UKH

From the New York Times; I am not sure if you need to create a login to view articles, I am sorry if this is the case. Even if so, it's worth it - this is sobering and might help some people to focus more on what this pandemic is doing, and less on "lockdown workarounds so they can enjoy a meadow in the sunshine"
It's not graphic but it is stark.

https://nyti.ms/3dzOuqf?referringSource=articleShare&fbclid=IwAR3xH4rtp...

To everyone who is arguing the nuances of why their situation is different, why their need to go on that bike ride / hike / run is so important, or is splitting hairs about what constitutes reasonable exercise, I recommend reading this and projecting to the UK in 2 weeks time. 

Thank you, you put it a bit better than I did. 

In fact I will repost the link, with your words, on certain threads. 

I couldn't finish looking at that, broke down in tears, - not so much for the poor victims, but the photos of the medical staff in action.

More like, why they need to buy something on eBay or Amazon.

Whilst sorry for your distress, I think that is the desired effect. It is a strong piece of journalism. Pure facts conveying more emotion than anything with an opinion commentary. 

That's a difficult read and a horrifying glimpse into our near future.

Thanks, jk

As you say, a stark read. Thanks for posting.

It’s one of the strangest OPs to have got likes and positive responses! But I get it and I appreciate the feedback. I think this needs spreading around all your social media etc. I’m doing it on my Facebook and WhatsApp. It’s not new or unique information but the presentation is spot on at least for me and those in whatever bubble I occupy 

What terrifies me from this article are the images. There is a huge difference in the level of PPE employed by ambulance crews in Italy and what we are attending in here in the UK. While our Italian counterparts are universally clad in gloves, Tyvek suits, eye protection and FFP3 respirators, Uk crews have to attend wearing gloves, thin plastic aprons, no eye pro and simple surgical masks. I can't help feeling that we could well be about to see a disaster engulf the NHS unless kit is sourced and protocols changed. Here's a fuller explanation from a thread in The Pub:

The only reason they’ve taken the FFP3s off us is because they’re running out. You can reuse an FFP3, just don’t touch it with dirty gloves, avoid any contact with the inner and store it in a paper bag (not plastic).
FFP3s (designated N95 in the US) are classed as a respirator, they’re designed to protect the wearer from airborne particulates. Surgical masks aren’t respirators, their main purpose is to stop the wearer breathing crap over the patient, which is why the inner is designed to absorb moisture (the clues in the name, they’re meant to help infection control of open wounds in surgery) they will protect the wearer from gross contaminants, large droplets and splashes...but that’s it. Best study I can find indicated that surgical masks provide 6 fold protection against airborne particulates against 100 fold with FFP3. 

New guidance is that we only use FFP3s in aerosol generating procedures, but apparently a patient on a neb isn't aerosol generating and sitting in the back of an ambulance with a violently coughing suspected covid patient doesn't require FFP3 either. WHO and OSHA state we shouldn't be within 6 feet of such patients wearing just surgical masks. I'm worried, not just for myself, colleagues and my family. I'm worried frontline NHS are about to become a significant infection vector simply because we've not got the right PPE.

Rishi Sunak stood in Downing Street last night smiling and clapping the NHS and he said "whatever you need, that's what you're going to get", we aren't getting what we need, not by a long stretch.

Sorry to see your earlier optimism about our preparedness and trajectory has gone. Stay safe out there and thank you, I really hope you get the kit you need to keep getting us the help we will.

jk

Thanks firstly for what you are doing for society; I’ve seen your posts but haven’t thanked you directly 

Thanks also for pasting that text into this thread, I had read it but the more you disseminate it, the more thoughtful people will become (I hope) 

Do everything you can to keep yourself and colleagues safe. Without you we have nothing . 

You misunderstood, along with many others on the thread. There was no optimism on my part. Back in January I was talking about how cutbacks had led to a dangerous deficit in the NHS's ability to cope with any significant increase in patient numbers (hospital in 5 days thread). My point, repeated several times, was that we shouldn't be contributing to the fear which has seen supermarket shelves emptied and NHS PPE stocks decimated by an anxious public.

In an epidemic PPE isn't there just to protect the wearer, it's there to protect our whole community. The point has been made in several articles, including this one, that the Italians saw a pattern where health workers, unknowingly, became infected and then disseminated the virus to the most vulnerable in society, the elderly and infirm, with whom clinical staff have close contact as a normal part of their duties.

In terms of PPE, the NHS is woefully ill equipped to deal with corona. Pay attention to how clinicians around the world are kitted out. We are attending suspected covid cases in an apron and an almost completely ineffective surgical mask. We're beyond trying to maintain a sense of calm now. We're on the brink of seeing a national disaster unfold for want of an extra couple of quid spent on disposable respirators and paper overalls.

