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Hey all, lets all be civil with the responses here if possible... 

In all seriousness, WHAT WOULD YOU DO, if you walked into the ED and you were told, "we have no more masks" but "the cdc says bandanas are okay for now, or grab a ziploc and fill it with leaves, poke holes in it and duct tape it to your face"

I am preparing for this day. This is, in one way or another, what we signed up for in emergency medicine (not literally this but I guess it comes with the territory), but would ya'll still work or what?

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I think this gets to the heart of what is our ethical duty?  In the same way to the thread, "Are you willing to die for your patients and your practice? How about risking your family?"

If the shortage is due to a national shortage then I would get to work as normal.  If the shortage were due to my employer being inappropriate I would require proper PPE before doing anything that is not truly emergent.  For example, I have posted elsewhere that an NP colleague of mine was barred from wearing her personally purchased N95 masks while working in our hospital's "covid clinic."  Under that type of situation, unless the hospital was able to provide me with proper hospital acquired PPE I would refuse to work except for truly emergent situations.

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On 3/23/2020 at 5:58 PM, mgriffiths said:

I think this gets to the heart of what is our ethical duty?  In the same way to the thread, "Are you willing to die for your patients and your practice? How about risking your family?"

If the shortage is due to a national shortage then I would get to work as normal.  If the shortage were due to my employer being inappropriate I would require proper PPE before doing anything that is not truly emergent.  For example, I have posted elsewhere that an NP colleague of mine was barred from wearing her personally purchased N95 masks while working in our hospital's "covid clinic."  Under that type of situation, unless the hospital was able to provide me with proper hospital acquired PPE I would refuse to work except for truly emergent situations.

you made some good points and I agree. And I have absolutely zero shame in saying that I am 100% not willing to die for my patients, because, quite frankly, this is not the military and I have a family that needs me. Call it cowardly, really don't care. I will go into the trenches until the end of time if I have the right protection, otherwise, I'm all set...... To simplify things, how many providers would perform a DRE on a patient who was Cdiff positive, MRSA positive from a perirectal abscess, without gloves? the answer is zero... nobody would, under any circumstances... 

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Got my P100 respirator today; fallback in case we get to the point of needing bags of leaves in the ED...

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6 minutes ago, ohiovolffemtp said:

I wonder if the cartridge respirators that were distributed to fire departments during the WMD scare would be of value.

We've been considering anything in inventory.  If we run out of masks, we may be using SCBA on medical calls.

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If I went to work tomorrow and my charge nurse told me we have no more respirators/mask/PPE...I would refuse to take an assignment and I would clock out and not return...with my resignation effective immediately emailed. 

When all is said and done, if I contracted COVID and died, then what? I'll just be another memory. That's it. No legacy. The CEO will continue to sit pretty - well and alive with his/her family. Me? 6 ft under.

 

Edited by Diggy
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I think you have posed the question in a way that really may become the experience of multiple clinicians: you walk in and are told there is not proper PPE--for your shift TODAY.

I believe in general this isn't going to be a far-sighted forewarning from hospital admins. It will be a last-minute decision that will need to be made on the fly. Absolutely made worse with the "I told you so's" of clinicians warning admins of waning PPE supplies.

The thought of abandoning patients and other coworkers is a really big pill to swallow. I can't say for sure what I would do. My instinct is that I would go in and try to use the best makeshift PPE I could. Then complain like hell and send info to both higher ups and admins. And maybe the media, like a ER doc did with a New York Times vlog I watched yesterday.

But.. no sé..........

https://www.nytimes.com/video/nyregion/100000007052136/coronavirus-elmhurst-hospital-queens.html

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No.

I would not be a hero by continuing to work.  I'll get sick and take possibly take up limited resources.  Before I go home to quarantine, I'll be potentially spreading the virus to uninfected patients.

Also, CDC does not say bandanas/home made masks/scarves are "OK." They recommend it as a last resort, better than nothing, if no PPE is available.  

 

From CDC:

"In settings where facemasks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face."

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10 minutes ago, DarwinStarwin said:

The thought of abandoning patients and other coworkers is a really big pill to swallow.

 

9 hours ago, Diggy said:

If I went to work tomorrow and my charge nurse told me we have no more respirators/mask/PPE...I would refuse to take an assignment and I would clock out and not return...with my resignation effective immediately emailed. 

When all is said and done, if I contracted COVID and died, then what? I'll just be another memory. That's it. No legacy. The CEO will continue to sit pretty - well and alive with his/her family. Me? 6 ft under.

 

Unfortunately, patient abandonment is possible grounds for a malpractice lawsuit if there is necessary care to be given and one did not provide a valid reason, reasonable notification and/or covering provider. With that said, what are the implications during a pandemic? It's not the patient's fault that we're not properly protected. This would need to be discussed with a malpractice lawyer. 

After all, aren't we taught to apply the overhead oxygen mask to ourselves first before helping anyone around us? If there's none of us left, who will take care of these patients? Uncertain times, indeed. 

