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Hospital staff must prepare to manually ventilate patients when oxygen is scarce


Hospital staff were instructed to prepare to manually ventilate patients if they ran out of oxygen.

It came when health chiefs warned of "nail-biting difficult" weeks, saying NHS workers were at "battle stations" across the country. Approvals are rising as Covid-19 rates continue to rise.

Almost 23,000 beds in England were occupied by coronavirus patients on New Year's Eve – far more than the 19,000 that were occupied at the height of the first wave in April.

Yesterday, 613 more deaths were reported across the UK within 28 days of testing positive, bringing the total death toll to 74,125.

There were also 53,285 new cases. Several hospitals have warned in the past few days that the surge in admissions is putting pressure on oxygen supplies.

Staff at a major London hospital were instructed to prepare for an "oxygen failure" that could force them to manually ventilate patients with an "ambu bag" – a hand-pumped plastic ball that pushes air into the lungs.

A message distributed to employees on Thursday stated: “There is currently a very high demand for medical oxygen in the entire health system. All hospitals closely monitor their use to ensure that the oxygen supply to the lines is safely monitored. & # 39;

In a sharp warning, it added, “You need to know what to do when the oxygen supply goes down. Disconnect the tube from the patient. Connect the inflation bag to the oxygen cylinder. If you don't have oxygen bottles, don't panic, just inflate with Ambu bags. Ventilate manually – 12 breaths per minute. & # 39;

It turned out that coronavirus patients in other London hospitals are already "competing" for ventilators to keep them alive.

Dr. Megan Smith of Guy & # 39; s and St Thomas & # 39; Hospital Trust in the capital said medical professionals are faced with "dire" decisions as they have to decide which patients will have access to life-saving treatment for Covid-19 and which Not.

Saffron Cordery, deputy general manager of NHS Providers, which represents hospital trusts in England, said approvals will continue to rise over the next 14 days.

"The next few weeks will be extremely difficult for the NHS," she told BBC Breakfast.

Regarding Thursday's numbers, she said, “We have nearly 1,000 deaths today and we were there in April. This is incredibly difficult to deal with, and this new variant of the coronavirus is also spreading much faster. & # 39;

Dr. Adrian Boyle, vice president of the Royal College of Emergency Medicine, said NHS staff were "tired, frustrated and fed up". He told BBC Breakfast, “How will it be in the next few months? I don't know, I am worried. We are very much at battle stations. & # 39;

NHS England last night insisted they have enough oxygen to meet current needs and are working with suppliers to meet future needs.

Dr. Smith warned that an expected surge in patients triggered by people mingling with family and friends over Christmas has not even begun. The situation is expected to get worse this month and in February.

Official NHS figures show intensive care units across the country are facing more problems this winter, despite an average of 743 extra beds being made available per day to cope with Covid patients.

Data from NHS England shows 743 critical care beds were available in the last week of December than the same week of 2019 – 4,394 versus 3,651.

In the same week, an average of 828 patients were in intensive care – 3,340 up from 2,512 in December 2019 – suggesting the strain of Covid-19 is larger than the hospitals prepared.

Many of the extra beds are in London – 253 of them – but even that was not enough to prevent the surge in coronavirus patients.

By Christmas week, two hospitals' intensive care units were 100 percent full, and another 11 out of 18 were more than 90 percent full, each with fewer than six beds for new patients.

In the past few days, grim reports have surfaced in the capital of forcing some of the major hospitals to treat Covid-19 patients in ambulances outside or dismantling wards to make room for intensive care patients.

Although the city has a huge nightingale hospital at the Excel center, nursing unions say there aren't enough staff to manage it and the equipment has been removed since it was put on standby over the summer.

NHS bosses warn that even hospitals that are not full or almost full will have more problems than usual due to the sickness rate of the staff and the fact that beds have to be more distributed around the hospital due to social distancing.

Medics are picking up a patient from an ambulance at Royal London Hospital this morning, January 1st

Medics are picking up a patient from an ambulance at Royal London Hospital this morning, January 1st

Dr. Smith said in an interview with ITN on Friday, “It's not a position any of us would ever want to be, and we're used to making tough decisions as doctors, but deciding the outcome of a competition A ventilator is easy not what someone signed up for.

