RCoA responds to on-going PPE situation

On 17 April 2020, Public Health England (PHE) set out updated guidance for PPE use and reuse by healthcare professionals.

The College, alongside the Faculty of Intensive Care Medicine, the Intensive Care Society and the Association of Anaesthetists, has issued a statement on the COVID-19 guidance and information hub.

In response to shortages of PPE, the Government agency responsible for the protection of healthcare workers suggests changes to use and reuse practices that appear to be of unproven safety. An example is a suggestion that FFP3 masks can be folded up and placed in a plastic bag between sessions treating COVID-19 patients. Although this is referred to in a document published by the US’s Center for Disease Control and Prevention (CDC), it is a measure that is only recommended as part of what the CDC calls a “crisis capacity strategy”. The UK Government has tacitly admitted that it cannot supply PPE to the standards formerly published by PHE and supported by the College.

In response to this updated guidance, President of the Royal College of Anaesthetists, Professor Ravi Mahajan said:

“I am acutely aware of significant concerns from our members, who are on the frontline in this battle against COVID-19, about changes to PHE’s guidance over the use of PPE and the on-going levels of PPE supplies available to anaesthetists. 

“We know there are shortages of PPE, and PPE shortages put lives at risk. Not just the lives of our members, who, with nurses, doctors from other front-line specialties and other healthcare workers, are leading the fight against COVID-19, but those at home to whom they return after their long hours of work at hospital.

“The British Medical Association has reported results of a snapshot survey of its members. The results confirm what many of our members are telling us: shortages are real - PPE is not just in short supply - key elements of PPE needed for the safe care of COVID-19 patients are actually unavailable in some hospitals. Almost 50% of BMA members who responded felt pressured to work while wearing inadequate PPE in an area in which aerosol-generating procedures were being performed – the highest risk areas for healthcare workers. Although this snapshot survey may not reflect the picture across the whole of the NHS, it supports our view that many of our members feel that they are being placed in a very difficult situation by shortages of PPE.

“No doctor wishes to have to make the agonising choice between the health of a patient and their own health or that of their colleagues or loved ones. However, employers have a clear responsibility to provide adequate protection for their employees and, if employers fail to do so, employees have the right – and arguably on occasion a duty – to put the benefit to society of their ongoing health ahead of the treatment of an individual patient. This is not something that is going to happen very often – even during the current pandemic – but it is something that every doctor will evaluate carefully when the risks of infection are high and the PPE with which they are provided is inadequate. The General Medical Council (GMC) provides guidance on this issue and makes clear that doctors must assess the situation on an individual case basis.

“In our statement, we make clear that if one of our members is faced with such a decision, and they follow GMC guidance, discuss the problems with colleagues, do their best to acquire and use effective PPE but, having made all the efforts they reasonably can, are forced to conclude that the risk to their own health is unacceptable and that they cannot treat a patient, the Royal College of Anaesthetists will offer them its support. This is one of the worst situations in which a caring doctor or any other healthcare worker can be placed and we sincerely hope it does not arise.

“This pandemic has placed almost intolerable pressures on people, hospitals, governments and nations. It is easy to blame the Government for failures in the provision of PPE, but we must accept that we are all doing our utmost to help and care for the people of the UK in unprecedented circumstances. The Royal College of Anaesthetists will continue to do what it can to support the NHS, the Government, its members and – most important of all – patients.

“I will continue to closely monitor the situation, while maintaining an open dialogue with the Government on the importance of adequate PPE supplies for anaesthetists. 

“As anaesthetists, your highly skilled, committed and selfless work in caring for your patients is central to the United Kingdom’s battle against the virus. The conduct of our members is a matter of great pride for the College and me personally, and I offer you my heartfelt thanks. In the meantime, I will continue to work constructively and in a measured way with the Government to resolve this unsatisfactory situation.”