Protect staff, protect patients

by Phil Banfield

Taking your eye off the personal protective equipment ball in a stressful situation is all too easy

Location: UK
Last reviewed: 12 February 2021
phil banfield

I was crash-called because the woman in room 5 was beside herself and colleagues couldn’t find her baby’s heartbeat soon after her admission, distressed with contractions.

The registrar was preparing for another emergency in obs theatre.  I was already changed and wearing a fluid repellent mask and hurried into the room to find my very experienced SAS colleague already assessing the situation.

I made straight for ‘the head end’ to say hello and explained what we thought was happening.  She was progressing in labour rapidly but losing control – her shell-shocked partner arrived so I talked to him too.  It looked like she might be fully dilated and therefore able to be delivered without the need for theatre.

At that moment of a patient’s panic and despair, holding a hand to convince them that they can do what they believe to be impossible is my instinct.  With a bit of assistance from the registrar, all was well.  Disaster avoided.

Later that evening, her routine admission COVID swab came back positive.

I hadn’t needed a visor when I first entered the room, but the rapid progress to delivery meant I was not using the recommended level of PPE - and I was directly in the firing line.

Through a lack of situational awareness, I had let my guard down and now it was self-isolation.  I had had my first Pfizer jab and I’m in a high-risk group, with some high-risk family members – how could I have been so stupid?

Now, this transgression would still apply even after my second dose of vaccine, but it reminded me of how easy it is to take one’s eye off the ball – it was letting colleagues and worse still my family down; they have been vigilant and obsessive, and I allowed myself to be distracted.

I am in unbelievable in admiration of the dedication and stamina of many of my colleagues in emergency medicine, critical care, care of the elderly, medicine and myriad other specialties and roles who I know have been harder hit by this pandemic than me. 

They look to me, and their Union, though for encouragement, support and above all tenacity in securing the right PPE at the right time and the best protection they could have to face a virus that has failed to obey rules and that has been shown to be colour blind as green and red merge during this third wave from a mutated variant.

My BAME colleagues in particular feel let down – having highlighted their disproportionate risk, many have stayed in the frontline and suffered for it; the sudden announcement that the second Pfizer jab would be delayed for up to 12 weeks was been seen by many as a slap in the face.

We now see staff going off sick – and being ill - with COVID, five weeks or more after their initial jab and their families are isolating, whilst dreading catching COVID themselves as unimmunised passive spectators. 

The failure to provide evidence of safety for the change of dosing of the Pfizer vaccine flew in the face of an NHS endlessly reminded about following evidence-based practice. 

The evidence as it existed, suggested that the first Pfizer dose may not stop onward transmission.  In this, the data for the Pfizer and AZ vaccines is different – neutralising antibodies only seem to be seen reliably after the second Pfizer dose.

Given that nosocomial infections have decimated some hospitals and care homes, stopping spread is as important in these environments than protecting individuals with vaccination, and while additional infection control measures will remain with us for a long time to come, protecting staff is the best way to protect the patients under their care. 

My mum gets it.  At a spritely 85, she has patiently sat in front of ‘The Repair Shop’ and Lovejoy repeats for nearly a year.

She and my stepfather had their 1st AZ jab this weekend.  She is happy to wait a little longer – she can avoid exposure to COVID while she waits, but as she says, her son cannot.

My mother-in-law, too would rather her GP daughter be immunised fully to minimise the risk to our family when we return from work each day.

To hear speculation about vaccines being thrown away rather than given as a second dose to healthcare workers seems obscene to them, and their view is that it seems like contempt for a workforce that has gone above and beyond for so many months already, and whose greatest challenges are yet to come.

I try not to make the same mistake twice, to learn from such situations, and help prompt others to avoid my pitfalls.

We must forgive ourselves and each other if we are to progress collaboratively and not in conflict. It is difficult when the aims appear incompatible and our perception of priorities and duties is at variance with our core raison d’etre.

If the first dose of Pfizer protects the doctors, the second protects their patients. We are a membership organisation and a union standing up to protect its members: the BMA looks after doctors, so they can look after you.

Phil Banfield is BMA Welsh consultants committee chair