The island’s medical professionals are in full scale preparation mode due to the Covid-19 pandemic, and the Bermuda Hospital Board [BHB] has provided an overview of the steps and measures being taken.
They stressed that the “community actions now – social distancing, washing hands, not touching our eyes, nose, and mouth, adhering to quarantine and isolation guidelines and staying at home – are the most important actions that will enable the healthcare system to cope.”
BHB explained that they have 20 ventilators and an additional 8 have been ordered, and noted that they were in the middle of a bed replacement programme, so the 48 new beds that are arriving on Monday — which were going to replace the older beds — will now be additional bed stock.
They have some 420 nurses, 118 physicians, 203 nurse aides and 31 EMTs and noted that they have additional nurses in administrative and leadership functions and nurses and doctors in the community who can also add to these numbers in a time of crisis.
They also noted that they were anticipating increases in need for personal protective equipment and other supplies since February, so put in multiple advance orders to have more in stock than usual.
Clinical Care Tents
A spokesperson said, “BHB has three clinical care tents and a negative pressure piece of equipment that can be attached to them has been ordered.
20 Ventilators And 8 Ordered
“BHB has 20 ventilators an additional 8 have been ordered. We are awaiting info on when they will arrive.
“An additional note on the number of respirators: the number of ventilators is only part of the equation. You need bed spaces where there is oxygen available, and critical care staff who are specially trained to look after ventilated patients.
“Although Covid-19 most significantly affects the lungs, all critically ill patients are at risk of multiple organ failure, so this specialised critical care training is vital. So our ability to care for critically ill Covid-19 patients rely equally on equipment [such as ventilators], staff and space.
“For this reason, we are looking at increasing our capacity outside of the Intensive Care Unit at KEMH and utilising all bed space with available oxygen.
“This is an exceptional situation, there is not a hospital or healthcare system that is built, supplied and staffed to be ready for a pandemic like this. We are an island so cannot transfer staff in from other regions like China did. So we are looking at cross-training and up-skilling our existing staff, and collaborating with healthcare colleagues in the community who can help support services.
“This is why we cannot stress strongly enough that the community actions now – social [physical] distancing, washing hands, not touching our eyes, nose, and mouth, adhering to quarantine and isolation guidelines and staying at home – are the most important actions that will enable the healthcare system to cope, along with on-island testing, and border control. This gives us the chance to slow and maybe even eradicate the virus in Bermuda.
Additional Bed Stock BHB Can Use
“Increasing our Acute and Critical Care bed capacity is a priority. Our current number is 120 acute care beds [90 in the Acute Care Wing and one ward in the General Wing]. We are working with Government to discharge at least 30 long term care patients, use operating room spaces, and other ward areas.
“Some good news is that we were in the middle of a bed replacement programme – we replace hospital beds after a defined period of years. This means 48 new beds are arriving on Monday. They were going to replace the older beds but will now be additional bed stock we can use.
“There are nine beds in the Intensive Care Unit.
Numbers & Breakdown Of Clinical Staff
“A review of staff numbers in February [as daily this can change] shows at BHB there were 420 nurses, [383 full time and 34 casuals], 118 physicians, 203 nurse aides [165 full time, 37 casuals, 1 temporary], 31 EMTs [22 full time, 8 casuals, 1 part time].
“There are additional nurses in administrative and leadership functions, nurses and doctors in the community who can also add to these numbers in a time of crisis, especially if staff themselves are ill or in quarantine.
Number Of Specialised Staff Required For Managing Critical Covid-19 Cases
“About 40 nurses with critical care training, 12 anaesthetists [plus 2 physicians in the community with training who could support], and 13 ED doctors.
“There are also certain specialty doctors and nurses in the hospital and community who can help work to support ED and inpatient care. This will need to be a team effort to get through.
Measures In Place To Prevent Healthcare Workers From Contracting The Virus
“Physically there are nine negative pressure rooms in the ACW that stop air flowing out and several HEPA filters that can be brought into rooms of infectious patients. The fifth floor of the ACW has a separate air filtration system that isolates it from the rest of the building.
“Staff who have to go in patient rooms [doctors, nurses, housekeeping] have personal protective equipment [PPE] and current WHO and CDC guidelines which we following advise that in general care surgical masks, eye protection, gowns and gloves should be used.
“For procedures in the throat, called aerosolising procedures – a higher level of protection is used for airborne precautions. This a PAPR hood which covers the whole head and has its own filtered air supply, or an N95 mask, gowns and gloves. There has been advanced training throughout February and March for staff who have to go in patient rooms – about 200 training and education sessions have been undertaken.
“We also are changing operations to protect patients and staff, having people call rather than just turn up in Emergency, having outpatients called before they come in for their regular appointments to check for risk factors and potential symptoms, and moving to appointment only in lab and imaging diagnostics, rather than allowing walk-ins.
BHB Covid-19 Contingency Plan
“We anticipate the most seriously ill will come to hospital and some of them will need critical care support. We have appropriate triage in Emergency, we are maximising our operations for inpatient capacity and have arrangements in place so we can call on staff in different areas, and in the community.
“We have plans for patient flow to keep Covid-19 patients away from daily operations, because people will still need the hospital for other healthcare emergencies – from accidents to heart attacks and strokes.
“We are cross-training and up-skilling existing staff, and looking into opportunities with the Bermuda College for an express training for nursing aides [which exists in other countries even before the pandemic] – as supporting nurses can give them more capacity for the higher level functions.
“We suspended elective surgeries from Monday 18 March in order to start cross-training and upskilling our operating staff; and this also helps increase bed capacity.
“Already we are reducing outpatient services to focus on inpatient needs, moving to remote consultations to try and care our most chronically unwell outpatients. To reduce the potential for infections coming into the hospital, in waiting areas, lobbies and into the rooms of our vulnerable patients and staff, we have restricted visitors to only by exception and are asking people visiting Emergency to come on their own, or with a maximum of one companion.
“Again, we do not want more people in our waiting rooms with more likelihood of cross infections. We have already moved our hyperbaric chamber to emergencies only [which is mostly for diving accidents], but emergency services may have to stop in the event of a surge in the hospital as we will need the oxygen for ventilated patients.
” We have also been anticipating increases in need for personal protective equipment and medical supplies, and drug usage and since February have put in multiple advance orders to have more in stock than usual.