Awareness and use of prone position for awake patients with suspected COVID-19

Abstract

Introduction: Evidence is growing that prone positioning may be a simple, safe, and effective technique to improve oxygenation in awake patients with COVID-19 who are unresponsive to initial therapy. However, there is little evidence about its use in the prehospital environment. This study explores clinician awareness and experiences of this in a large ambulance service in south east England. Methods: An online survey was distributed to 3377 operational ambulance clinicians working for the South East Coast Ambulance Service NHS Foundation Trust to assess their awareness of using the prone position for patients with suspected COVID-19 and their experiences of its use in their practice. Results: A total of 278 respondents completed the survey, of whom 229 were aware of the use of the prone position for awake patients with COVID-19 and 18 had attempted to use it in their practice. Ten reported improvements in clinical observations and patient comfort, and six patients showed clinical improvement only. There were no reports of deterioration. The most common reason for not attempting prone positioning was the absence of formal training or guidance. Conclusion: Ambulance clinicians are aware of the use of the prone position for patients with COVID-19 and a small number have used it. The majority of clinicians who were aware of the procedure did not use it because of the lack of guidance or concerns over patient safety. When attempted, prone positioning in prehospital practice may be an example of practice borne of ‘clinical courage’. Further research is needed before the prone position can be routinely used in prehospital practice.