Redeployment to the intensive care unit
01 May 2020
Dr Sancia Fernando
Dr Sancia Fernando graduated from Barts and The London School of Medicine and Dentistry in 2018. After a year of working as a foundation dentist, she decided to pursue further postgraduate training and challenge herself with a year in Oral and Maxillofacial Surgery (OMFS). Sancia currently works as an OMFS Senior House Officer (SHO) in Northwick Park Hospital. In this blog series, she describes her experience of redeployment and details the contributions that the dental workforce can bring to caring for critically ill patients during the COVID-19 crisis.
Through the eyes of an Oral and Maxillofacial Surgery Senior House Officer:
As a dentally qualified OMFS SHO, the first several months of training pose a challenge. You are, as they say, ‘thrown in at the deep end’. With limited exposure to the hospital setting prior to embarking on these training posts, resilience is required to help manage the nature of the maxillofacial trauma and major head and neck oncology cases we see.
As the threat of the COVID-19 crisis advanced, alterations to the structure of our training programme commenced. After a call for the redeployment of OMFS SHOs to the intensive care unit (ICU) of our hospital, we were posed with the reality of facing a new challenge.
How exactly can we, as singly dentally qualified OMFS trainees, contribute to the ICU? How can we contribute to the care of the most critically ill patients within the hospital setting? With oral and maxillofacial surgical cases branching from reconstructive oncology to Ludwig’s angina, we already face exposure to the ICU during the postsurgical care of patients. By training as dentists, we possess a sound appreciation of medical knowledge, an innate ability for attention to detail and show resilience under pressure. In fact, a recent publication from NHS England (1) provided key competencies and mapping of potential roles for the dental workforce during the crisis. Our capabilities can cover the realms of sedation and surgical skills. Potential roles of adequately trained members of the dental workforce highlighted by NHS England include providing cannulation, phlebotomy, suturing, and patient triaging, to name a few. By redeploying our workforce into such roles, it can help to significantly support the workload that will inevitably arise with the influx of patients. Our potential for contribution to the COVID-19 workforce is invaluable.
The first few shifts of my ICU deployment were more of an emotional experience as a junior clinician. Although we, unfortunately, had some of our OMFS inpatients contract the virus, for the first time, I was confronted with rooms full of critically ill infected patients – many of them being in age ranges and medical health categories I was not expecting.
With one of the principal features of patients with advanced COVID-19 being the development of acute respiratory distress syndrome (ARDS); the implementation of periodic prone positioning during mechanical ventilation is carried out for suitable patients to help improve oxygenation. (2) This was something I had not witnessed in my training so far. Proning, however, does not come without risk, and therefore our scope for learning and on the spot training by being exposed to this role is immense. Complications of the procedure could include airway obstruction, endotracheal tube dislodgement as well as loss of venous access, and therefore meticulous teamwork and communication are essential. To ensure efficacy and patient safety, we work alongside skilled anaesthetists, physiotherapists, and intensive care nurses, to name a handful. By taking the time to have regular discussions with the critical care teams regarding the management of patients, assisting in intubations, and learning key principles of critical care nursing, our competencies are being enhanced every day. More importantly, the more our competencies increase, the more we can contribute to care for these patients. I have since developed an understanding of principles behind endotracheal tube troubleshooting, (3) ICU equipment, and have expanded on my knowledge of physiology.
After this healthcare crisis is managed, I am sure that we will discuss what lessons were learnt. What greater lesson is there to be learnt, that at a time of a global health crisis, healthcare professionals from all specialties and grades were able to step up into new environments for the benefit of our patients. I write this with a main intention – for junior clinicians like myself, as well as colleagues from other specialties who may feel somewhat anxious by the prospect of being redeployed – that we all possess crucial transferrable skills that can help our patients and workforce. We all have a part to play, and there is so much to learn. Transitioning to the frontline can result in vast change and can come at a great personal sacrifice. However, by recognising our potential as healthcare workers to contribute in whatever way we can, our National Health Service and patients will be well supported.
- NHS England. Redeploying the Clinical Dental Workforce to Support the NHS Clinical Delivery Plan for COVID-19. (cited April 2020).
- Matthay M, Aldrich J, Gotts J. Treatment for severe acute respiratory distress syndrome from COVID-19. Lancet Respir Med. 2020 Mar 20. [Epub ahead of print].
- Higgs A, McGrath B, Goddard C et al. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth. 2018; 120: 323-352.