19 July 2009

Over the top?

One of the neighbours children is a medical student. Two or three years ago his parents asked Dr Grumble to see him as he was going to Cambridge for an interview. Dr Grumble gave him a mock interview and concluded that he had no chance whatever of getting into Cambridge. But he didn't say so. Except to Mrs Grumble. Of course he gave the hapless child some advice on interview technique and likely interview questions. And, to Dr G's amazement, he got in and is now studying as a clinical student at a hospital in Cambridge.

In the early days of the 'flu outbreak his parents spoke to Mrs Grumble. They were shocked to discover that their offspring had been in contact with a patient with swine 'flu and that, allegedly, the right protective equipment was not available. Mrs Grumble just shrugged. She knows how the NHS is. She knows that all the hype about thorough planning is more hype than anything else. There has been a vast amount of planning but its value to those at the coalface is doubtful. It's always like that.

But that was weeks ago. By now you would think that the top hospitals would have sorted out the right protective equipment for staff. But when Dr Grumble saw a case of suspected 'flu just yesterday his staff told him that the right equipment was not yet available. So he instructed them to record this in the records in the hope that Mrs Grumble might possibly get some compensation should Dr Grumble succumb. The slightly odd thing is that Dr Grumble cannot remember using any special protective equipment with 'ordinary' flu which also kills a few of Dr Grumble's patients each year. In fact Dr G has never ever seen the protective equipment he is supposed to use. It is apparently so sophisticated that you need special training to use it.

Already some of Dr Grumble's staff have gone off with suspected 'flu. One announced his illness on a ward round as he became unwell by which time Dr Grumble had been in contact with him for longer than he would have spent with any single patient. Another was already sick which left Dr Grumble without middle grade support. It's probably an age thing. Dr Grumble has lived through a few epidemics. He has had 'flu. More than once. Probably it has left him with some protection. Preliminary figures bear this out. The staff who have gone off are in an age group at higher risk of catching 'flu but their risk of dying from it is low. For Dr Grumble it is the other way round.

What's the message to this? The message is that we cannot ring fence ourselves from this infection and that the likelihood is that sooner or later those of us who do not have some sort of protection from previous exposure are going to catch this disease and that attempts to keep the lid on its spread are futile.

In China they have a different approach. Judging by the video, they are better equipped with protective equipment - though some of the masks the public use seem useless. It's their country. They can do what they like but Dr Grumble thinks they are wasting their time and money. They are never going to contain this disease that way. It is just not going to be possible. But common sense does not stop the madness of planners either in China or closer to home.

If you don't want to risk being confined to barracks, Dr Grumble would advise giving China a miss for the time being.


the a&e charge nurse said...

A&E staff have great fun with PPE (personal protective equipment).

We put the 'yellow suits' to simulate chemical or radiation incidents for decontamination training.
Hell, we even have a geiger-counter if we are feeling particularly paranoid.

All the gear has been approved by the boffins at Porton Down apparently, and is said to protect from 99% of deadly virus's or chemicals.

We had a slightly scaled down version of PPE during the SARS era (after an anaesthetist and nurses died in Canada).
To be honest, nobody had a clue how to assemble it

Apart from a bog-standard mask (and gloves) is there any other gear that we should be wearing if swine flu is suspected - anyway, how much planning goes into opening a box and putting a mask on?

Dr Grumble said...

Clearly a&e charge nurse has not had any training either.


GP Informed said...

Out here in GP land (i.e. the real world) the situation is no less comical. The PCT have promised protective equipment ( i.e. a face mask) for many weeks now but nothing has materialised. Would it help (probably not), would wearing it help spread the ongoing panic and over the top fear among patients - certainly. Try explaining to the vast majority of patients presenting with coryzal symptoms that they will get better without help from the wonderdrug cure-all that is tamiflu and they just wave the Daily Mail at you saying everyone is going to die (and incompetent GPs will be to blame)

Dr Grumble said...

It is difficult to reassure patients from behind a mask. Even medical students get frightened. They tend to stand in the corner of the room holding their breath for as long as they can lest they catch whatever it is. You will have to guess what Dr Grumble does in such circumstances to reassure everybody.

Dr Genesis said...

I have seen one and one only truly confirmed case of swine flu. I know, because I swabbed him. I wore a mask (only after I had been talking to him for five minutes already in his bedroom). I swabbed him, took the mask and gloves off, washed my hands (in his en-suite bathroom) then left. That was on a Thursday, some weeks ago. By the time the result came back the following Tuesday he was better. No Tamiflu. And I'm fine by the way.