PPE personal protective equipment for COVID

Today's episode is a bit different – I'm going to be sharing thoughts that aren't my own at all. You may have seen this piece around the internet called “There is no emergency in a pandemic.” I've seen it reproduced on a variety of platforms, but this is the link to where I first saw it. I've also seen many comments on this piece on Facebook, Reddit, and other spots, some of which are well worth reading. This piece really is great food for thought, so I'm simply going to read it to you, discuss a few poignant comments, and hope to give you something thought-provoking to share with others. You can find the auto-generated transcript below.



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No Emergency in A Pandemic? COVID-19 Reflections (TRANSCRIPT)

Hey there friends! Welcome to The Career Prescription podcast (aka The Career Rx). I’m your host Marjorie Stiegler.

Today, I'm gonna do something a little bit different, and it's not really about careers at all. It's more about understanding our current reality- the risks, priorities, choices- in words that that I would never have been able to craft and create. But I came across something online that I think is just really worth amplifying, and it has probably been read by many, many more people than will ever listen to this podcast. But in any way that I can, I want to get this message out not only for my colleagues who are health care professionals, but also for every single person in the United States in the world to understand really where some things are going wrong here on PPE and for a shift in perspective around the personal protective equipment.

The personal protective equipment, as I've talked about before, isn't really about the person wearing it. It does protect them, but it protects so much more than just that person. And importantly, it protects other patients, other potential patients and their family members. And it's ah, it's the way in which diseases like COVID-19 and others spread is so closely linked to this idea of personal protective equipment or PPE. And as of late, because there is such a tremendous shortage, I'm starting to see a whole lot of changing guidelines about what's needed – and again not based on science or that it isn't actually needed, but just based on the fact that there isn't enough.

And there has been a lot of angst and fear and frustration for clinicians who are either not getting what they need or they're being advised for appearances – for sort of public relations – not to wear the equipment that they need. And there is an effort around rationing and sharing or reusing of this equipment. And I think while I have spoken a couple weeks ago about how important this was in sort of the pre-surge timeline now, realizing that there are hundreds of thousands of cases in the United States and just the other day, Dr. Fauci said we might see 100,000 or more deaths in the United States. So I think it's really, really important to revisit this – that personal protective equipment is not about people who are asking for it specifically.

And so I came across this post. It was written again not by me, but by somebody who was a a medic and a responder to the Ebola crisis. And as best as I can tell, based on this link, this person is a nurse, a former army medic by the name of Aaron Mishler. Then he was an Ebola responder in West Africa in 2014 and he has reposted, I believe, something that he wrote back then because it has applicability to the COVID-19 crisis. So the following again, not my words at all. I'm going to literally read this to you.

He says “I was asked to repost this with the news of 13 Italian doctors dying from COVID-19…” which now I'm gonna insert really quickly here -that seems like an awfully long time ago in a very, very small problem compared to what we are now facing. Probably because people have not heeded this advice. OK, I'm gonna start again. These are his words:

“I was asked to repost this with the news of 13 Italian doctors dying from COVID-19. If you do not have proper PPE, do not go in. No matter what.

This post is for my healthcare workers, docs, surgeons, Nurses, aids, and EMS, and all staff.

There is no emergency in a pandemic.

You as a healthcare worker are a force multiplier. Your training and experience is invaluable moving into this crisis. So, you’re going to be faced with some very difficult moments. You’re going to have to put your needs first.

I’m speaking specifically about PPE and your safety.

If you’re an ICU nurse, or an ICU doc, and you become infected, not only are you out of the game for potentially weeks (or killed). But your replacements could be people without your expertise. Your remaining co-workers are short staffed now, more likely to make mistakes and become ill themselves. You stop being a force multiplier and start using healthcare resources.

You going in may save the patient, it may not. But you cant save any patients in the weeks you’re laying in a hospital bed or using a vent yourself.

People are going to die. Do not become one of them.

There is no emergency in a pandemic.

During the Ebola outbreak, people were dying. But at no point did we rush in, we took the 10 minutes to put on our PPE with our spotter. If we didn’t have proper PPE we did NOT go in.

There is no emergency in a pandemic.

You may work in long term care, and want to rush in to save a patient you have had for years. Do not go in without your PPE.

There is no emergency in a pandemic.

You may have a survivor in the room, screaming at you to come in because their mother is crashing. Do not go in without your PPE.

There is no emergency in a pandemic.

You may have an infected woman in labor. Screaming for help. Do not go in without your PPE.

There is no emergency in a pandemic.

You may have a self-quarantined patient with a gunshot wound who is bleeding out. Do not go in there without your PPE.

There is no emergency in a pandemic.

Doing nothing may be the hardest thing you’ve ever had to do in your life.

Many of you say, I could never do that. I wouldn’t be able to stop myself from rushing in and saving my patient.

Liberian nurses and doctors said the same thing, and many did run in to help, saying PPE be damned. My patients need me.

Then they became infected, they infected others. And they died.

They didn’t help anyone after that.

Do not let the deaths of hundreds of healthcare workers be forgotten.”

That's the end of his post, which is either titled or should be titled “There is no emergency in a pandemic.” It's a really, really powerful piece, and I think it's so important because it illustrates in a very, very vivid way the very difficult choice it is to not take care of a particular patient without the proper equipment that you need not only to protect yourself as this force multiplier, but to prevent spreading it to other people. To prevent that health care associated spread.

