Coronavirus/PPE discussion thread

[ProteinTreasure]

The situation with the lack of personal protective equipment is extremely concerning and worrying.

How do you all deal with it?

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[smq123]

The situation with the lack of personal protective equipment is extremely concerning and worrying.

How do you all deal with it?

Which shortages have you, personally, experienced? Masks, gloves, or face shields?

 

[ProteinTreasure]

Which shortages have you, personally, experienced? Masks, gloves, or face shields?

Thank you for your reply. I don't personally work in the U.S. I am referring to news reports about shortages of masks and other protective equipment in NYC and other cities.

 

[Eyeseeyou1091]

Which shortages have you, personally, experienced? Masks, gloves, or face shields?

For me (medicine intern, major US city but not in NYC) we've experienced a restriction of access to surgical masks and N95s. Specifically, N95s need to be signed out from a specific location then returned after each use (ie for a single patient, you can't keep it for the day). Additionally, the hospital has issued a call for donations from the community. For now, N95s are being saved to be reused until they are deemed too dirty, thought it is unclear what that means. Certainly though there must be some shortage if masks are being re-used.

The biggest problem with this is when it comes to rapids/code blues while on nightfloat. We're still expected to get masks from this one location and sign them out each time we need one. Its started to be the case that COVID positive/ COVID rule outs are getting rapids called but at night we don't know their status since they aren't our patients. Going to the desk to sign out a mask is impractical, particularly in the rare case that it is a real rapid/code blue and not a BS call. The consensus is that people are probably being exposed. Many residents, including myself have purchased N95s for themselves just to have them on hand should a situation arise.

For what its worth, our class has been sharing this site which seems to be actively searching for supplies of in stock equipment for HCWs who need them.

 

[ProteinTreasure]

For me (medicine intern, major US city but not in NYC) we've experienced a restriction of access to surgical masks and N95s. Specifically, N95s need to be signed out from a specific location then returned after each use (ie for a single patient, you can't keep it for the day). Additionally, the hospital has issued a call for donations from the community. For now, N95s are being saved to be reused until they are deemed too dirty, thought it is unclear what that means. Certainly though there must be some shortage if masks are being re-used.

The biggest problem with this is when it comes to rapids/code blues while on nightfloat. We're still expected to get masks from this one location and sign them out each time we need one. Its started to be the case that COVID positive/ COVID rule outs are getting rapids called but at night we don't know their status since they aren't our patients. Going to the desk to sign out a mask is impractical, particularly in the rare case that it is a real rapid/code blue and not a BS call. The consensus is that people are probably being exposed. Many residents, including myself have purchased N95s for themselves just to have them on hand should a situation arise.

For what its worth, our class has been sharing this site which seems to be actively searching for supplies of in stock equipment for HCWs who need them.

Thank you for your reply. Wishing you all the best!

 

[doyouhaveaflag]

We are getting multiple emails per day from hospital administration that we both have plenty of PPE and are not at risk and that our hospital is requesting community donations of PPE.

All our N95 masks that were laying out were taken by random employees, presumably for "home use", at the beginning of the arrival of the virus in our area. We now have to re-use them. The disposable yellow masks have to be specifically requested from the front desk people on the appropriate floors. However, in the OR area we have our normal access to our disposable paper masks of choice.

We did have one incident in which several OR staff were infected after an intubation in which N95 masks were not used. Unclear if they were unavailable or it wasn't a known exposure. All our intubations are now done with just anesthesia staff in the room wearing N95 masks. However, another person posted elsewhere that the virus remains airborne after intubations for a while, so those of us entering the room afterwards with regular masks may be under-protected.

The ED staff appears to have appropriate protection that they are reusing (goggles, masks, gowns). However, I know a gen surg resident who says he was denied appropriate PPE in the ED while seeing a consult due to a shortage. So, it's not clear what the situation really is.

 

[ProteinTreasure]

We are getting multiple emails per day from hospital administration that we both have plenty of PPE and are not at risk and that our hospital is requesting community donations of PPE.

All our N95 masks that were laying out were taken by random employees, presumably for "home use", at the beginning of the arrival of the virus in our area. We now have to re-use them. The disposable yellow masks have to be specifically requested from the front desk people on the appropriate floors. However, in the OR area we have our normal access to our disposable paper masks of choice.

We did have one incident in which several OR staff were infected after an intubation in which N95 masks were not used. Unclear if they were unavailable or it wasn't a known exposure. All our intubations are now done with just anesthesia staff in the room wearing N95 masks. However, another person posted elsewhere that the virus remains airborne after intubations for a while, so those of us entering the room afterwards with regular masks may be under-protected.

The ED staff appears to have appropriate protection that they are reusing (goggles, masks, gowns). However, I know a gen surg resident who says he was denied appropriate PPE in the ED while seeing a consult due to a shortage. So, it's not clear what the situation really is.

Thank you for your reply. Wishing you all the best!

