Bhubaneswar: The Department of Health and Family Welfare has issued a set of recommendations for all districts and municipal corporations across Odisha to strengthen critical care for management of COVID – 19. A letter issued by Additional Chief Secretary (Health), Pradipta Kumar Mohapatra, in this regard stated the following:
Decentralization of Critical Care: The Covid patients requiring critical care should be first managed in the ICU / HDU of all districts instead of being referred to Bhubaneswar or Cuttack in a routine manner.
Training: More training should be imparted at grass root level and district-level hospitals, so that patient management is accurate and referral will be reduced.
Referral policy: All facilities should follow the notified referral policy to enable seamless coordination between the sending and receiving hospitals. The Cluster district concept must be followed. Patients insisting on being referred to Bhubaneswar or Cuttack should be counselled and dissuaded, as there is life risk in transport.
Transport: Patients in transit should be accompanied by Emergency Medical Technician so that the patients do not develop hypoxia dining transport. Unless stable, the patients should not be transported.
Close monitoring and timely early stage treatment should be given to cases in wards so that fewer patients become serious to be put in ICU.
- The emphasis should be on providing non-invasive care like HENC, may be provided in all the Covid Hospitals.
- Remdesivir can be considered for moderate patients, if allowed under ICMR protocol.
- Care should be taken for early detection of lungs infection.
Step-down ICU: To decrease the load on ICU, there should be Step-down ICUs. The patients who become stable in ICU should be shifted to the Step-down ICU. The HDU/ Semi ICU beds should be at least half the number of ICU beds.
The concept of virtual ICU may be started so that appropriate care can be given by expert advice from remote tertiary hospital level.
More number of dialysis beds, maternity beds, Oncology beds, trauma beds may be created for Covid patients, especially in peripheral facilities.
- AHPGIC can have 25 beds to take care of Chemotherapy requirement of Covid cases with cancer.
- SCB can have NICU to take care of Covid positive infants.
Diagnostic facilities such as CT scan (interpreted by Radiologist) and ultrasound of lungs should be strengthened in peripheral hospitals. Peripheral doctors can be trained in these diagnostic procedures.
Re-deploying resources: Wherever possible, trained manpower can be mobilized from low-burden districts to high burden districts.
Support to hospital teams: Treating teams should be provided with timely required support in terms of equipment and drugs.
Morale building: the teams working in Covid facilities and especially in the ICUs should be regularly encouraged and their efforts appreciated to keep up their morale in these difficult times.
Continuing Education: There should be continued structured discussions amongst treating teams and State level experts through online meetings/seminars so that latest protocols can be discussed and there is cross learning and mentoring across teams.