ERH: We’re now on the COVID-19 frontline

By Ivy Jensen

IT STILL does not seem quite real here but Echuca Regional Health is still staring down the barrel at the biggest health crisis in its history.

Never before has a pandemic affected life as we know it like coronavirus has.

And standing on the frontline are our healthcare workers – the emergency department doctors and nurses who will be hands-on as the cases come in.

The hospital has spent weeks getting ready for COVID-19 with health professionals going through repeated training sessions so they can swing into action the minute that first serious or critical case arrives.

And while many consider frontline staff the heroes, emergency department unit manager Craig Frew said they were just doing their jobs.

“We don’t consider ourselves heroes. We’re just doing what we do every day,” he said.

“This is our role, and this is what we do. It’s just a little bit more complex at the moment.”

Echuca Regional Health ED manager Craig Frew at the hospital's negative pressure room which will be used to intubate COVID-19 patients.

Craig said the hospital had set up dedicated intubation facilities in its two negative pressure rooms, one of which was in the ED and the other in the medical ward.

“If a patient deteriorates and needs intubation – an airway support tube down the throat – and ends up on a ventilator, that procedure has to be done in a negative pressure room,” he explained.

Negative room pressure is a technique to isolate patients with airborne contagious diseases to prevent cross-contamination from room to room.

“It’s all about reducing aerosol because when a tube goes down, the risk of COVID coming out of the lungs is much higher,” Craig said.

“Those rooms have been set up for that procedure and we’re doing simulation training to cover that process.”

Two groups of specialist staff recently attended intubation training in Bendigo before training local staff through simulation sessions.

“We had staff take on the role of airway nurse, airway doctor, team leader etc.,” Craig said.

“It’s a systematic approach to make sure everything is covered to reduce that risk of exposure to our staff.

“If we get to that point, staff are in full PPE, gown, hairnet, goggles, masks and double gloves. It’s all about staff safety as well as the best outcome for the patient.”

Echuca Regional Health's Gemma Wilson, ED unit manager Craig Frew and Rob Grant during a COVID-19 training session.

Worst-case scenario, if there was an influx of patients with coronavirus who needed hospitalisation, Craig said the hospital would be able to cope.

“We have capacity for quite a number because elective surgery has been cancelled, so we could take 10 easily if need be,” he said.

“We’re lucky we’ve got some highly skilled staff with their level of expertise because there was initially talk of there not being enough ICU beds in the state and while we don’t have a dedicated ICU, we have high-dependency unit.

“If we did reach the point where we didn’t have access to ICU beds, or the ability to transfer patients out, then we could maintain them here with our critical care-trained staff who would be able to look after ventilated patients.

“Plus, we’ve got access to five ventilators here. We do ventilation but it’s normally short-term.”

For patients suspected of having coronavirus and needing hospitalisation, Craig said they would be co-located at one end of the wards as inpatients.

“We can locate them anywhere in emergency, obviously wearing a face mask, but we’ve chosen to co-locate them away from the general daily business because we’re still doing running that in parallel,” he said.

The back-up plan is Bendigo hospital.

“It is our referral centre and the team there has been very supportive, and they’ve told us if we have positive cases they are prepared and willing to take those patients, so we’ve always got that back-up,” Craig said.

Echuca Regional Health staff Hayley Currie and senior medical officer Dr Gerhard Uys during a COVID-19 training session.

“The same goes for if a patient intubated and on a ventilator, we could cater for them short-term up to 24 hours, but Bendigo is our referral point.”

Just as ERH is the referral point for Kyabram, Rochester, Elmore, Cohuna and Kerang.

Echuca hospital is one of 19 Victorian hospitals with a screening clinic set up specifically to test for COVID-19.

It is set up in the short-stay unit, which closed down late last year due to funding.

As of last week, more than 400 people had presented for screening, with just over half meeting the guidelines to be tested.

“We’ve had kids, teenagers, right through to people in their 80s,” Craig said.

“We also get lots of phone inquiries because there is so much anxiety out there and people are just unsure.

“We are very strict with guidelines as set by Victoria’s chief health officer and as a publicly funded hospital that’s what we work to.”

This has caused frustration among some people.