 

[wholeheartedly]

Well, I know from our rural critical access facility trying to get supplies in everything is on backorder from gowns, to gloves, to N95s, surgical masks, face shields, and hand sanitizer so we did order from the state cache (mostly denied except gowns and gloves) and we are soliciting PPE donations from the community and oil companies. We are ok for now (especially since we restricted stuff to stop people from stealing it), but just ok. And it goes fast with the COVID-19 pts.

 

[Money-Moniker]

Has anyone been forbidden from using their own N95s despite not being provided with adequate PPE by the hospital? I am hearing that this is a fairly common occurrence and it infuriates me to no end. I start residency in July and have been thinking of having my friend in China ship me a supply of N95 equivalents but I don't want to spend the money if I will then be told I can't use them since they're not "hospital approved" and will just have to go in with "hospital approved" naked head instead.

 

[Saddleshoes]

Has anyone been forbidden from using their own N95s despite not being provided with adequate PPE by the hospital? I am hearing that this is a fairly common occurrence

This was one of the first directives put out by our administration.
I don't understand the details and did not question the details.
My department orders our own PPE and it is different from the standard issue by the rest of the hospital. We just told our staff and residents not to wear our PPE outside of our area.

 

[KnuxNole]

Are there residents that are taking care of COVID+ patients? I know there are programs that are avoiding exposure and residents who all refuse to go near COVID+/PUI unless they get hazard pay.

 

[LucidSplash]

Are there residents that are taking care of COVID+ patients? I know there are programs that are avoiding exposure and residents who all refuse to go near COVID+/PUI unless they get hazard pay.

Where do you know this from? Personal knowledge or just “through the grapevine?”

Look at what is happening in major hotspots like NYC. Everyone is caring for COVID patients.

 

[hallowmann]

Are there residents that are taking care of COVID+ patients? I know there are programs that are avoiding exposure and residents who all refuse to go near COVID+/PUI unless they get hazard pay.

Residents are absolutely taking care of Covid patients. They haven't needed all of them to here yet, but we're definitely taking care of PUIs while waiting for testing to come back. Fortunately that's only been taking a couple of hours.

 

[Throwawaydoc]

Are there residents that are taking care of COVID+ patients? I know there are programs that are avoiding exposure and residents who all refuse to go near COVID+/PUI unless they get hazard pay.

What programs are doing that? I think that is very smart of them regarding hazard pay

 

[Mass Effect]

What programs are doing that? I think that is very smart of them regarding hazard pay

Yeah, I'd love to know the program that has residents ballsy enough to refuse to care or COVID patients without PPE. I think they're doing the right thing and should be praised.

 

[Throwawaydoc]

Yeah, I'd love to know the program that has residents ballsy enough to refuse to care or COVID patients without PPE. I think they're doing the right thing and should be praised.

Agreed. Medicine has lacked balls for a long time. Finally showing some. Definitely want to hear where this was. Gotta do it as a collective group.

 

[E=mc^2]

I've decided that I will not be attending my residency starting in June if I am not provided proper PPE. I hope others follow but if not I'm doing it alone.

Health cant be bought for any price.

 

[ThoracicGuy]

I've decided that I will not be attending my residency starting in June if I am not provided proper PPE. I hope others follow but if not I'm doing it alone.

Health cant be bought for any price.

If you decide not to show up to your residency, you will be found in violation of NRMP rules and banned from NRMP programs for up to 5 years.

Good luck finding another residency.

 

[operaman]

We’ve actually managed to do rather well on the PPE front.

We’ve been pretty resourceful as a residency and department and have built up our own stock of N95s and higher and also developed multiple ways to resterilize them. Every resident in my department has at least 2 respirators plus a face shield in their bag at all times.

We also made it clear to leadership that we would not be doing any procedure or entering any room without adequate PPE. To me it’s just as essential as a cutting instrument is for a surgery - without it the procedure just can’t happen. Thankfully our leadership has been on board with this too. They’ve even helped us out together go bags of PPE to use in emergent procedures. So at least in this one case admin seems to have done well.

We’ve got restrictions on PPE in general. We have centralized distribution for masks and the OR resterilizes our N95s for us if they aren’t visibly soiled.

We are definitely allowed to BYO - the joint commission has even said this was ok ( and those *****s won’t even let me drink a Diet Coke at the nurses station!) so it will probably become more common. I see the point of restricting it because they presumably aren’t verified as genuine and haven’t been fit tested. We got our hospital to formally fit test us in our stuff so we know it works.

I’m a big proponent of refusing to do anything that’s unsafe such as performing an emergent procedure on a potential covid patient without adequate PPE. That said, I think we also have a personal responsibility to do whatever we can to find equipment and plan for emergencies so this doesn’t happen or at least happens rarely. I’ve made it clear that I will not put myself into a dangerous situation and have told all my junior residents to do the same, even if it means a bad outcome. Our GME and other leadership have firmly had our back on this.

I guess my hospital is handling this particular issues about as well as they can. We’re slowly making progress on other areas where I think we lag other hospitals, but PPE is an area we seem to be doing well.

