Advice for those wearing ppe
17th March 2021 | Dr Melanie Dani
Introduction
This article looks at the challenges for fainters having to wear PPE during COVID 19 and offers some advice
PPE offers some protection from COVID 19. This usually consists of an FFP3 mask, a tight-fitting mask with a filter that if worn properly, feels like it impedes breathing, particularly on the in-breath, as if one were breathing in via a long thin tube (imagine breathing through a bubble-tea straw). On a typical shift in ICU, a health care professional may be expected to wear this FFP3 mask together with a full head cap, visor and full gown and gloves. Once donned, the protective equipment usually is worn for the entire shift. For colleagues with a tendency to faint it can prove a further challenge. This was brought home to one of the Stop Fainting team working a shift in one our ITUs recently.
At 6pm he heard a colleague calling for help from one of the isolation room where she was caring for a ventilated patient. As he put the necessary PPE cover for her, she told him that she was sweating profusely and feeling very faint. She did not faint but did go home earlier that day. The next day they were on the same shift together and he offered some further insight into her questions about why she may have felt unwell the day before.
“Mary” had been redeployed to ITU; a change she had embraced enthusiastically. However, a combination of new shift hours and fewer trains meant having to leave for work very early in the morning. Too early to have her normal breakfast. Late into a busy shift she was called from her usual role to stop “running” around to cover looking after a patient in a side room. For the first time in a while she found herself standing relatively still by a bedside. She suddenly noticed feeling prodromal symptoms and called for help.
PPE and the “perfect storm “of fainting triggers
With a visor, FFP3 mask, gown and gloves, it’s clear that healthcare professionals will not be able to drink as usual throughout their shift. Mary admitted that she had not had much to drink that day and missing breakfast.
Working in warm environments and wrapped in further layers of cloth and plastic, it’s likely to mean that that dehydration will become a common feature of day to day work life. Also, practically, no one wants to spend all that time donning PPE only to have to doff the same for a toilet break because one may have drunk too much. So, the inclination is to keep low on fluids (just in case) before your shift in order to last the shift without having to doff prematurely for that toilet break.
The continuous heat under the gown, inability to drink throughout the shift in addition to the emotional and physical demands of caring and treating patients in novel circumstances and during long shifts increases the tendency to pre-syncope and syncope. The pressure to care for our sick patients may lead to health care professionals soldiering on… but for how long? “Mary’s “symptoms also started as she found herself in a relatively stationary position after she had been moving around
Apart from the exhaustion of a long, dehydrating shift, those with a tendency to vasovagal syncope and low blood pressure states will be more prone to developing worsening in symptoms of pre-syncope and syncope during or after their shifts or during a downtime moment
So how do you prevent vasovagal syncope during your long Covid-19 shift?
Here are a few tips:
– Acknowledge that you may have a pre-existing tendency to faint and declare to your shift manager that you may need more frequency breaks to rest and hydrate (and even to take toilet breaks).
– Hydrate well prior to your shift, and perhaps take a toilet break immediately before your shift. You should be aiming to consume between 2-3L per day. If you are known to lave low blood pressure, then a salty snack early in the day (or night) is also a good idea.
– Continue to perform isometric exercises (clenching calves, quads and buttocks) throughout the day.
– Take particular care to avoid standing for long periods, for example during a ward round. There is no shame in sitting in a chair. Consider this a service to your team and your patients, and you want to be in the best shape you can to continue your shift.
– Rest well – try to keep a good routine and sleep enough for your needs.
– Have a good meal and plenty of fluids, perhaps focussing on water and juice rather than coffee or tea.
– Try to minimise (as much as possible) possible triggers such as stressful journeys through better planning. For instance, asking you manager about any travel and accommodation options offered by your Trust or organisation.
Good luck and stay well! We hope these tips will help you to continue help your patients.
