Scottish COVID-19 inquiry Impact hearing | Health and social care |21 March 2024 (morning session)
Highlights from today's sesssion feature the Intensive Care Society.
The first witness to testify was Dr.Barbara Miles, a qualified doctor and consultant in intensive care medicine and anaesthesia. In addition, currently president of the Scottish Intensive Care Society. SICS was founded in 1991 to promote, coordinate and represent the speciality of intensive care medicine in scotland and is a registered SCIO charity number SC050112.
In a very bland testimony largely bereft of any facts the only standout points i noted from Dr.Miles was the comments made around ICU drug supply levels within Scottish hospitals during the first lockdown.
‘‘There was a significant increase in demand for certain sedative agents for ICUs'‘
‘'We needed to use them more..many countries needed to use them more’’
‘‘People did what they could with substitution and alternative agents.’’
Alternative agents ?
‘‘Maintenance of drug supplies were a problem throughout the pandemic as demand exceeded normal levels of requirement: sedative agents and muscle relaxants were particularly affected in the first wave.’’ -Paragraph 39 of statement
Dr.Miles also mentions staffing issues with untrained staff being redeployed to ICUs.
‘‘NHS Staff were redeployed from their usual area of work, as elective services reduced, to help provide expanded critical care services.’’ -Paragraph 42 of statement
‘‘Many staff redeployed from other areas had no critical care experience or training….Staff redeployed to ICU and HDU expansion were not necessarily critically care trained and these staff required support in their redeployed role.’’-Paragraph 43 of statement
‘‘Many redeployed staff had no training in intravenous drug preparation/administration or training in the management/care of intensive care patients. It takes approximately 18 months for a nurse to fully achieve competencies and complete their education in critical care.’’ -Paragraph 44 of statement
According to the Journal of Intensive Care ICU muscle relaxants come with a wide range of potentially very serious side effects. Highly trained staff are required to administer for minimal risks to patients.
‘‘The use of NMBAs in the ICU setting risks numerous complications. Most notably, neuromuscular blockade results in prolonged patient immobility that can lead to the development of acquired weakness, myopathy, pressure ulcers, nerve injuries, and risk of deep venous thrombosis (DVT).’’
‘‘NMBAs have been known to cause adverse pulmonary outcomes such as decreased inspiratory flow, residual paralysis and impaired airway protective reflexes.’’
Dr Miles elaborates further in her statement on COVID impacts on ICU capacity.
‘‘As COVID became the predominate diagnosis in many ICUs, ICU mortality rose above pre pandemic levels. In the initial wave of COVID, ICU could offer best supportive therapy.’’ -Paragraph 51 of statement
Yet, as we can see for ICU/HDU (high dependancy) ovreall admissions and death rates during the peak of the pandemic was less or no more severe that prior years.
2020-2021=30,913 total admissions (pandemic)
2018-2019=31,614 total admission (no pandemic)
For HDU:
''Between 2019 and 2022, there has been a decrease of 9,111 HDU admissions
(-30%)''. - Source: Public Health Scotland
Below is number of patients admitted that then sadly died after mechanical ventilation in Scottish ICUs.
I would like to know why untrained ICU staff re-deployed to ICU when overall admissions to Scottish hosptials 2020 and into 2023 have been the lowest on record ?
It was also stated many experienced nurses have now left the profession in Scotland.
‘‘Mmany experienced staff have left. Reasons given at exit interview in the 'CD and Lead nurses COVID-19 Pandemic, Scotland, 1 Jan 2020 - 31 Dec 2022' survey were progression and promotion, COVID, burnout, earlier than planned retirement, a change, stress, poor skill mix and no time for education. The median reported loss of nursing staff is 42.5% and units reports losing hundreds of years of nursing experience.’’ -Paragraph 56 of statement
End
links:
Dr Barbara Miles full statement- https://www.covid19inquiry.scot/sites/default/files/ev-documents/sci-wt0321-000001.pdf
Full video-YouTube-Scottish COVID-19 inquiry-Impact hearing | Health and social care | 21 March 2024 (morning session)
https://www.dailyrecord.co.uk/news/scottish-news/bereaved-families-faced-stark-choice-32411800.amp
https://publichealthscotland.scot/media/21021/full-report.pdf
https://scotland.shinyapps.io/phs-covid-wider-impact/