I would caution some of the other posters who are thinking of making some big stand. No matter what you should show up and be willing to work. Save the battle for the last mile if the battle happens at all. You can round and write notes and do all sorts of work without entering a room, so even if they have no PPE at all you can still find ways to help and work safely while attendings use the little remaining PPE to enter the rooms. Part of why I think we’ve had a good response from our leadership is that we are actively looking for ways that we can work and help and do so safely; we aren’t just drawing a line in the sand and expecting the hospital to do all the work.

 

[E=mc^2]

If you decide not to show up to your residency, you will be found in violation of NRMP rules and banned from NRMP programs for up to 5 years.

Good luck finding another residency.

Thank you for the concern. I have been in touch with a legal team and will be exploring all avenues possible. I am well aware of the coercive nature of residency and how many residents feel they have little to no power in a system that many feel is abusive towards them.

Thankfully this culture is changing in medicine and has dramatically shifted even in the past few years especially at the medical school level.

I too see the concern about future potential earning losses if I am not able to properly do my job because the hospital system is unable to protect me or my patients. This is certainly their duty to do so, and I will use the full powers of legal services, the media, and every single possible avenue to make sure I have protection. Not having this protection would endanger my patients and it is a violation of the oath i swore when I entered the medical field.

 

[DocWinter]

Thank you for the concern. I have been in touch with a legal team and will be exploring all avenues possible. I am well aware of the coercive nature of residency and how many residents feel they have little to no power in a system that many feel is abusive towards them.

Thankfully this culture is changing in medicine and has dramatically shifted even in the past few years especially at the medical school level.

I too see the concern about future potential earning losses if I am not able to properly do my job because the hospital system is unable to protect me or my patients. This is certainly their duty to do so, and I will use the full powers of legal services, the media, and every single possible avenue to make sure I have protection. Not having this protection would endanger my patients and it is a violation of the oath i swore when I entered the medical field.

Didn't you say you were yet to start residency?

Consider starting out with a more open minded approach to your program and PD. Don't go running in guns blazing and your mind made up it's you and your lawyer and the skewed force of the media against what you are unfairly labeling as your merciless, abusive program.

 

[operaman]

Thank you for the concern. I have been in touch with a legal team and will be exploring all avenues possible. I am well aware of the coercive nature of residency and how many residents feel they have little to no power in a system that many feel is abusive towards them.

Thankfully this culture is changing in medicine and has dramatically shifted even in the past few years especially at the medical school level.

I too see the concern about future potential earning losses if I am not able to properly do my job because the hospital system is unable to protect me or my patients. This is certainly their duty to do so, and I will use the full powers of legal services, the media, and every single possible avenue to make sure I have protection. Not having this protection would endanger my patients and it is a violation of the oath i swore when I entered the medical field.

I hope you're exaggerating in this post! There's an art to everything and going in with lawyers and threats and guns blazing is an approach that will not get you far. As for media, the news cycle is already turning on this issue and by July 1 nobody will give a flip about your PPE or lack thereof; you'd be lucky to get it in some crappy online "news" outlet by then much less a publication anyone reads. On the flip side lets say you and your lawyers make a big scene, the hospital can simply claim force majeure and dissolve your match contract entirely. So even if you "win," you will lose and be reapplying for the Match or scrambling to some open position if one even exists.

I would advocate a more tactful approach and assume the goodwill of the hospital and the program. Look for ways to work with them to make things safe while respecting the fact that the hospital is also facing incredible challenges. Asking for some kind of guarantee of PPE is simply not realistic and you will never get this from them; however, asking your GME office to craft policy that ensures you as a trainee will not be compelled to enter an unsafe situation without PPE is very reasonable and has already been done at many facilities, mine included. Some have gone further to say that trainees are forbidden from entering a room without proper PPE. Even if the hospital runs out of ALL PPE, there are still plenty of things you can do as an intern that don't require direct patient contact with infected patients.

There are times to take a stand, but you must be very selective and very careful with how and when you do this. Sometimes it means you have to be sneaky - there were some unsafe things happening in my own institution that I subtly addressed by using back channels and some obscure policy technicalities without having to make some grand statement. If your goal is to start training in July and do so safely, then there are many ways to accomplish this without lawyers and threats and by working with your institution. If your goal is to have your 15 minutes of twitter fame, then by all means have at it!

 

[ThoracicGuy]

Thank you for the concern. I have been in touch with a legal team and will be exploring all avenues possible. I am well aware of the coercive nature of residency and how many residents feel they have little to no power in a system that many feel is abusive towards them.

Thankfully this culture is changing in medicine and has dramatically shifted even in the past few years especially at the medical school level.

I too see the concern about future potential earning losses if I am not able to properly do my job because the hospital system is unable to protect me or my patients. This is certainly their duty to do so, and I will use the full powers of legal services, the media, and every single possible avenue to make sure I have protection. Not having this protection would endanger my patients and it is a violation of the oath i swore when I entered the medical field.

 

[Gastrapathy]

Can’t wait for the next thread in 18 mo or so

 

[DocWinter]

Can’t wait for the next thread in 18 mo or so

The standard “help, pgy2 about 2 B out of a job, my PD tryin a fire me pls helllllllp”?