COVID-19 was first identified in Wuhan, China and is caused by the novel coronavirus SARS-CoV 2. It has now spread rapidly to over 190 countries and territories around the world and has been declared a global pandemic by the World Health Organization. The virus is spread through droplet transmission and currently has a mortality rate of over 4% globally. The pediatric population has been found to be less susceptible to the disease with the majority of children having milder symptoms and only one pediatric death being reported globally so far. Despite this, strategies need to be put in place to prevent further spread of the virus. We present a summary of the general measures implemented at a large adult and pediatric tertiary hospital in Singapore (National University Hospital) as well as the specific strategies in place for the operating room and pediatric intensive care unit.
Increasing the survival rate is the singular priority of practitioners providing care to critically ill patients during the SARS-CoV-2 pandemic in the face of ventilator scarcity. However, as Fig 1 demonstrates, the overall mortality with shared ventilation may exceed ventilator allocation with standard-of-care treatment. It is important for practitioners to acknowledge that shared ventilation is an unproved medical treatment that may cause more harm than good, and its benefit should be demonstrated in a scientific and ethical manner. Physicians of any hospital proceeding with shared ventilation should, at a minimum, (i) obtain informed consent that acknowledges its unproved benefit, (ii) offer non-invasive respiratory therapies or palliative treatments as an alternative, (iii) diligently record and analyse outcomes before and after implementation of shared ventilation, (iv) expeditiously disseminate the conclusions of their analysis publicly, and (v) develop an ethical protocol to discontinue shared ventilation if pre-specified evaluations show harm. It is incumbent upon the first practitioners offering shared ventilation to demonstrate its benefit. Without undertaking such measures, implementation of shared ventilation diminishes the ethical and scientific basis of our care and risks an increased rate of death in the patients we are desperately trying to save.
Background A major challenge for medical undergraduates is the application of theoretical knowledge to the management of acutely ill patients1. It is essential for medical students to develop appropriate clinical and non technical skills, however opportunities are limited in the undergraduate training and simulation is underutilised1. We aimed to assess final year medical students’ clinical and non technical skills through simulated scenarios. Method Students were divided into groups and received the same medical emergencies scenarios. Students were marked for their clinical and non technical skills using the Anaesthetics Non Technical Skills scoring system. A scoring system was designed to assess clinical skills for patient initial assessment. Mean value was calculated for the clinical and non technical skills. Medical students were also asked to provide the number of the simulation sessions that they received during their training. Feedback was also obtained for the simulation sessions. Results Between April 2014 – May 2014, 20 final year medical students have received simulation sessions so far. Medical students demonstrated a mean score of 13.3/16. With regards to non technical skills medical students demonstrated acceptable non technical skills in each of the four domains: Task management (mean: 3.18 ± 0.23), Team working (mean: 3.1 ± 0.5), Situational Awareness (mean: 3 ± 0.5), Decision making (mean: 3.1 ± 0.25). Medical students during their overall training have received a mean number of 4.35 simulation sessions (range 1–7). 50% of them were delivered at Croydon University hospital. 100% of students found the simulation sessions extremely useful and they addressed descriptively the need for more simulation sessions. Potential impacts According to our observations, final year medical students demonstrate acceptable clinical and non technical skills. However the number of simulation sessions that they receive during their undergraduate training is remarkably low and therefore consideration must be given in implementing simulation curriculum in the final year of undergraduate training.2 References Weller J, Simulation in undergraduate medical education: bridging the gap between theory and practice, Med Ed 2004; 38: 32–38 Weller J, Nestel D, Marshall S et alet al. Simulation in clinical teaching and learning, Med J Aust 2012; 196 (9): 594
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