I’m currently detecting quite a bit of, “Shock, Horror!” on Twitter by the infection prevention and control community this evening by the release of a new government document daring to propose how we might consider the re-use of personal preventive equipment (PPE.)
“Considerations for acute PPE shortages” I view as a useful “thought piece,” issued this evening by a government seeking to try and answer some of the difficult questions we are all currently facing and rather than the shock and indignation, I prefer to read and think through how I feel about what is being proposed. I learned some of my most valuable career lessons the last time I was involved in a crisis situation and I’d like to tell you a story from that crisis to illustrate my point.
In the spring of 1982, General Galtieri invaded the Falkland Islands. Not personally, he persuaded his military to do so.
As a Surgeon Lieutenant in the Royal Navy and a trainee medical microbiologist I was sent by Hercules to Ascension Island to join HMS Brilliant, which led the battle group to retake South Georgia. During the attack, we were involved in the chase of the Argentinian submarine Santa Fe as well as landing SAS soldiers on the island. Having re-taken the island, there was an incident which involved the death of an unfortunate Argentinian sailor. As a trainee pathologist, I was invited to go and examine the body and write a report for the military command in London. The ship had been ferrying SAS soldiers ashore in the helicopter. The battle won, the soldiers were asked to leave the helicopter and a number of us were sent down the backend of the ship to jump into the helicopter in their place. As I walked towards the helicopter, one of the SAS approached me and offered me his pistol to take with me in case I needed protection. I kindly declined.
The helicopter doors had been removed and there were no seats internally. The Diving Officer was also in the aircraft and was going to blow the screws of the submarine that had been captured. The captain of the aircraft said, “Jump in, hang on and don’t fall out, you won’t live long in this water.” I sat on a box of explosives.
We took off in fog and the captain of the aircraft advised he had no idea where we were in the fog and had to find the edge of the island visually by flying very slowly towards what was a lump of rock sticking out of the water. He suddenly found it, veered and then followed the coast to Grytviken.
When the war was over, and we were back at Ascension Island where I was due to pick up transport back to the UK, I was invited and join the aircraft to be ferried back to Ascension Island. I was taken into the ship’s hanger where the same helicopter pilot took me and colleagues through a safety briefing. He explained we were to be strapped in at all times, we were not to move until instructed, and he also went through the escape procedures in the event of a crash in the sea or overland.
I asked him what had happened? Why all the sudden rules and regulations? He explained, “Last time you flew with me, we were in a state of war. Now we are back to peace time operations and normal safety rules apply.”
I tell the story because it illustrates that things are different in a war. We are not currently in a war but we are certainly in a battle.
The rules have to change. You will change as you respond to what is going on and I suggest in retrospect, this will be one of the most exciting and challenging times of your lives. These opportunities do not come along often and you will learn an awful lot about yourselves. You will need to rise to new challenges, do things that are risky and take decisions in the absence of instructions from on high. As you have already witnessed, the start of this journey is chaotic. My Falklands story shows this is always the case. Most people have never done this before and so they are also learning. Try not to criticise. It’s difficult.
What I read in this new guidance document was a clear statement that what is proposed is for consideration in an emergency situation. If you run out of PPE, you are faced with a dilemma. Do you refuse to work or do you choose to work differently? I would choose to work differently and I would look to this document and consider for myself what I will do.
Since originally writing this piece, Wales has issued the guidance with a clear note to advise shortage of PPE is not anticipated. This is clearly welcome but I would continue to urge you to read carefully as the guidance will help you think though how you could respond if you were faced with this dilemma.
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