& # 39; In terms of emotional trauma to these people, it's terrible. We shouldn't have to do it, but we are. & # 39;

She explained that the increase in patients that London's hospitals are already grappling with probably doesn't even include many of the people who inevitably get coronavirus over Christmas.

"The patients we are seeing now – and we are already higher than the peak we had in March and April – were infected two or three weeks ago," added Dr. Smith added.

“The patients we'll see as a result of the rules being relaxed around Christmas, and the people who don't necessarily follow the rules properly, we'll see in two or three weeks.

"I think January and February are going to be the toughest and most terrifying months most healthcare workers will ever face in their careers."

Health Department data shows 23,813 people were hospitalized with Covid-19 in the UK on December 28, the latest numbers.

This is more than at any other time during the pandemic, even during the devastating first wave in March and April.

About 1,847 of these people were ventilated in intensive care units, while others were in the intensive care unit but were not ventilated.

Weekly NHS figures show that despite efforts to set up more intensive care beds in England, the wards are still significantly busier than they were in December 2019.

Intensive care for adults was around 76 percent full for England in the last week of 2020, compared to 69 percent in the same week last year.

This was an average for the whole country, and some hospitals in the areas hardest hit by the coronavirus were 100 percent full, with no extra intensive care beds for the entire week and possibly even longer.

Turning to London, now once again the epicenter of the country's crisis, data shows that 13 out of 18 hospital trusts in the city had six or fewer ICU beds available to admit new patients last week.

Ambulances queued outside the Royal London Hospital last night, where bosses said they were in "disaster mode" with only one nurse for every three Covid patients

Ambulances queued outside the Royal London Hospital last night, where bosses said they were in "disaster mode" with only one nurse for every three Covid patients

Two hospital trusts had no vacant intensive care beds and three had an average of only one extra bed during the week.

Critical care is usually a last-ditch effort to save the life of someone who is beginning to die from coronavirus and is reserved only for the sick. Elderly patients who are too weak to survive the harmful effects of ventilators are usually excluded.

A comparison of the intensive care units in London with a year earlier shows that in 2019 the busiest intensive care units in the city were 86 percent busy, compared to 100 percent this year. Only five hospitals are less full this year than the busiest last year.

Daily hospital admissions in England have risen since the national lockdown ended on December 2nd and are now worse in some parts of London than they were in the spring.

When the UK declared a record high of 55,892 coronavirus cases and nearly 1,000 more deaths yesterday, the executive director of University College London Hospitals Trust (UCLH) said the intake was "much more" than during the first wave in the spring.

Professor Marcel Levi announced that the 550-bed hospital now has 220 Covid patients, with the number increasing by five percent per day.

He added that the "real pressure" is in the intensive care unit, which now has "70 very sick patients".

According to The Guardian, entire floors of the hospital are being dismantled and rebuilt so that they can be used as intensive care units. They will be equipped with oxygen and Continuous Positive Airway Pressure (CPAP) machines that make it easier for people to breathe.

In the meantime, the Royal London Hospital announced yesterday that it is in "disaster mode".

In an email to staff, heads of the hospital in Whitechapel in east London – Britain's busiest – warned that there is only one nurse for every three Covid patients.

"We are now in civil protection mode," the message reads. "We no longer offer high-standard intensive care because we don't … Things get harder before they get better."

Covid-19 hospital admissions in the UK have been rising steadily for weeks, driven by a surge in England after the second national lockdown in November caused only a brief drop in numbers

Covid-19 hospital admissions in the UK have been rising steadily for weeks, driven by a surge in England after the second national lockdown in November caused only a brief drop in numbers

Patients wait 24 hours for beds inside, with some taking taxis to A&E to skip the line of ambulances waiting outside.

Health professionals say the sheer number of patients who come to some hospitals means they can't always give the seriously ill people the care they need.

Dr. Pushpo Hossain, a 31-year-old junior doctor in London, told The Sun: “Never before have so many patients been in need of oxygen at the same time, and many NHS hospitals are old buildings that were not built to provide oxygen on such a large scale.

“We have the oxygen to supply patients, but what we don't have is the ability to make it available to everyone at the same time. We are constantly monitoring all of our patients to see who can deliver oxygen so we can reduce performance. & # 39;

In an interview with the newspaper, A&E medic Dr. Priyesh Patel added: “In A&E we often run out of bed and I had to see seriously ill patients in ambulances because they waited over four hours to come to the hospital.

