Nicholas Yule – Prince Charles Hospital
Well where do I start? What a different world we find ourselves in as radiographers. Our entire situation suddenly changed when we first heard about COVID-19 a few months ago and this has continued throughout the pandemic. Our working practices and the way we interacted with other staff and patients rapidly and dramatically changed while different advice regarding personal protective equipment (PPE), which change weekly if not daily, was implemented.
Initially however, radiographers were not always identified to be frontline workers, despite the fact that we have to examine all patients. This included the queries, positives and the very ill patients on COVID-19 wards and ITU where they were being ventilated. Most members of the public are unaware of the work done by radiographers on the frontline and most news items simply refer to doctors and nurses. With help from our Society and College of Radiographers health and safety and industrial relations representatives, our role was recognised and it was good to hear Prime Minister Boris Johnson mentioning radiographers when he was discharged from hospital. I would like to pay tribute to all those working in the NHS and to emphasise that all have an important role to play.
Our working practices radically changed and our department had to cancel all non-urgent examinations from CT scanning to ultrasound examinations. Our emergency department also saw a marked reduction in patient attendances, which again had a radical effect on the work of the whole department. This reduced our requirement to perform routine patient examinations, but the time taken on the examinations we were performing was actually longer and this meant that rotas were changed to even up the amount of staff in work at any time and for the possibility of having to cover staff shortages due to the necessity for self-isolation.
The hospital also adopted a traffic light system, red COVID-19, amber and green areas, reducing the risk of cross-infection and keeping COVID-19 and non COVID-19 patients separate.
Despite having worked in the NHS for 32 years and being involved in dealing with previous pandemics there has been nothing to compare to this; however, in all this it must be remembered that we still have to examine the routine patient.
The most worrying time was when I had to attend the COVID-19 ITU for the first time. It really felt like being a first year student again, not really knowing what to expect and in addition having to cope with the more advanced donning and doffing of PPE, which have become the new buzz words.
Examining patients in COVID-19 ITU was extremely daunting and stressful at first. Working practices and routines had to be completely modified, the way of approaching the bedside of the very ill patient and the setting up of the examination had to be radically changed. We decided to have two radiographers working as a team to carry out all COVID-19 mobile examinations. This involved one radiographer working in the “clean” area and the other in the “dirty” area. Our professionalism and patient care is always at the forefront when we undertake these examinations but to relieve the stress we pretended to toss a coin to decide which role we would take. This does help to reduce the tension, especially when the coin rolls under the mobile.
Changing into theatre scrubs and shoes is the easy part – now for the donning of the PPE. Thank goodness there are theatre assistants (TA) outside ITU who are marvellous and explain thoroughly what to wear and how to wear it. Yes, I was shown before how to wear the PPE, but nothing can really prepare you until you have experienced it yourself for the first time.
The TAs really are indispensable and make things far easier to cope with. They helped to tie the surgical gown and the plastic over-gown, then the theatre cap, the FFP3 mask and lastly the wonderful visor, which was made and donated by The Royal Mint in Llantrisant – a bit different from making coins of the realm but equally important.
Once all kitted out you tend to forget the amount of times that you check with the TA to make sure it is all OK.
Pushing the mobile into COVID-19 ITU will be something I will never forget: standing there, seeing patients in the pods with anaesthetists and nurses in their full PPE, Jupiter hoods, staff names and times written on their gowns, I did think that I had just walked on to a movie set.
I will admit I was worried – the thought of my mask slipping down, the seal around the mask incorrect or of doing something wrong – but all the staff were amazing and soon put me at ease. Trying to hear and communicate can be difficult, or is that just me? With hand signals we soon worked it out.
With the DR examination plate in its protective cover, the patient details checked, patient sat forward and the x-ray taken, it is time for the removal of PPE, which has to be meticulously remembered. Doffing PPE has a sequence that must be carefully performed, but first the mobile unit needs to be cleaned down. I have to admit, before this pandemic the mobile we now call our COVID-19 mobile had never been cleaned as much as during the past few months, even down to the wheels.
The emphasis on doffing the PPE in the correct order may sound silly but the need to get this right and remember the instructions is all that goes through my head. But the feeling at the end of the procedure when you remove the FFP3 mask is heaven. Just don’t look in the mirror. Once all PPE is removed, handwashing is next – who else sings happy birthday while washing? The whole examination is quite involved and very time-consuming; I’d never thought a portable x-ray would take so long.
It must be recognised that all staff in COVID-19 ITU are working in conditions that few people will ever experience and even after the relatively short time that I was in ITU I was extremely hot and the scrubs were …. well I think you can guess that part. Keeping hydrated in these areas is really important and now I fully understand why staff are only allowed to work in there for a limited time.
When attending the general COVID-19 wards, the same principal of PPE is undertaken; however, there is no need for a surgical gown, FFP3 mask or scrubs. Again we decide who is clean and who is dirty. Both radiographers have to don a plastic white apron, gloves, facemask and visor.
When we open the cubicle door we are not really sure how ill the patient will be but at all times we have to convey to the patient a sense of calm and try to show them that this is all second nature to us, when really we are feeling nervous and anxious. I have often wondered just what the patient must be thinking when we walk into the cubicle in PPE and pushing a large mobile unit. It must look like a scene from a science fiction film.
Working in CT has also changed, we now only scan urgent and USC patient appointments. We use our cannulation room as a doffing room when we have a COVID-19 ITU patient and as a dirty area so staff can wait there during the scan. We also have a clean and a dirty radiographer. One will be in the scan room to position the patient and connect up to the injector, while the other is in the control room with the door locked – you will be surprised by the amount of times staff have tried to get in while wearing their full PPE.
With all positive COVID-19 or query COVID-19 patients the corridors and doorways are manned by the porters who stop anyone from entering the corridor when the patient is being transferred. Lockdown even happens in the hospital and then staff from our facilities directorate will come back and clean the scan room. Unfortunately this causes a delay as we are unable to scan anyone else for about 20 minutes after cleaning so we do try and scan all COVID-19 patients at end of the day to reduce the impact.
The lack of correct PPE has been widely reported in the news bulletins and in some areas this may be the case, however, I have to praise Cwm Taf Morgannwg University Health Board as we have always had the correct PPE available. It may have been sourced from different companies but it is always available and of the correct type.
I am delighted to have been given the opportunity to write this short article on my experiences working as a radiographer during this very difficult time. My overall experience has left me feeling proud that I work in the NHS and during all this I have never questioned why I became a radiographer. On a positive side, I am well experienced using PPE now, but I am never too arrogant.
I’ll admit I have been anxious and stressed at times, missing hugging and seeing my two children, even though they are 29 and 26, and seeing my parents, but the public support, donations and seeing the turn out every Thursday has been amazing and certainly does lift your spirits.
Everyone in the department has pulled together, supported each other and the bond we all have for one another will forever remain. We really are a family and I am delighted to work in Prince Charles Hospital – as the saying goes: “If Carlsberg did radiology departments…”
No one is sure what the future will bring, but knowing that we have the best healthcare system, amazing work colleagues and wonderful loving families will get us all through this. After all, we are radiographers.
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