Concerns over staffing as Mater Hospital reveal intensive care unit full
The Director of Critical Care Medicine at the Mater Hospital in Dublin has warned that the biggest challenge in the treatment of Covid-19 patients will be staffing problems.
Dr Cormac O’Loughlin told RTÉ radio’s Morning Ireland that while the hospital has plans to move patients into other wards with ventilators, the biggest challenge will be the staffing problem.
He said: “To run an intensive care bed requires a huge amount of medical staff, in particular nursing staff. We have a standard of care which is one-to-one nursing so every patient has a dedicated nurse 24 hours a day to run our normal standards of care for intensive care in Ireland.
“That would be threatened, that could be diluted if we stretch beyond the numbers we're comfortable with, so that's a bit of an unknown yet, but we have plans - all we can do is our best.”
Dr O’Loughlin, who is president of the Intensive Care Society of Ireland, said that the intensive care unit at the Mater hospital is full and some patients, who have been ventilated, have been moved to the high dependency unit for care.
He said: “There are 18 beds in our standard ICU, we have been running 17-18 beds for the last few years, between the mix we are full, we have also had to move some of our sicker patients out of ICU and into the high dependency for ventilation.
"That happened just before the weekend, we're lucky that we had a lead-in time to allow us shut down the normal activity of the hospital and free up a lot of space capacity, which has allowed us to build plans for surge activity.”
Dr O'Loughlin added that he is already beginning to get referrals from the wards this morning, where some patients are beginning to deteriorate.
He went on to describe Covid-19 as “a unique disease” without a definitive treatment, but he pointed out that some patients have done very well in the ICU and have been discharged back to the ward.
Dr O'Loughlin said: “These patients are very sick, this is a devastating lung injury, the ones that require admission to intensive care - some are lucky enough that they have the physiological reserve, the strength to fight this off on their own immune system, without intervention from intensive care.
Unfortunately some are not so lucky and the process that undermines the pneumonia continues to worsen while they're in intensive care and it goes back to the original problem - there is no definitive treatment for this, there's no anti-viral agent that has been proven to work, there's no other agent that we can give them, as opposed to a bacterial pneumonia - we give them antibiotics and it helps.
“All we're doing is giving support, we're doing organ support, we're supporting lungs, kidneys etc. and we're giving the patient a chance to recover. We're trying to minimise complications - if they recover then that's fantastic and it makes everyone feel great about the interventions that we're using, but there's certainly the fact that some patients are not recovering and some have passed away in intensive care. It's very hard for us to do more than support them as best we can."
Dr O'Loughlin said the hospital will do everything it can for families in this very difficult time and offers the opportunity for family members to come in and wear personal protective equipment in order to say goodbye.
Many families had been reluctant to do this and he said that staff will do all they can to be with a patient when they die.
He added: “It's extraordinarily difficult we've never seen anything like this before - we have a very well established end of life pathway in the hospital in intensive care and a lot of that has gone out the window because of this disease.
“As best we will do everything we can to help them to be with them in this very difficult time. There's huge challenge around us, there's a lot of fear in the community, there’s a lot of fear in the intensive care community, among medical staff, about this disease.
"We're seeing a lot of our own staff getting sick, that's been reflected throughout the world, it's extraordinarily difficult, our job is to look after patients and by extension their families and we will do everything we can to help them in this time.”
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