Life on the frontline
A nursed ons personal protection equipment before starting work in the covid-19 specialist intensive care unit at the royal infirmary of edinburgh
Nervous laughter fills the corridor as colleagues help each other painstakingly prepare for another shift.
Gloves and gowns are donned, then a second pair of gloves before friendly faces disappear behind masks and visors.
There is more methodical checking in the mirror before job titles are scrawled on aprons. In an emergency, knowing who’s who can make all the difference.
This is life in the Edinburgh Royal Infirmary’s specialist coronavirus intensive care unit (ICU).
“The main reason patients come to ICU is mainly for their breathing, so we have ventilators,” says ICU consultant Mike Gillies. “Other types of ICU support are things like dialysis.”
An entire ICU ward is now solely treating Covid-19 patients as the Royal Infirmary ramps up to meet demand.
The health board has quadrupled its intensive care capacity to 113, with 35 to 40 being cared for at the Royal, the city’s Western General and St John’s in Livingston.
Lessons have been learned from colleagues in London, which has borne the brunt of the outbreak in the UK so far.
The response is a team effort, with the medical physics team even converting up to 50 anaesthetic machines into ventilators.
“We’ve got ventilators and the most important thing is nursing staff and staff to look after the patients,” says Mr Gillies. “If we get to the point of increasing sickness rates, it might become more difficult. We’d emphasise the message to stay at home and provide the support.”
A separate ICU ward is also being staffed to treat conventional cases, including car crash casualties and heart attacks.
“Unfortunately, we can’t turn that work off,” Mr Gillies says.
Nurses start their 12-hour shifts donning PPE kit before heading into the ICU for a handover with colleagues on the progress of patients.
They then join a conference call with colleagues at the Western General and St John’s to discuss staffing and equipment.
“We’ll do the rounds and see every patient twice a day to make a plan for that patient – drugs, ventilation and any other treatment,” Mr Gillies says.
Medics are also learning as they go along.
“Sometimes we need to put patients on their front if they’re having real difficulty breathing,” Mr Gillies says. “It helps with the lungs and the blood supply.”
Such painstaking work is labour intensive and compounds the need for fit and healthy staff, with one nurse per patient in the ICU.
“It uses a lot of resource,” says senior charge nurse Lesley Triseliotis. “We have to be very careful turning over someone when they’re sick – it takes six or seven of us.”
And at every level, these extraordinary efforts are taking their toll on staff. “The hardest thing is we normally have families of patients coming in, but because of Covid-19 families haven’t been coming in – it’s very difficult for them and us,” says Ms Triseliotis
Site director Janice Alexander says: “The A&E department has been divided into two parts or zones.
“The red zone is for detecting and receiving Covid-19 patients.
“The green zone deals with all other patients coming to the hospital so we can care for them.”
With a spike in coronavirus cases expected, two rooms of the A&E department are being prepared to handle the influx.
Along with their patients, staff are also looking out for each other as the strains of dealing with the pandemic take their toll.
“Caring for a group of patients who have an infection that can be passed on is worrying,” says Ms Alexander.
“Wearing PPE daily when dealing with patients suggests a sense of calm about it all.”