How Covid Helped Make Us Relevant Again

COVID patient on Ventilator (photo compliments of Google)

I just had a conversation with my old friend Jane Sage. She is, as her name implies, a sage of respiratory therapy. Back in the day, she was my mentor. Anytime I had a question about anything respiratory, she was the go-to person. And she "always" had a brilliant answer.

That was part of our conversation today. She retired about 10 years ago. But, she continues to work as an RT at another location. She works at a smaller hospital where you don't get to take care of many ventilators. You don't lose your skills, she said, but you still get rusty after a while. You need to freshen up on your skills and knowledge.

I think a similar thing happened here at the RT Cave. When I started, when Jane was in her RT prime, it was in the mid-1990s. Back then, we would keep most of the critical patients. 

Back then, ACLS even had us keeping heart attack patients. We would keep them in our unit for 24 hours until they were stabilized. And then they were shipped if necessary to where the experts were. 

We also kept all neurological patients. This was because we had a neurologist. 

We kept all COPD and asthmatics. We kept patients with ARDS. 

So, it was rare that we shipped patients.

There were times when we had 5 or 6 ventilators running. 

We had art lines. We had central lines. We had everything. 

And we learned. And our work meant that we used what we learned. 

Over time, policies changed. 

ACLS changed its guidelines. Now they recommended heart attack patients be stabilized and shipped within an hour of arrival to an ER. 

Stroke patients are shipped. Those with kidney failure are shipped. We do keep many COPD patients. But those who don't turn around right away, those who require the expertise of a pulmonologist, were shipped. 

So we no longer kept these patients. Our neurologist quit. So we lost our patients with neurological disorders. Soon, our critical care unit became nothing more than a glorified step-down unit. 

This was how it was until October 2020. This was when we got a surge of COVID patients. 

The large hospitals at that time were filled to capacity. They could no longer accept patients. So, every COVID patient stayed here. This includes COVID patients with COVID related pneumonia and ARDS. This included COVID patients who needed to be proned. (Grammarly wants me to change proned to prone, but I think it is now safe to use proned as a noun)

In my 25 years as an RT, I never proned patients. Since October, I have proned a patient ten times. My boss worked at a big hospital for most of his career. So, he refreshed me on the formulas used to determine the best ventilator changes to make based on ABG results. 

He refreshed me on ARDS/ ALI Ventilator Guidelines. Actually, he made me aware of how they work. As noted, rarely did we ever keep ARDS patients. And the guidelines were created after we started shipping them. So, we had no reason to learn these guidelines other than just to learn. 

COVID forced us to refresh our skills. It forced us to talk to the experts at the large hospitals to quickly update our skills. This is what was necessary to take care of COVID patients in critical condition. COVID made us relevant again.