Abstract
The COVID-19 pandemic has placed a significant personnel burden on intensive care units across the globe. Physicians from various specialties, including otolaryngology, have heeded the call and been redeployed to provide support, serving in a capacity outside their usual scope of practice. The author shares personal experience from redeployment and provides a framework for otolaryngologists to maximize their impact while providing high-quality patient care and preserving their personal safety.
Across the globe, health care systems are meeting the challenge of COVID-19 head on, with intensivists facing the brunt. 1 While otolaryngologists have trained extensively in a narrow field, this crisis has led some of us to expand our role and volunteer for redeployment to aid our intensive care unit (ICU) colleagues. 2
Redeployment can be thought of in 2 phases: the first involves preparation of physicians for an anticipated surge; the second involves providing support to the frontlines during peak/late phases, when resources are most scarce. Redeployment is not appropriate for everyone. Most otolaryngologists will need to remain at their posts, managing urgent needs—including head and neck cancer and airway compromise—that, if neglected, can lead to significant morbidity and mortality. 3
The risks must also be considered when deciding whether to redeploy. Even if a hospital has adequate personal protective equipment, exposure risk in the ICU is substantial. Otolaryngologists must evaluate personal risk factors, including advanced age and comorbidities such as immunocompromise. The possibility of transmitting illness to at-risk family members must also be weighed. Some intensivists have chosen to self-isolate from their families while on service.4,5 Although no guidelines exist, redeployed otolaryngologists may consider the feasibility of self-isolation based on their own circumstances.
As a laryngologist, I would have preferred to be redeployed to a dedicated intubation/procedural team, utilizing the airway skills with which I am most comfortable. However, during this crisis, our preferences must come secondary to best maximize our impact. During redeployment, I was fortunate enough to acquire some experience that, I hope, will be useful to otolaryngologists considering redeployment.
Personal Protection
ICU clinicians are responsible for their own safety and must advocate and protect themselves at all times—particularly during the donning and doffing process, where contamination can easily take place. Whether it is disinfecting a powered air-purifying respirator or removing an N95 mask, we should display the same diligence that we do when scrubbing into the operating room. Use this time to don not only the personal protective equipment but also the mind-set required in the ICU. Adherence to the strict habits necessary to maintain safety while in the ICU can be taxing, but it is important to remain diligent when coming on and off the unit. Situations will inevitably arise where a patient requires immediate attention; however, we must remember that personal safety takes precedent—and that means taking the time to properly don our equipment before responding. Consider an approach to patient care that limits time in the ICU (eg, utilizing conference rooms for rounds): the longer we are in the unit, the longer we are at risk; therefore, we should limit our physical presence as much as possible.
Flexibility in Scheduling
When facing redeployment, review your proposed schedule with the lead intensivist to ensure that your efforts are being optimized. The lead intensivist will be aware of changing staff needs that may not be apparent to the person designing the initial redeployment schedule. Being flexible is essential to maximizing your impact.
Teamwork in the ICU
In contrast to our usual role as surgical team leader, when redeployed we find ourselves in a different environment and must fit into the framework of an intensivist-led team. In order to do this job successfully, one must become familiar with many skills that we take for granted as attendings—how to efficiently put in orders, determine the location and status of necessary ICU equipment, and establish lines of communication with other services.
Getting Up to Speed
While brushing up on ICU medicine before redeployment is important, most of the learning will be done on the job, preferably during an early pandemic phase. Be a “sponge” on rounds, and ask questions, regardless of simplicity. As we are working outside our normal scope of practice, it is important to relinquish the role of attending and accept the role of a can-do collaborator. From a medicolegal standpoint, this role is also most appropriate. The best way to learn is to do the tasks yourself. Don’t be an observer. Take on your own patients, but ask for help often when encountering the unfamiliar. Start with low volume and gradually increase the load.
Utilizing Our Skill Set
Although procedures such central lines and arterial lines may be best performed by other team members, certain procedures, such as gastrostomy tube or tracheostomy placement, may be more suited to our skill set. 6 The presence of an otolaryngologist readily able to consult on problems such as epistaxis and postextubation stridor is invaluable. 7
Education and Quality Improvement
Redeployment can be an opportunity to educate our colleagues. On a formal or informal basis, education on topics including postintubation laryngeal injury, ICU-related dysphagia, and tracheostomy care has been well received by ICU clinicians and will lead to improved standards of patient care. 8
Managing Your Otolaryngology Practice
Redeployment can be full-time, but your otolaryngology patients will continue to require guidance. It is essential to have supportive colleagues assist in the management of your practice so that you are able to participate in redeployment without neglecting your established patients. 9
Self-care
The stress experienced by health care providers can be overwhelming, and during these times, it is more important than ever to acknowledge our physical and mental health needs. 10 Even in isolation, support from family, friends, and colleagues can be invaluable in preserving our morale.
I have witnessed ICU team members show tremendous resolve, and we as otolaryngologists must continue to be an example to our students, residents, and colleagues and support those working on the frontlines of this pandemic.