Question

Henry works for a large metropolitan health service as a (HCP) physiotherapist and specialises in respiratory physical therapies for Intensive care patients post intubation. Over the last month Henry has explored his options of continuing to work due to the prevailing risks associated with COVID 19. Henry has sought counsel from his friends in relation to the issues of him working whilst he is also a parent with his wife Catherine and 2 children Josie 5 and Declan who is 11. Henry has a few thoughts and options to explore, and these include taking his long service leave for the next 8 weeks. Taking leave without pay for a period of six months. Henrys central concern is around protecting his children and wife from being infected with COVID 19 as the risks of workplace exposure are very real. Henry finds himself in conflict with his duty of care and worries about his family should he continue to work. He discusses his quandary with his line manager, who suggests that should he contract this illness he will be supported by the health facility and that he should secure accommodation away from his family whilst he works. Over the past week Henry has become even more distressed with having to work with the ICU team to decide how they ration the beds available to them and how they prioritise who receives care in their unit of 10 beds.

Answer 1

He y can continue to work with team in intensive care unit. He was worried about pandemic virus which affects his family if he continues to live with his family. His aim to protect his family from corona virus pandemic. As per his manager suggestion, he can select separate accommodation to avoid transmission of virus to his family. He even stressed about prioritize the patient in intensive care unit which consists of 10 beds only. The following guidelines that help him to prioritize the patient

                   In the case of pandemic periods, the intensive care unit available beds are 10. Therefore the patient will be prioritized on the basis of the criteria, the patient who meets criteria are allocated into intensive care beds. Criteria used as a scale from 1 to 8. The minimum score is used for patients who get benefit from intensive care unit. Patient is prioritized based on severity of illness and associated with co morbidity of illness such as diabetes mellitus, heart disease, and lung disease. The care from health service people are increased priority and minus scores from the created priority score

There should be withdrawal of ventilator if the patient is unable to survive in the use of ventilator. Therefore the patient is likely to improve with use of ventilator, are benefited by withdrawal of the patient who is least survival from the use of ventilator. This can be done by the after consulting with family. The process of withdrawal can be done by the following steps

  Step 1. Therapeutic use of mechanical ventilator should be time limited step 2 patients should not be withdrawn from the ventilator immediately when the patient is treated for more than days and survived step 3; decision of mechanical ventilator withdrawal and allocating   is based on team which includes doctors mainly senior physician, nurses, physiotherapist, social worker. This helps to resolve conflicts of commitments and reduce distress to single member step 4: it is the step of providing care to patient who withdrawn from the mechanical ventilator

Prioritize the patient on the basis criteria that includes inclusion criteria and exclusion criteria

Inclusion criteria include arterial blood gas analysis hypoxemia and refractory respiratory failure and the patient who needs the support of vasopressors with associated in a case of arrest

Exclusion criteria; the patient who refuses the treatment in Intensive care,2. The patient who writes the advances directives in case of emergency3. In case of associated co morbid condition such as hemorrhagic stroke 4. Patient associated cancer with poor prognosis

Priority score 1: if the scores the 0-1 and consists of I, and one organ failure and predicted survival is more than 80%

score 2: if the score 2 and/or consists of II mild disease and/ or 2-3 failure and /or predicted survival of the patient is 50%

score 3; if the performance score 3-4 and/ or III and /or more than 4 failure and /or predicted survival less than 50%

score 4; if cardiac arrest and end stage failure, dementia or score IV or V OR predicted survival of patient is less than 20%

After the prioritize the patient, the bed are allocated to patient and based on the cardio and respiratory symptoms of the patient and ventilator used by the patient , the physiotherapist can give care to patient. even if he continues to have stress, it is better to have some breathing techniques and some rest after discussing with manager. becasue there is availability of respiratory therapist in intensive care unit to be considered. if he takes leave, it would affect patient who receives care. it is better to have relaxation therapy such as yoga and meditationn for 20 minutes to refresh his mind and other diversional therapy such as music in rest time