Physiotherapists on the front line of a pandemic

Shihoko: Working in ICU is always a busy environment, with no quiet or down times, as there are always critically ill patients to care for. Our tertiary hospital provides care to neurosurgical, general surgical, medical and cardiothoracic cohorts. In the initial phase of the pandemic, I supported the organisation’s COVID planning to help our hospital prepare for a possible influx of COVID positive cases. We planned and prepared for the worst. One of the ways we prepared was to establish a new ICU ward, expanded beyond the existing 26-bed ICU. I was placed in charge of the dedicated COVID ICU established to care for patients who were COVID positive or suspected positive. Thankfully, we didn’t receive the number of patients we expected and were never at full capacity. However, those patients who did come in, were there for a long time and required significant time commitment. One example is clinicians wearing PPE (personal protective equipment) and ensuring it was fitting properly, with a colleague making sure it was secure to protect us from exposure. Another situation that increased the time to care for COVID patients, was the need to modify patient assessments. We were unable to use stethoscopes or bring them into ICU to minimise the spread of infection.

I knew and worked with physiotherapists and clinicians in Melbourne’s CBD and western suburbs who treated the majority of patients in Victoria’s outbreaks in mid‐2020.

For more on the role of physiotherapists during Covid read our blog and this article in Pursuit.

How did front line physiotherapists know how to treat and manage COVID patients?

Shihoko: As it was a new virus, there wasn’t much written research initially about COVID and its long‐term effects. There was some initial research coming out from international healthcare experiences with COVID, such as from Europe because the pandemic presented there before coming to Australia.

Because I had worked at several Melbourne hospitals, I still had connections with fellow colleagues, and there was significant collaboration and sharing of resources, as we learned about the virus, how to treat patients, what medications and equipment would support patient recovery and identified the training that physiotherapists needed in the COVID context. As physiotherapists, we undertook training with medicine physicians in the proning treatment of patients to improve their breathing, and implemented early mobilisation as soon as practical to reverse the effects of patients being in bed for a long time. A group of Australian physiotherapy clinicians developed guidelines, which helped to inform how we would assess and treat our COVID patients. Their recommendations can be found here: Physiotherapy management for COVID‐19 in the acute hospital setting: clinical practice recommendations

As a physiotherapy clinician and leader of a COVID ICU, what was that experience like for you personally?

Shihoko: In a disaster situation, you don’t always have time to reflect on how it might be impacting you until later on. My responsibility was to provide leadership to the team, to provide strength and try to demonstrate that I was coping. There was the underlying anxiety of catching COVID, being as careful as possible, but realising even if I did the right thing, I still may catch it. I needed to communicate to the team and allay their anxiety when I was feeling similar. Like many people, there was emotional fatigue from the uncertainty. It was an unsettling time, as we didn’t really know how contagious it was and how many cases would come through the door. It was challenging for our physiotherapy department, as we changed the structure and were no longer working alongside our musculoskeletal, neurological, and medical stream colleagues. We worked in bubbles of staff, ensuring not all one team in a single bubble, in case someone in the bubble becomes COVID positive. I was grateful for our organisation who delivered regular weekly communications, weekly forums and newsletters to staff.