Evolution of plastic surgery provision due to COVID-19 – The role of the ‘Pandemic pack’ (2020)

As COVID-19 spreads quickly from Asia via Europe to the rest of the world, hospitals are evolving into hot zones for treatment and transmission of this disease. With the increasing acceptance that operating theatres are high risk areas for transmission of respiratory infections for both patients and surgeons,1Raphael T.Why surgeons don't want to operate right now. Bloomberg. Available at URL:https://www.bloomberg.com/opinion/articles/2020-03-24/the-coronavirus-crisis-is-putting-surgeons-at-risk-too(accessed April 3 2020,).Google Scholar and with our health care systems being generally well-designed to only deal with occasional high-risk cases, there is an obvious need to evolve our practice. Although social media campaigns via the British Association of Plastic, Reconstructive and Aesthetic Surgeons (#StaySafeStayHome) and British Society for Surgery of the Hand (#PlaySafeStaySafe) are attempting to raise awareness and reduce preventable injuries, we are still seeing a steady stream of patients present to our plastic surgery trauma service. We have had to act immediately so our systems can support essential surgical care while protecting patients and staff and conserving valuable resources. As a department we have developed a set of standard operating procedures which cover the full scope of plastic surgery from the facilitation of emergent life and limb saving surgeries, rationalised oncological management to the management of minor soft tissue and bony injuries. We have been cognisant of the need to reduce footfall to the hospital and the stratification into “dirty” and “clean” areas with attempted segregation of non-, suspected and confirmed COVID cases within inpatient clinical areas. This has resulted in displacement of assessment and procedure rooms within the unit. The ward itself has been earmarked as an extended intensive care unit due to its layout and facilities. Standards of practise have changed, with an emphasis on “see and treat” as operating theatre availability has been reduced due to the reduced availability of nurses and theatre staff and their conversion into intensive care areas for ventilated patients. There is also an emerging assumption that all patients are COVID-19 positive until proven otherwise.2Pearce C.GPs should assume ‘most’ patients have Covid-19 and use PPE, says NHS England. Pulse. Available at URL:http://www.pulsetoday.co.uk/clinical/clinical-specialties/respiratory-/gps-should-assume-most-patients-have-covid-19-and-use-ppe-says-nhs-england/20040541.article(accessed April 3 2020,).Google Scholar The combination of unfamiliar environments, lack of accessible equipment, requirement to reduce time spent with patients and adherence to social distancing has resulted in the need to provide a more mobile and flexible service. In order to support our mobile service, we have found that, as in other disaster situations where specialised bags have been deployed,3Ando W. et al.Handling and packaging of medical bags at acute disaster sites under high-temperature conditions.BMC Res Notes. 2020; 13: 158Crossref PubMed Scopus (1) Google Scholar using a simple bag containing essential equipment and consumables has revolutionised our ability to work at the point of referral and avoid unnecessary trips to theatre. Despite their simplicity, bags have been fundamental for the development of human civilization, with the word originating from the Norse word baggi and comparable to the Welsh baich (load, bundle)!!!4Wikipedia. Bag. Available at URL: https://en.wikipedia.org/wiki/Bag (accessed April 3 2020,).Google Scholar Our portable “pandemic pack” is now being carried by the first on-call in our department. This pack contains a 10 L Ultra Dry Adventurer™, polymer dry bag measuring 36 cm (W) × 70 cm (L) as shown in Figure 1. The contents are shown in Figure 2. We have found this adequate for managing most common plastic surgery trauma and emergency scenarios. The bag is easily cleaned with 1000 ppm available chlorine (in accordance with Public Health England guidance) after each patient exposure. We have found it useful to make up two packs in advance so that one is available at handover whilst the other is replenished by the outgoing team.Figure 2Contents of the Pandemic Pack.View Large Image Figure ViewerDownload Hi-res image Download (PPT) We are sure that this concept has been used elsewhere, but if it is not common practice in your unit, we would advocate implementing such a toolkit to facilitate management of trauma patients and reduce the amount time frontline staff need to be in a potential “dirty” environment during the COVID-19 pandemic. None. None.