Where in your view is the holdup to fixing this?  The big logistics machine seems slowly to be rumbling to life.  I hope you and your colleagues get all the kit needed to protect all of us soon.  My department donated much of its PPE kit to the NHS but given how this was getting thrashed out 2 months ago on UKC it’s so very disappointing to hear it’s not already sorted on the ground.

It's a terrible conjunction of panicked neurotics exaggerating symptoms to get an ambulance response to come and check them out (wasting a full set of PPE each and every time) and ridiculous bureaucracy and fragmentation in NHS supply lines. In the area that I work different hospitals, GP surgeries, walk in centres even different sectors of the same service, all have different procurement systems. My own ambulance service cannot keep up with demand and hasn't a hope in hell of providing front line staff with FFP3's, yet I know for a fact that major PPE manufacturers haven't even been approached let alone had orders placed.

It's a complete scandal and no one is addressing it.

Edit: I'm far too low on the totem pole to know for sure but I'm starting to think that this entire clusterfuck might have started like this...

Clinical oversight- "Damn, we haven't got the FFP3's that our guidelines say we need to protect our staff from a highly infectious virus like Covid 19. What are we going to do?"

"Look, we can't panic the troops or the general public. We'll downgrade the PPE requirements now so we can muddle through until we have the kit in place"

Procurement- "Oh look, they've changed the guidelines. Don't bother ordering all those FFP3's, we don't need them"

...I just can't think what else could be going on

If you can suggest anyone I and  other readers can usefully lobby without making things worse - the appropriate level in the management beast - let me know.  As an outsider and given that the critical things appear to be made from common materials in high volumes, it’s hard to see this as a problem with technical ability which does suggest an organisation failing to get its shit together.

Hope you don’t mind me editing your post for emphasis. Thank you again for your clarifying post 

I don't think things can be made worse now, the tsunami is almost upon us and I doubt the comparative squeak this small part of the internet could generate would make a blind bit of difference.  Lemming and me are both very worried about this, up until 14 days ago, all UK hospitals and ambulance services had one set of PPE protocols...then they were suddenly downgraded, yet our TV screens and newspapers are filled with reports from around the world showing everyone else dressed as per our original protocols. 

It's not just our service that's been downgraded either, 3 out of 4 hospitals I've attended in the last week were all in the same boat, only Wythenshawe seemed to be following original guidelines. I must have spoken to 20 plus paramedics and doctors about this in the last week and only one consultant appeared unfazed.

Edit: Write to your MP, write to Rishi, write to Piers bloody Morgan... I think it's quite probably too late now in any case

I’ll do what I can tomorrow.  It may just be pissing in to the wind. It’ll be one of the exceptionally rare times I lean on having “Professor” in my title. (I’ll miss out the details - youtube.com/watch?v=NNihymK_XJA& )

As I said in a previous thread; we may have strong differences in opinion sometimes but I’ve long known you’re the better person; there’s no way I could do what you’re doing.

Hi,

This is appalling. In an attempt to highlight this I have contacted the Guardian via their online information sharing route. Maybe good if other people could do this as well. Stay safe, Simon

I can add that in primary care we also just have the basic surgical mask, plastic apron and visor which is to be used when assessing suspected covid patients.

There is no PPE for other situations, despite the fact the London hospitals are now seeing multiple patients attending with other complaints (such as urinary infections) who are subsequently found to also have covid.

In both SARS, and MERS, healthcare was a major vector for transmission and I really hope that when the dust settles, we're not asking "How could we let this happen?".

I'd really appreciate it personally, quite apart from it being a civic minded thing to do.

That's just bollocks

Edit: I'll PM you some additional stuff I can't put on here.

My wife's team (community physios, visiting mostly elderly people in their homes; currently trying desperately to stop beds being taken up, and some preparing to redeploy as respiratory physio) has a similar situation - plastic aprons and gloves, no masks (they're supposed to be coming, but they don't know when, and it won't be the good ones), no eye protection. Not as critical as for your lot, but inevitable that many will catch it in patients houses.

There's a feeling they're simply considered expendable, and they know they'll be spreading it to highly vulnerable patients, too.

Go-to the "They work for you website" and demand this is sorted via your local MP. As a forum surely we can cover most MP's around the country with multiple requests. Do it now. It only takes 5 mins. Simon

I wouldn't lean on it too hard - means piss all to most folks (quite rightly)

Read  one of my other recent posts and you’ll see I agree with you. There are limited circumstances where it makes a difference.  

Get yourself and your teams oil rig survival suits or divers drysuits and a place where they can be washed down*. If you're going to be spending all your days taxiing covid 19 patients you might as well not burn through disposable PPE.

*Our fire station has been designated 'ambulance decontamination central' as they've got a yard with proper drainage.

Try doing 40 minutes of CPR in a dry suit. Guaranteed to kill you far faster than covid 19

Very pertinent article out in The Lancet today regarding PPE

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30727-3/...

Very sobering thread, this.