty PPE, difficulty reading visual cues, inability to debrief with colleagues in a break room, and a particularly awful new challenge:

“The loss of patient family support, and for paediatric intensive care patients, inability to have a parent at the bedside, is challenging for the care of the infant or child, even with use of virtual communication.”

Could you begin to imagine not being able to be with your child if they were critically ill in hospital?

And, obviously, it won’t just be Covid patients who’ll be competing for a bed. The car smashes and heart attacks don’t stop.

The ICU Working Group says healthcare workers and the places that employ them must be protected if they have to start being selective about who receives life-saving treatment.

“If unable to offer ICU admission based on capacity constraints, then a government-based mandate to protect facilities and healthcare workers is required.

“Transparent and accountable processes must be employed. Processes for appeal by patients and their families, and escalation must be available and documented.”

There’s a very good reason for this. US doctor Anna Pou was arrested on second-degree murder charges when she made decisions no doctor should ever have to make in the aftermath of Hurricane Katrina.

This confronting story talks about the reality many of delivering healthcare in a crisis situation. 

propublica.org/article/the-de…

And the difficulties with triaging in a crisis.

Is this a job you’d sign up to do?

As I type this, the news is on. People are up in arms about the “slow road out of lockdown”.

I understand that a lot of people are under pressure, but few people would comprehend the pressure our healthcare workers have been under for 18 months - with no end in sight.

Here’s a link to the report.

If our hospital staff are asking for indemnity for the decisions they’ll be forced to make in the coming months, it should be a wake-up call for all of us.

ozsage.org/media_releases…

This is an excellent explainer:

https://twitter.com/DrKate_Miller/status/1439878903284199424

And this:

https://twitter.com/sparnis/status/1439869965130080257