COVID-19: how we have prepared for the surge that’s yet to come

An emergency nurse in Belfast says vital work to increase capacity and improve infection control has seen staff pull together like never before

Personal protective equipment helps the fight against COVID-19. Picture: Shutterstock

In mid-January, two of our emergency department (ED) consultants at the Belfast trust where I work began monitoring the COVID-19 outbreak in China.

They soon realised the gravity of the situation. 

Predicting the surge in coronavirus cases we could expect

By the time COVID-19 reached Italy, they were gathering figures and predicting that the surge in Belfast would occur in mid-April, with an estimated 3,500 positive cases and 165 people needing intensive care.

At that stage, we only had 100 intensive care unit (ICU) beds in the whole of Northern Ireland.

We have a large population of older people in our catchment area, and staff had already experienced a very busy winter, so the enormity of a surge in demand caused by COVID-19 was really overwhelming.

The trust realised it needed to work differently, and that if we didn’t act swiftly it would be too late.

View our COVID-19 resources

Practical preparations for a rise in COVID-19 patients

By mid-February, there was a real push to prepare Ulster Hospital, and the medical consultants were listening to the advice of the ED consultants.

‘Credit must go to the trust staff because since mid-February everyone has cleared their diaries and prioritised this vital work’

We developed a structured plan, but then the criteria for suspected COVID-19 cases changed: anyone with a respiratory problem should now be treated as a potential COVID-19 case – and this accounted for 30% of our ED attendances.

At this time, we had set up an area attached to the ED that was being used for COVID-19 swabs taken by ED staff wearing full personal protective equipment (PPE).

A 20-bed observation ward in the ED, with its own separate entrance, was cleared for use as a COVID-19 ED for potential cases, where all staff wore PPE.

Test runs are to ensure everything and everyone is in place 

Some of our surgical wards have negative pressure rooms (used to isolate patients with airborne contagious diseases), so we performed some test runs with potential cases, locking down the corridors and transferring patients from the small COVID-19 ED to these rooms.

We did a dummy run with a real patient who was admitted to ICU with what turned out to be flu, but he was treated as a patient with COVID-19, so staff had the opportunity to work in that situation.

All of this preparation smoothed out a lot of the process for us before the genuine cases started coming through.

Most of the emergency department shifts to COVID-19 treatment

Since mid-March we have been seeing more suspected cases – more than the designated area could deal with – so we flipped the spaces. Now 80% of the ED is designated for suspected COVID-19 cases and 20% for non-COVID-19 patients.

We now have a senior registrar based outside the ED who asks patients their symptoms before directing them to the appropriate department.

Credit must go to the trust staff because since mid-February everyone has cleared their diaries and prioritised this vital work.

Staff meetings provide status updates 

We have a one-hour COVID-19 meeting every morning, and all staff wearing PPE have earpieces to wear under their suits so they can communicate.

We are also looking to move the open-bay medical assessment unit to a new building that has single rooms, so that nursing staff can care for patients more effectively and safely.

The teamwork has been incredible; all hands to the pump.

‘We know it’s coming, and we feel we have prepared as much as we can, but we won’t know the full impact until it hits’

The support we are receiving locally, along with the kindness of people, is unbelievable and overwhelming.

A local restaurant owner brought in 50 freshly cooked meals for ED staff, and said to ask for more when things get tough. A science teacher contacted us to say she could make face masks for us; a local clothing manufacturer is making scrubs for the staff; and free pizzas are being delivered.

It is all so humbling.

Staff are anxious but are there for each other

At the moment it is calm in the ED department, but there is a degree of trepidation among staff; it is like standing on a beach and watching a tsunami coming towards us and there is nothing we can do but prepare and brace for it.

We know it’s coming, and we feel we have prepared as much as we can, but we won’t know the full impact until it hits.

Staff are scared about what they are going to see and about the decisions they may have to make around triaging patients for ventilation, for example.

They’re worried about their health, and the health of their families, and whether we have the resilience to deal with this after a hard winter.

But everyone is watching out for each other; I have never seen people pull together so tightly.

Strong teamwork between departments

I can see relationships building throughout our services that weren’t there before and will never be broken after this; such as with our estates and IT staff, who are not typically seen as the core of the NHS, but who have been with us every step of the way.

None of us want to go through this, but it has made everyone pause and ask, ‘Why am I here?’ and adopt a ‘can do’ attitude.

We really are seeing the best in people and for that I am eternally grateful and humbled.

Roisin Devlin is an emergency nurse, and interim clinical manager for unscheduled care at South Eastern Health and Social Care Trust, Belfast, Northern Ireland