The North-Cen­tral Re­gion­al Health Au­thor­i­ty (NCRHA) is giv­ing as­sur­ances it is do­ing every­thing pos­si­ble to pro­tect its staff even as they con­tin­ue to be in­un­dat­ed with in­creas­ing num­bers of “very ill COVID-19 pa­tients” in the Emer­gency De­part­ment.

In an of­fi­cial state­ment is­sued to­day, the NCRHA seeks to al­lay fears and ad­dress con­cerns in the pub­lic do­main that its med­ical cen­tres are not pre­pared to deal with grow­ing num­bers of COVID-19 pa­tients, and that its staff is too burnt out to man­age the ris­ing tide.

The fol­low­ing is the full text of the NCRHA state­ment…

The NCRHA takes se­ri­ous­ly the sto­ry that has been pre­sent­ed by the Trinidad and To­ba­go Ex­press in to­day’s news­pa­per.

The Au­thor­i­ty ac­knowl­edges that, in light of the in­creased in­take in Emer­gency De­part­ments, na­tion­al­ly, cou­pled with the surge in the num­ber of pos­i­tive COVID-19 cas­es, the North Cen­tral Re­gion­al Health Au­thor­i­ty has sys­tem­at­i­cal­ly im­ple­ment­ed nec­es­sary mea­sures to ex­pand and boost its ca­pac­i­ty in or­der to be bet­ter po­si­tioned and pre­pared to de­liv­er the best pos­si­ble pa­tient care.

The NCRHA al­so notes, with trep­i­da­tion, the ris­ing tide of very ill pa­tients in­fect­ed with the COVID-19 virus who are now be­ing cared for by a fi­nite hu­man re­source at the Emer­gency De­part­ment.

It is im­por­tant to note that staff who are cur­rent­ly en­gag­ing this surge of very ill pa­tients have been en­gag­ing the rig­ors of the COVID-19 virus over the last two years with­out cease. In or­der to avoid burnout, the NCRHA tries to ro­tate staff, es­pe­cial­ly in high traf­fic ar­eas. Ro­ta­tion al­so pro­vides op­por­tu­ni­ties for oth­er qual­i­fied mem­bers of staff to gain ex­pe­ri­ence and ex­pand their re­spec­tive skillsets. These process­es are not un­der­tak­en with­out the di­rect su­per­vi­sion and in­volve­ment of high­ly qual­i­fied se­nior team med­ical per­son­nel.

Psy­cho­log­i­cal and psy­chi­atric ses­sions are con­duct­ed with our in­her­ent re­sponse team in or­der to build psy­choso­cial re­silience with­in the sys­tem.

As best as pos­si­ble, staff re­as­sign­ments are tasked to in­di­vid­ual de­part­ments, as the re­spec­tive de­part­ments, it is thought, would best know the in­di­vid­ual strengths and weak­ness, sched­ules of the of­fi­cers and var­i­ous pe­cu­liar­i­ties that make the of­fi­cer suit­able or un­suit­able for a giv­en du­ty.

A nurse dressed in a complete hazmat suit. (Image courtesy NCRHA)

PPEs …  At present, the AED has un­der­tak­en nu­mer­ous steps to en­sure that the de­part­ment re­mains func­tion­al and is equipped with all nec­es­sary PPEs re­quired. Reg­u­lar checks and up­dates are con­duct­ed to en­sure that there are no short­ages that would con­se­quent­ly af­fect the de­liv­ery of health­care. In an­tic­i­pa­tion of de­mand, the Au­thor­i­ty has al­so re­cent­ly ramped up its sup­ply of PPE by 150%. There is no short­age.

Gloves …  The de­part­ment has var­i­ous sizes of ster­ile and non-ster­ile gloves for use by all staff. Week­ly stocks checks are un­der­tak­en by nurs­ing per­son­nel to en­sure that stocks a rou­tine­ly re­plen­ished. Our cur­rent sup­ply is over 150% of uti­liza­tion.

Don­ning and Doff­ing …  All so­lu­tions for doff­ing are read­i­ly avail­able and ac­ces­si­ble. In ad­di­tion, rel­e­vant staff re­ceived IPC train­ing which teach­es prop­er tech­niques for doff­ing and don­ning which the NCRHA en­gaged dur­ing the ear­ly on­set of the pan­dem­ic and con­tin­ues still on a reg­u­lar ba­sis.

Sat­u­ra­tion Mon­i­tors …  At present, there is an ad­e­quate sup­ply of pulse oxime­ters, with week­ly mon­i­tor­ing of stock to en­sure that what is de­plet­ed is re­plen­ished in a time­ly man­ner. We al­so pro­vide our pa­tients with SPO2 mon­i­tors.

