Nurses wearing their full complement of PPE. (Image courtesy NCRHA)

The North-Central Regional Health Authority (NCRHA) is giving assurances it is doing everything possible to protect its staff even as they continue to be inundated with increasing numbers of “very ill COVID-19 patients” in the Emergency Department.

In an official statement issued today, the NCRHA seeks to allay fears and address concerns in the public domain that its medical centres are not prepared to deal with growing numbers of COVID-19 patients, and that its staff is too burnt out to manage the rising tide.

The following is the full text of the NCRHA statement…

The NCRHA takes seriously the story that has been presented by the Trinidad and Tobago Express in today’s newspaper.

The Authority acknowledges that, in light of the increased intake in Emergency Departments, nationally, coupled with the surge in the number of positive COVID-19 cases, the North Central Regional Health Authority has systematically implemented necessary measures to expand and boost its capacity in order to be better positioned and prepared to deliver the best possible patient care.

The NCRHA also notes, with trepidation, the rising tide of very ill patients infected with the COVID-19 virus who are now being cared for by a finite human resource at the Emergency Department.

It is important to note that staff who are currently engaging this surge of very ill patients have been engaging the rigors of the COVID-19 virus over the last two years without cease. In order to avoid burnout, the NCRHA tries to rotate staff, especially in high traffic areas. Rotation also provides opportunities for other qualified members of staff to gain experience and expand their respective skillsets. These processes are not undertaken without the direct supervision and involvement of highly qualified senior team medical personnel.

Psychological and psychiatric sessions are conducted with our inherent response team in order to build psychosocial resilience within the system.

As best as possible, staff reassignments are tasked to individual departments, as the respective departments, it is thought, would best know the individual strengths and weakness, schedules of the officers and various peculiarities that make the officer suitable or unsuitable for a given duty.

A nurse dressed in a complete hazmat suit. (Image courtesy NCRHA)

PPEs…  At present, the AED has undertaken numerous steps to ensure that the department remains functional and is equipped with all necessary PPEs required. Regular checks and updates are conducted to ensure that there are no shortages that would consequently affect the delivery of healthcare. In anticipation of demand, the Authority has also recently ramped up its supply of PPE by 150%. There is no shortage.

Gloves…  The department has various sizes of sterile and non-sterile gloves for use by all staff. Weekly stocks checks are undertaken by nursing personnel to ensure that stocks a routinely replenished. Our current supply is over 150% of utilization.

Donning and Doffing…  All solutions for doffing are readily available and accessible. In addition, relevant staff received IPC training which teaches proper techniques for doffing and donning which the NCRHA engaged during the early onset of the pandemic and continues still on a regular basis.

Saturation Monitors…  At present, there is an adequate supply of pulse oximeters, with weekly monitoring of stock to ensure that what is depleted is replenished in a timely manner. We also provide our patients with SPO2 monitors.

Oxygen…  At present, over two hundred oxygen tanks with oxygen gauges are readily available. Oxygen tanks are routinely replenished daily at 4–5-hour intervals to ensure that there is no shortage of supply. In fact, in response to the surge in COVID-19 cases, the Authority has further initiated an additional 25% ramp up on oxygen tanks to meet the increasing demands. Our current supply is our 200% utilization.

In addition to which, the NCRHA has a team of EMTs doing regular oxygen rounds, in tent areas particularly, every 3-4 hours to check patient oxygen levels. This team also has standing orders to gauge whether or not patients are accessing necessary levels of oxygen—whether to be reduced or increased.

A head-and-shoulders shot of a nurse dressed in a complete hazmat suit. (Image courtesy NCRHA)

In an effort to reconcile the inevitable issues that will arise due to the growing demands of larger and larger numbers of very ill patients on a finite number of doctors, nurses and other ancillary staff—(drivers, cleaners, patient escorts, etc), a variety of strategies have been employed:

   ●   Institution-wide, mandatory, general and specific, tiered training of various levels of staff, in anticipation of potential crisis situations in relation to the COVID pandemic spearheaded by Training and Development Unit alongside IPC unit in areas such as: Airway Management, Basic Emergency Training-COVID-19, Basic Life Support (BLS), Care of the Ventilated Patient, Conversations on Mental Health Talk Series, Covid-19 Vaccine Process Flow, Covid-19 Vaccine Sensitization, Covid-19 Ward Management, CPR, Gauges on Medical Tanks, Grief Management, ICU, IPC Training & Sensitization COVID-19, Management of Post COVID as well as Psychosocial Support

   ●   Creation and development of specific protocols for the management of the response.

   ●   Vaccination of willing staff, in keeping with the national policy

   ●   All officers who volunteer are accepted and qualified

   ●   Hiring of dedicated officers for work in COVID facilities

   ●   Bolstering of locum pools of officers for replacement of staff on leave

   ●   Diversion of resource from the non-COVID pathways to the COVID pathways, depending on need assessment.

   ●   Where officers are reassigned, they are placed on a formal roster indicating their requirements. In situations of acute need, this may be substituted by direct communication with the individual through Department heads.

   ●   In cases where it is recognized that the staff is working in excess of their contractual time, there is an existing a compensation system in place, which is fully operational and currently being utilized.

   ●   In standard response to a massive surge, as would be the case in a mass casualty, all officers on site are requested to render assistance. These are extraordinary times.

   ●   In the execution of the response, there may be the minor instance where these guides may not have been possible or recognized, due to unforeseen illness or unavailability.

Notwithstanding, the North Central Regional Health Authority has engaged an investigation into the allegations and is continuing to monitor the ongoing situation. We will continue to engage consultation at all levels to preserve the dignity of our staff and our patients.