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A Physician Associate in a Pandemic

After a 10-month hiatus from my blog after buying and renovating a house… I’m back! And what a time to be working in healthcare. I’m sure you’re all well aware of the havoc Covid-19 is having on the world but read on to find out how it’s changed day-to-day work and how you can get involved too.

At the beginning of March, we started to hear about Corona virus at work but I didn’t know much about it personally. Back then, it seemed like a big deal was being made out of something small. I had a holiday booked for the end of March and was blissfully counting down the days. Then we started receiving information about staying at home if you had symptoms of cough or fever. It wasn’t clear how long you needed off and it seemed like advice was changing every day.

By mid-March I had fallen ill with a temp and body aches. Even then I was convinced I didn’t have it and testing for staff didn’t exist yet. I lost my sense of smell and taste by day 5 but still I wasn’t convinced. I felt guilty not being at work despite the fact it took me about 10 days to feel back to normal. Even now I have no way of knowing if I really had it or not.

When I got back to work, things had changed quite a bit. People outside of surgical specialities had started wearing scrubs instead of work clothes (could get used to that), rotas were changing and the news that trainees would not be rotating was made official. As the rota master for the Cardiology juniors, this meant changing my beautifully crafted excel spreadsheet – which includes trainees, clinical fellows, 3 PAs and 1 ANP.

Soon the team was shrinking as the trainees were the first to be taken onto the medical rota covering Covid wards. Now the clinical fellows have been taken too leaving 1 junior doctor, the PAs and ANP covering Cardiology patients. Obviously we still have our Consultants and Registrars but it’s still a big change for us. I’ve not had to look after many Covid patients as our acute coronary care is being kept as a non-Covid area, although we’ve had patients that have tested positive and then been moved to a Covid ward. Exposure seems to depend on your specialty, I know the Respiratory PAs at my hospital are working on Covid wards as are other PAs.

In terms of work load, many people are afraid to come to hospital, so they are dealing with symptoms at home and not seeking medical attention which is worrying. For example, in Cardiology we have seen a rise in late presentation MIs. On the other hand it is also keeping unnecessary admissions at bay. This also means we don’t have as many patients as normal and 2 of our cardio wards have been turned into Covid wards. In terms of PPE, I have always managed to get what I need in the areas I’ve worked in which is reassuring.

Speaking to the people working on Covid wards I've learnt the importance of knowing/deciding a patient's ceiling of care. That is, understanding a patient's wishes as well as the limitations of their treatment by assessing their ability to recover from illness. Someone for full escalation will be taken to intensive care if needed. However if a patient is for ward-based care, they will remain being treated on the ward as being taken to intensive care is unlikely to be beneficial. Communication with the patient and family is key to ensure everyone is of the same understanding.

Another obstacle in this is that most Hospitals are on lock-down and not allowing visitors so alot of difficult conversations are having to happen over the phone. Phoning a relative to explain that their loved one has tested positive for Covid when they're already in hospital for something else serious made me squirm on the other end of the line. The silences seem even longer when you can't see the person you're talking to.

A separate learning point is knowing when to escalate a patient. There a several reasons for a patient needing intensive care, such as ventilatory support, septic shock, post surgery etc. In patients with Covid-19, many are requiring escalation for ventilatory support. This is because the virus can lead to severe inflammation of the lungs and subsequent fluid build up around the alveoli causing Acute respiratory distress syndrome (ARDS). Close monitoring of saturations helps to identify patients whose oxygen demands are not being met despite oxygen therapy. That's your cue to get help.

Shoutout

I've worked as a Healthcare Assistant in the past so I’ve always had huge respect for nurses but this Pandemic has reminded me again of just how amazing and self-less they are. Usually once the ward round is over, there is less need for interaction with patients unless they are acutely unwell and particularly at this time where minimising contact is important. But for nurses and healthcare assistants it’s business as usual. Observations still need doing, medications still need giving, IVs still need putting up, food still needs to be served. They are the true front line.

What you can do to help

Graduate PAs awaiting National Exams

If you’ve sat and passed your University PA exam but awaiting your Nationals, you can join the FPA COVID-19 special temporary register. This will allow you to be considered for a role as an Assistant Practitioner (AP) - Band 5 AfC.

More information on this link, click the ‘Special Register’ tab

https://www.fparcp.co.uk/covid-19?fbclid=IwAR3s0DyF7hn4k33CPEQO7RscRF7HgjJyVQOg-fD8y4LLvzX5QtvXMKxh4Y4

2nd year Student PAs

Similarly to above, the FPA has made provisions for 2nd year PA students to practise as Physician Associate Support Student (PASS) - Band 4 AfC. More information on the same link above.

Student PAs in the NW

If you are a student at North West University, you can volunteer to work in the NHS as part of the Covid response. For further information and signing up use this link https://www.onemedforms.manchester.ac.uk/s/f/zoKqPNwkjRfW89MVy7EDS44wZ0Aq?fbclid=IwAR2_543cGlv6l8UU-8Gf6fjPgqGfKRZf8301_zM0VEQcfkOW-SYn0rM_3ic

Whether you’re working in primary care, secondary care, volunteering or studying, stay happy, healthy and safe! Everyone’s efforts are really showing and hopefully this will be over soon.

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