Oxy­gen …  At present, over two hun­dred oxy­gen tanks with oxy­gen gauges are read­i­ly avail­able. Oxy­gen tanks are rou­tine­ly re­plen­ished dai­ly at 4–5-hour in­ter­vals to en­sure that there is no short­age of sup­ply. In fact, in re­sponse to the surge in COVID-19 cas­es, the Au­thor­i­ty has fur­ther ini­ti­at­ed an ad­di­tion­al 25% ramp up on oxy­gen tanks to meet the in­creas­ing de­mands. Our cur­rent sup­ply is our 200% uti­liza­tion.

In ad­di­tion to which, the NCRHA has a team of EMTs do­ing reg­u­lar oxy­gen rounds, in tent ar­eas par­tic­u­lar­ly, every 3-4 hours to check pa­tient oxy­gen lev­els. This team al­so has stand­ing or­ders to gauge whether or not pa­tients are ac­cess­ing nec­es­sary lev­els of oxy­gen—whether to be re­duced or in­creased.

A head-and-shoulders shot of a nurse dressed in a complete hazmat suit. (Image courtesy NCRHA)

In an ef­fort to rec­on­cile the in­evitable is­sues that will arise due to the grow­ing de­mands of larg­er and larg­er num­bers of very ill pa­tients on a fi­nite num­ber of doc­tors, nurs­es and oth­er an­cil­lary staff—(dri­vers, clean­ers, pa­tient es­corts, etc), a va­ri­ety of strate­gies have been em­ployed:

   ●   In­sti­tu­tion-wide, manda­to­ry, gen­er­al and spe­cif­ic, tiered train­ing of var­i­ous lev­els of staff, in an­tic­i­pa­tion of po­ten­tial cri­sis sit­u­a­tions in re­la­tion to the COVID pan­dem­ic spear­head­ed by Train­ing and De­vel­op­ment Unit along­side IPC unit in ar­eas such as: Air­way Man­age­ment, Ba­sic Emer­gency Train­ing-COVID-19, Ba­sic Life Sup­port (BLS), Care of the Ven­ti­lat­ed Pa­tient, Con­ver­sa­tions on Men­tal Health Talk Se­ries, Covid-19 Vac­cine Process Flow, Covid-19 Vac­cine Sen­si­ti­za­tion, Covid-19 Ward Man­age­ment, CPR, Gauges on Med­ical Tanks, Grief Man­age­ment, ICU, IPC Train­ing & Sen­si­ti­za­tion COVID-19, Man­age­ment of Post COVID as well as Psy­choso­cial Sup­port

   ●   Cre­ation and de­vel­op­ment of spe­cif­ic pro­to­cols for the man­age­ment of the re­sponse.

   ●   Vac­ci­na­tion of will­ing staff, in keep­ing with the na­tion­al pol­i­cy

   ●   All of­fi­cers who vol­un­teer are ac­cept­ed and qual­i­fied

   ●   Hir­ing of ded­i­cat­ed of­fi­cers for work in COVID fa­cil­i­ties

   ●   Bol­ster­ing of locum pools of of­fi­cers for re­place­ment of staff on leave

   ●   Di­ver­sion of re­source from the non-COVID path­ways to the COVID path­ways, de­pend­ing on need as­sess­ment.

   ●   Where of­fi­cers are re­as­signed, they are placed on a for­mal ros­ter in­di­cat­ing their re­quire­ments. In sit­u­a­tions of acute need, this may be sub­sti­tut­ed by di­rect com­mu­ni­ca­tion with the in­di­vid­ual through De­part­ment heads.

   ●   In cas­es where it is rec­og­nized that the staff is work­ing in ex­cess of their con­trac­tu­al time, there is an ex­ist­ing a com­pen­sa­tion sys­tem in place, which is ful­ly op­er­a­tional and cur­rent­ly be­ing uti­lized.

   ●   In stan­dard re­sponse to a mas­sive surge, as would be the case in a mass ca­su­al­ty, all of­fi­cers on site are re­quest­ed to ren­der as­sis­tance. These are ex­tra­or­di­nary times.

   ●   In the ex­e­cu­tion of the re­sponse, there may be the mi­nor in­stance where these guides may not have been pos­si­ble or rec­og­nized, due to un­fore­seen ill­ness or un­avail­abil­i­ty.

Notwith­stand­ing, the North Cen­tral Re­gion­al Health Au­thor­i­ty has en­gaged an in­ves­ti­ga­tion in­to the al­le­ga­tions and is con­tin­u­ing to mon­i­tor the on­go­ing sit­u­a­tion. We will con­tin­ue to en­gage con­sul­ta­tion at all lev­els to pre­serve the dig­ni­ty of our staff and our pa­tients.