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4 hours ago, Sed said:

 

Unfortunately, patient abandonment is possible grounds for a malpractice lawsuit

It is only considered patient abandonment if I ACCEPTED a patient assignment then decided to leave without reporting off that assignment. Hence why I said I would refuse said assignment and clock out.

Edited by Diggy
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^ I thought I read somewhere that Cuomo signed some legislation that significant limited malpractice in NYC recently to help deal with the pandemic.

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40 minutes ago, Diggy said:

It is only considered patient abandonment if I ACCEPTED a patient assignment then decided to leave without reporting off that assignment. Hence why I said I would refuse said assignment and clock out.

Would a set shift not be considered an assignment of sorts? Also, if you recall, the stipulation requires adequate notification. I don't think that showing up to your shift, refusing to clock in, and then walking out is a reasonable amount of notification. But then again, neither of us are lawyers so there's no sense in discussing technicalities. Just thought I'd throw it out there so everyone protects themselves in all ways. 

Stay safe out there! At least you still have a job cuz I won't here soon. Lol

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Patient continuity of care never requires a provider to place themselves at meaningful risk of harm.  If you don't have a BVM or similar device, you're not required to do mouth-to-mouth on a coding patient.

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This might be unpopular opinion in the medical world since we are all supposed to have hearts of an angel, but I'd probably leave. If I am being asked to do something that places an unnecessary level of risk for myself and subsequently my family, then I'm out. Sorry.

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3 hours ago, HanSolo said:

This might be unpopular opinion in the medical world since we are all supposed to have hearts of an angel, but I'd probably leave. If I am being asked to do something that places an unnecessary level of risk for myself and subsequently my family, then I'm out. Sorry.

I'm there with you. It's unfortunate that we don't have the necessary supplies and yet patients still need care. If no one is willing to step up, then who's to do it? Lottery? Only single, unmarried, and/or childless folks? Young providers who are at the presumedly lowest risk?

Don't even start on the fact that people are being furloughed or laid off which further decreases the workforce or the fact that ethics committees are having to develop protocols for possible ventilator allocation, aka lottery... 

Crazy times right now and foreseeable future. 

(Rhetorical questions, btw.)

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The time is coming. We’re reusing ppe now and frankly getting just one n95 makes for a shift on a newly formed covid unit is becoming very difficult. It’s flat out wrong. A doctor on our service already is declining to come to work. If it gets much worse I guess I will have to follow.

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Really hard.  Before having kids I would have worked.  (Course I volunteer for military service as well). 
 

after kids.  Wow really hard.  Leaving my job (likely gets fired) hurts them but having no dad is worse.  I would likely not clock in.  Call my wife.  Talk to her and make a decision together.  We are in it together. 
 

yup I would deal with serious guilt the rest of my (alive living) life.  

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On another thread I asked this question...would you die for your practice.  Many said yes....then I asked, would you sacrifice your wife, husband or kids....a choice you make for them?   Crickets......

It's criminal what we are being asked to do without adequate protection, and if even one spouse or kid of one of us dies because of it....it would not be worth it.

Edited by Cideous

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On 3/26/2020 at 4:12 AM, Diggy said:

If I went to work tomorrow and my charge nurse told me we have no more respirators/mask/PPE...I would refuse to take an assignment and I would clock out and not return...with my resignation effective immediately emailed. 

When all is said and done, if I contracted COVID and died, then what? I'll just be another memory. That's it. No legacy. The CEO will continue to sit pretty - well and alive with his/her family. Me? 6 ft under.

 

If my health/life  isn't important enough to provide PPE to me , I'm out of there!

Edited by CAdamsPAC

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On 3/26/2020 at 7:59 PM, HanSolo said:

This might be unpopular opinion in the medical world since we are all supposed to have hearts of an angel, but I'd probably leave. If I am being asked to do something that places an unnecessary level of risk for myself and subsequently my family, then I'm out. Sorry.

Why aren't the suits and bean counters right there beside the clinical staff since their failures led to the lack of PPE? Has anyone thought to ask where the grant money for "disaster preparedness" that so many health agencies and hospitals accepted went to???

Edited by CAdamsPAC
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2 hours ago, CAdamsPAC said:

Has anyone thought to ask where the grant money for "disaster preparedness" that so many health agencies and hospitals accepted went to???

Trips, meetings, food, consultants, occasionally into really cool looking binder covers for documents everyone forgot about and weren't remotely up to date.

I'm hearing echoes of why I left computer security.

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The responses to this thread are certainly interesting... and run the gambit of what one would expect.  It is not unreasonable to think of oneself in times like this when those who are supposed to provide for us have failed to do so, and in doing so, have made it impossible in some places to do our jobs - not without severe risk to ourselves.  This is not a reasonable standard to which anyone can be legally held - you may have to fight with your medical boards but in the end, you are not obligated to expose yourself to harm without protective equipment as part of your job.  The ED is our scene.  The first principle is scene safety.  If you are not safe, you just don't go in.  Me being dead does no one any good.

G

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