Background:
Many procedures requiring sedation in the pediatric emergency department are performed by consultants from outside the department. This team usually includes orthopedic surgeons and general surgeons. As sedation is now a standard of care in such cases, we evaluated consultants' views on sedation.
Objectives:
To evaluate consultants' views on sedation.
Methods:
A questionnaire with both open-ended questions and Likert-type scores was distributed to all orthopedic surgeons and general surgeons performing procedures during the study period. The questionnaire was presented at three medical centers.
Results:
The questionnaire was completed by 31 orthopedic surgeons and 16 general surgeons. Although the vast majority (93–100%) considered sedation important, a high percentage (64–75%) would still perform such procedures without sedation if not readily available.
Conclusions:
Sedation is very important for patients and although consultants understand its importance, the emergency department staff must be vigilant in both being available and not allowing procedures to "escape" the use of sedation.
The year of 2019 was a year in which global health took an unexpected turn. In late 2019, media worldwide began reporting about a new, mysterious, novel virus which originated in Asia. This virus, SARS-CoV-2, emerged in Wuhan, China and spread throughout the globe. In March 2020 a global pandemic was declared. World leaders were trying to determine how to face the disease. At the same time, millions of people around the world were under quarantine.
As students, we were exposed to the difficulty of our fellow medical staff colleagues working in Corona wards. The time spent by the medical staff in the Corona ward itself was restricted and the staff was required to wear personal protective equipment. Our colleagues felt that their human connection with the patients was disturbed and they were also having a difficult time recognizing one another. At the same time, the patients were feeling extremely isolated and anxious. Doctors with whom we have contact informed us that many patients in the Corona wards say that they feel lonely and isolated.
The patients had minimal contact with their families, and could not see the faces of their physicians. The media described the medical staff as "the people in white suits" which they could not even tell apart. Human connection is a basic need for human beings1. We hypothesized that denying people of basic human contact might be mentally harmful and even hurt their recovery from Corona.
A doctor working in the corona wards wrote: “My first week as a resident in the Corona unit. 12 hours shifts, no day nor night, I have no idea what day it is, and it does not really matter. The most difficult thing for me is patients’ loneliness. I limit entering their rooms to protect my team members and myself. When I must enter, I am completely covered with my protective equipment, so they cannot see anything but my eyes, which are also covered by huge goggles. Even with this protection, I limit my touch. Yesterday I went in to take a blood tests from an elderly patient, when I was done, as I was leaving the room, she begged me to stay. I could not handle her suffering and told her I would come back soon. I didn’t return yet…” (a quote from a Facebook post, posted by the doctor).
To deal with this situation, we founded the "More than Masks" project. This project offered a quick and simple solution- printing stickers with the staff members faces and placing them on their chest. Word about More than Masks spread quickly on social media gaining vast popularity and support enabling us to recruit funds as well as dozens of volunteers for the project. The volunteers assisted in graphic designing, printing the stickers and in transporting them to the wards.
The project has expanded not only to corona wards but also to other wards such as geriatric and pediatric medical centers, in which stickers of the smiling medical staff members can alleviate anxiety and might even help prevent the occurrence of states of altered mental status, such as delirium2.
Seeing pictures of the medical staff could promote feelings of familiarity which is a small gesture that makes an enormous difference, for both the patients and medical staff.
As of May 2021, the project has supplied stickers for approximately 2,400 medical staff members from about 50 wards in 19 different hospitals in Israel. Overall, over 300,000 stickers have been printed by the More than Masks project. In addition, an online portal was created in cooperation with HP indigo, to which every staff member can upload their photo and obtain a sticker. More stickers were printed by similar projects that were established around the world for example in the Philippines, Poland, Mexico, India, Argentina with help and guidance from the Israeli project More than Masks.
References
1. Hagerty, S. L. & Williams, L. M. The impact of COVID-19 on mental health: The interactive roles of brain biotypes and human connection. Brain, Behav. Immun. - Heal. 5, 100078 (2020).
2. Inouye, S. K. The Importance of Delirium and Delirium Prevention in Older Adults During Lockdowns. JAMA 325, 1779 (2021).