If you do not have the proper PPE, you should not go in. You don't actually know if going in and doing whatever it is you intend to do will make a difference for that particular patient or not, they may still not live. They may still suffer injury, but what you do know for sure is that if you go in in an unsafe way, that you are risking additional harm. And what was interesting to me about this post also is I saw it. I saw it elsewhere, but I also saw it on Reddit, and so I looked at some of the comments.

If we take a look at some of the comments, there is a theme. One person says: “In emergency response training, we learned triage for mass casualty situations. It was a tough lesson, but the goal is to maximize how many people come out of it alive. If someone is near death, you actually declare that person deceased. You don't spend time trying to save that person until after the triage is done. Normally, for non-disaster situations where there's only one person in danger, the goal is to save that one person.”

So a mass casualty situation is obviously very, very different from a regular trauma health care situation, and a pandemic is perhaps just as different.

Here are a few more comments. These are different, you know, from professionally different different domains. But they all have the same type of theme.

So this person says: “it's the same thing as how we're taught in the military. We're taught if our buddy is down, we have to make sure it's safe to go in before helping him. Everyone will be worse off if you charge in, and suddenly two guys are shot. If you want to help, make sure you're safe first.”

Then someone says: “Yes, this is SAR101 – nothing is more important than you because if you go down, not only are you now useless, but you're worse than useless because now you need saving.”

And another: “The same is true for mine rescues. If a man's passed out by the breaker box, make sure that air is good. Don't touch him or there'll be two people passed out by the breaker box.”

“Here's an anecdote for the average person. When you're flying in an airplane and they tell you in the event of emergency, put on your own oxygen mask before assisting your child.”

In the comments, someone asks: “But what what about when proper PPE isn't available?” and somebody replies: “Well, then you don't go in, full stop. No questions. If you go in and get infected then every single patient you see after that is at risk of getting infected as well. This is a pandemic, which means it's a numbers game. If you go in and save one life but get infected and spread the disease to a dozen other people than you've actively made the situation worse. If you go in, get infected and you notice it before you infect anyone else, you've still made the situation worse because now your hospital is down a trained doctor or nurse, and that means the already overworked staff are going to be even more overworked. No PPE, no entries, no exceptions.”

And it goes on the the point that that I guess I wanted to share today on the podcast is just this is in such a contrast with what is being expected and actually done in hospitals today. And of course, the justification is what we don't have enough. It isn't available. So what can we do? What is the best we can do?

But for some reason, there does seem to be, at least at this point – at the time of this recording – some disconnect between the idea of what we should be doing. It seems to be falling on the side of we should be doing things with lenient guidelines and makeshift supplies like home made bandanas rather than by saying, Well, if we don't have the proper PPE than instead of making the situation worse, as has just been described, you know, we're essentially going to just be limited by the amount of PPE that we have. And we will do our best.

And of course, that would do a few things. That one thing is it would stop this magnification of making the problem worse. It would prevent physicians and nurses from becoming utilizers of healthcare right rather than deliverers of lifesaving services. And it would also the be much more motivating to government, industry and anybody else who is in a position to provide this equipment.

I realize there is a shortage. I'm not suggesting it's all, you know, conspiracy theory in a box somewhere where we could just get hands on it easily. But what I am suggesting is that by sort of enabling this ‘get by' mentality and continuing to do a fair amount of non-urgent work and a lot of work without proper PPE that we're making the situation worse.

I've actually already seen legal websites where, where attorneys are offering to sue on behalf of anyone who thinks that they've been exposed because somebody didn't have the proper PPE. Now that is a really stark contrast to what we are seeing – physicians and nurses and other clinicians as well putting themselves in the line of fire but also being asked to really behave in a way that they feel is very altruistic, that they feel is their calling. They feel like they've got to go in and save that patient. And if you're the patient, you want them to come in and save you. But it flies in the face of the way that this all works in terms of an infectious disease process, and lands sort of squarely on that clinician in the most unjust way that I can possibly imagine.

So my friends and colleagues and my fellow citizens, if nothing else, I hope that you have a new appreciation for what it means when people are calling for personal protective equipment. They are not calling for it out of self interest. They're calling on it for the greater good, which includes your well being, your good, the good of your loved ones and the overall containment and treatment of this pandemic.

These are people who are brave and selfless and are asked to do something that is not in everybody's best interest. It simply isn't. And for those of you who have been struggling with these questions of whether to go to work and whether to engage in activities where you know you're inadequately protected, you know you're presenting a danger to others. You know you're doing the socially irresponsible thing by just showing up for your job. But you feel under tremendous pressure and fear to do so.

I just want you to know that you are not alone. The number of stories that you can probably find on the Internet and everywhere – but the number of stories that I personally have received on this are just mind blowing. So just know that you are not alone and you matter. Your patients matter and you matter. Your family matters and you matter. Other people matter, and you matter, too.

Thanks for joining me on this episode of The Career Rx Podcast!

Please be sure to subscribe and leave me a review on Apple Podcast, Google Podcast or whatever podcast player you’re using to listen today. Also, be sure to send me your questions so that I can answer them and give you a shout out on a future episode.

Bye for now,


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