"In the Resus department, where we are fighting to save the sickest patients, we can no longer contribute because there is no space."

The NHS says that while not all hospitals are full, those that are not still under much more pressure than usual due to the way wards must operate to stop the spread of Covid-19.

NHS England states on its website that coronavirus precautions are causing beds and staff to be used differently within the hospital in both emergency and elective situations than in previous years.

& # 39; Therefore, caution is advised when comparing the overall occupancy rates between this year and previous years.

"In general, hospitals will face capacity pressures at lower overall occupancy rates than they would have been before."

Doctors say they refuse orders not to give a second dose of vaccine

Doctors say they will defy government instructions to give a second dose to elderly patients who received a second dose of the Pfizer coronavirus vaccine on their first bursts.

A dispute has broken out over ministers' decision to ration vaccines to ration single doses to as many people as possible in an effort to stem the tide of deaths in Covid.

Officials warning that supply shortages could last until spring said patients who already had a dose of the vaccine should postpone their second – which they were told would receive three weeks later – for up to 12 weeks to let.

But doctors have been outraged, saying they will not deny vulnerable patients the vaccines they promised them because they fear the one-dose shocks will not work as well.

General practitioners criticized the policy as "grossly unfair" and frustrated scientists warned that clinical trials of the vaccine were only testing how well it worked with a three week hiatus so there is no evidence that the new regimen would work long term.

Professor Chris Whitty, England's chief medical officer, said in a letter with his colleagues in Scotland, Wales and Northern Ireland that a single dose could provide 70 percent protection and it would be more effective in a larger number of people than 95 percent protection in half as many .

Margaret Keenan, the first person in the world to receive a Covid-19 vaccine, received her second bump earlier this week.

But thousands of others across the UK will be postponing their second appointments so the NHS can focus on providing more people with bumps.

According to the Department of Health, a total of 944,539 people across the UK had received the first dose of a Covid-19 vaccine by December 27.

Essex has already reported a "major incident" as the number of coronavirus cases threatens to overwhelm the six hospitals and ambulances queuing outside of A & Es across the country due to the lack of beds and staff.

Gareth Grier, an A&E advisor at Barts Health NHS Trust in east London, said Friday, "If Covid patients are left in corridors, Covid will spread like wildfire in the hospital. This must not happen.

“Corridor medicine, which was previously endemic in emergency rooms, would kill people and staff if it happened again. Hence the terrible, terrible possibility of treating patients outside of hospitals.

It has been reported that UK hospitals are left with limited labor, ward space, oxygen and even pillows. Patients were treated by doctors in emergency vehicles because they waited up to six hours to be admitted.

In some cases, people were later rerouted more than 100 miles away while some crowded London intensive care units asked large hospitals in Tyneside and Yorkshire if they would accept some of their Covid patients.

On the day the UK vaccine Oxford / AstraZeneca was approved for use yesterday, Essex declared a "major incident" in its six hospitals that allowed it to move patients to another location, expedite discharge, additional staff consult and cancel non-emergency care and operations. The Department of Health and Welfare was due later on Friday to set out what aid the Essex government would be giving.

Doctors in areas worst hit by the rising number of coronavirus cases have said they are "extremely fearful" and just days away from making "terrible decisions" about who to treat and who will die got to.

The chaos has been attributed to dwindling oxygen supplies, and NHS bosses say staff absenteeism is twice normal due to illness and self-isolation. Some hospitals are asking nurses to return early from the Christmas vacation, and the January leave is now being banned by some trusts.

Social media footage showed ambulance queues lined up outside Royal London Hospital in Whitechapel and Queen & # 39; s Hospital in Romford, both in east London and Kent, when NHS Providers' deputy general manager, Saffron Cordery, warned of pressure on the NHS "rising at an unsustainable rate".

There have also been reports of delays in hospitals in East Anglia, South Wales and Birmingham, with Doctor Punith Kempegowda tweeted, “Just get off an & e after another long day. Almost all of these ambulances wait more than 3 hours with patients in them because there is no place in the hospital to bring them in.

There are also growing concerns about the number of people in their forties and fifties who have no underlying health problems on wards or even show up in intensive care units, a London doctor said.

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