“When we first opened, a lot of patients presenting might have had a runny nose or cough and their work or school told them to go and get cleared before coming back. They didn’t meet the criteria, so they weren’t receiving a swab,” Craig said.

“Some people were ringing the hotline and getting mixed messages being told they should be swabbed. When they were coming here and told they weren’t going to be swabbed, then there was some frustration, which you can understand given the heightened anxiety.”

Craig said the process for those attending the clinic started at emergency, where they would be given a mask, have their temperature taken and be ordered to wash their hands.

“Then they are assessed as per the matrix of the criteria as set by the Department of Health and go into our screening clinic, which is a separate area so they’re not sitting in our waiting room,” he said.

“There are areas where they can be in a cubicle or in the screening room if they warrant having a swab.

“If swabbed, they are given information about going home to self-isolate for three days minimum, depending on how long it takes for their results to come back. It can take up to four days because there are so many tests being done around the state.

“Swabs at the end of last week were a bit of an issue. We had about 20 swabs left but by the next day the Department of Health had given us another 100.”

Before patients who are tested leave the clinic, a referral is done to the complex care team.

“They make sure they’re in self isolation and do a welfare check to ensure they’ve got food and toilet paper and someone to check on them and find out of their symptoms are worsening and how they are feeling,” Craig said.

Echuca Regional Health's Gemma Wilson and ED unit manager Craig Frew during a COVID-19 training session.

With caregivers and healthcare workers among those at highest risk of contracting the disease through exposure, extra vigilance of hygiene practices is now as important as ever.

“You don’t know who’s positive coming in to be screened but that’s why we have all that handwashing, social distancing, PPE and all of that to reduce that risk as much as possible,” Craig said.

And while it would play on the minds of health staff, Craig said team morale was better than ever.

“The team have been fantastic, not just in ED but across the hospital,” he said.

“We’ve seen staff trying to help each other out. With some surgery being cancelled, there are a lot of staff around, so they are putting up their hands to help out, do extra shifts and to staff our screening clinic, which is open 9.30am to 6pm seven days week.

“Everyone who is doing that is doing it in addition to their normal contracted hours. We’ve got plenty of staff and they have been fantastic just wanting to do what they can to help out. The camaraderie has really come through. Everyone is working together as a team.”

As for Craig, he’s on the frontline on both sides – at work and home.

The coronavirus has not only impacted his day to day operations of managing an emergency department, but his family life.

“My wife is a GP in town so we’re both working fulltime, we’ve got kids, one of whom is doing year 12, which is a bit of a concern,” he said.

“Our other daughter is at Monash and is about to do online learning. Our son was in the States on a basketball scholarship and studying. He was due to come home in May, but we managed to get him home before the deadline set in and he’s just done his two weeks isolation.

“As a parent, you worry about your kids, especially when they’re in a different country and you see the stats in America.”

That is why Craig is more than happy to comply with the tough restrictions enforced in Australia.

“Everything the government have done has been completely necessary to stop that spread and very shortly we’ll see that curve flatten, but how long it takes I don’t know,” he said.

“We’re feeling much more reassured now we’ve got social distancing and isolation in place. The risk for us is lessened and we can still come to work and hopefully have a positive impact on the way it’s going and treating people.”

Echuca Regional Health ED manager Craig Frew at the hospital's COVID-19 screening clinic.

He is even optimistic enough to say he expects to see a reduction in cases.

“The two positive cases we’ve had in our clinic have all been from overseas travel. There has been no local or community-based transmission,” he said.

“Now we’re at the tail end of people coming back from overseas, anyone coming in now is in lockdown in a hotel, so that’s reducing that risk of them just ducking out to the shops or doing whatever.”

So, the real battle has now moved to community transmission and if it does break out here, Craig and his team are as ready as we will need them to be.

“We’ve never faced anything like this before. I don’t think anyone has,” Craig said.

“We’ve been through SARS, and that sort of thing in the past, and had lots of planning, but this pandemic is worldwide, global and we’ve never seen anything to the point where businesses are shut down and schools are affected.

“Because this is unprecedented and we’re learning as we go, things can change on a regular basis, so it is very difficult to manage. But the best thing is having a committed and professional team.”