The American Society of Anesthesiologists (ASA) held an online town hall on Thursday night to provide answers and updates on practice standards for treating patients with COVID-19.
Among the main topics of interest were the lack of availability of personal protective equipment (PPE), how providers should approach intubating patients suspected of having COVID-19, and whether elective surgeries should be canceled amid the pandemic.
Mary Dale Peterson, MD, the ASA president, gave opening remarks to highlight the urgency and gravity of the present situation.
“Our nation is in the middle of a historic public health crisis,” Dr. Peterson said, “and we are on the front lines.”
Dr. Peterson was joined by a panel of experts from the Anesthesia Patient Safety Foundation (APSF) and several ASA committee members to answer questions from over 6,000 participants.
One of the main concerns from members was how elective surgeries should be managed during the pandemic. The ASA and the panelists recommended that nonessential surgeries be postponed so resources, such as PPE and hospital staff, can be conserved for urgent cases, and that telemedicine should be practiced whenever possible.
The dwindling supply of PPE was also chief among members’ concerns and the recommendation was to conserve those resources for high-risk cases. The panelists suggested using N95 masks only with patients who are suspected of having COVID-19 and to use additional protective equipment, such as eye shields and surgical masks, to protect the providers and the N95 masks.
In addition, they suggested following CDC guidelines for reusing N95 masks to conserve the supply by adopting proper sanitizing and storing practices.
Another key point was the potential for adapting anesthesia machines for use as ventilators in the ICU. Several panelists stressed the need to make key alterations and to properly filter the machines, as it is possible to contaminate them when they are used in cases involving patients with COVID-19. After the case, they suggest cleaning and disinfecting high-touch surfaces on the machines with a hospital disinfectant approved by the Environmental Protection Agency.
The ASA does not recommend adapting these machines immediately, but it is considered an option of last resort for overwhelmed health care facilities. The ASA website provides further details on accomplishing optimal alterations and filtration for anesthesia machines.
The possibility of implementing dedicated intubation teams to focus exclusively on intubating patients also was discussed as a way to protect all hospital staff from repeated high-exposure procedures. Several panelists noted that it was a successful method used in China at the height of the crisis there. They also said this practice would be ideal for protecting any high-risk providers from those higher exposure procedures.
Dr. Peterson gave an update on how the ASA is working with the federal government to help prepare for the coming weeks. She said she presented growing concerns over the lack of availability of PPE during a teleconference with the White House coronavirus task force this week. She also said she promoted the potential for anesthesiologists to provide support by reconfiguring existing anesthesia machines into ventilators to aid treatment of patients with COVID-19.
For up-to-date information about treating patients with COVID-19. go to asahq.org/covid19info.
—Michael DePeau-Wilson
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TRAINED PERSONNEL STAT NEED! : CORONAVIRUS EMERGENCY VENTILATOR TRAINING OF NURSES TO MANAGE VENTILATORS IN THE ICU
There are 350,000,000 million Americans and if only 10% of the population get the coronavirus (COVID-19) that equals 3,500,000 people. If only 2% of that 3.5 million infected require mechanical ventilation that means we need 70,000 ventilators. We need TRAINED PERSONNEL TO MANAGE THESE VENTILATORS!
One critical care registered nurse (RN) can manage 2 ventilators during one 12 hour shift. The shifts are 7am-7pm and 7pm-7am. Therefore that’s 2 VENTILATOR-TRAINED NURSES that can manage only 2 ventilator-dependent patients for a 24 hour shift. Usual shifts are 3 a week, during a crisis we may be able to up that to 4 shifts a week.
We currently have around 3 million nurses. We have around 500,000 critical care RNs. We will need hundreds of thousands of critical care RNs to care for the minimum projection of 70,000 intubated, ventilated patients. That’s assuming none of the precious critical care RNs get infected themselves with the coronavirus and end up in quarantine.
We have a limited window of time and opportunity to rapidly train preferably nursing personnel and even other healthcare professions on ventilator usage. We need to mobilize our current nursing staff in logical departments like telemetry, emergency room, operating rooms, medical surgical and start training them NOW on VENTILATOR MANAGEMENT BEFORE IT BECOMES A CRISIS!
There are already programs, powerpoints, videos out there on training nurses how to use ventilators. We must organize our 3 million nurses NOW and train them NOW on ventilator management. I am urging all decision-makers to form a mobile NURSE VENTILATOR TRAINING COURSE NOW (videos, text messaging, emails) so we can be PROACTIVE in this future need.