Taking care of our carers
Louise Hosking, Director at risk management specialist and training provider Hosking Associates, outlines the importance of ensuring our health and care staff have the means to conduct their life saving work in the safest possible environment
I was born in Cambridge, cycle city. I cannot remember a time without a bicycle. It was my main form of transport throughout my childhood and teenage years. Now I have a smart hybrid with 21 gears and it feels like I’m cycling a Porsche if I take it into Cambridge, where, let’s face it, you only need a few gears and a large basket!
When the Covid-19 pandemic descended, cycling the lanes around my home in Hertfordshire was not only part of my “one a day” exercise; it has also proven to be essential for my mental wellbeing. Like so many, I have been sat behind a home office desk for longer than I could have ever anticipated; supporting our clients to support their businesses to trade Covid-secure and also to keep our own small business going at this unprecedented, challenging time.
However, my last sunny Sunday 20 miler did not go as planned. I cycled down a hill and was going to turn right into a country lane. With more cars on the road than there has been previously I positioned myself closer to the edge of the lane than I would have liked. I hit the gravel at the side, my bike slid sideways and I fell onto my right side. It hurt! I knew I had badly cut my arm and my left thumb was not in good shape at all. As I fell, my head bounced on the road twice. I felt the chin strap to my helmet tighten under my chin and my hat flex and cushion my head. A later scan would reveal no head injury – it did its job as designed.
I was taken by ambulance to A&E where I would spend the rest of the day and evening. As an occupational safety and health (OSH) professional I felt annoyed with myself for having to rely on all these resources when we are in the business of preventing their use. One of the doctors did joke if we got too good it would put them out of business which took my mind off my injuries for a while.
As I was wheeled into the A&E waiting area, then into an assessment bay, into x-ray, CT Scanning and treatment room I had plenty of time to watch and consider how care professionals in these public facing roles are protected from Covid infection.
These are busy areas with a lot of people working in close contact with each other. When an injured person arrives, they may or may not be able to respond to whether or not they have had Covid symptoms, or if they have been in contact with others [who have]. I was alert but in no place to process complex questions. I had my temperature taken. I was cold. Despite this, I reminded the paramedic I needed a face covering as we entered the hospital. There is no current way of knowing who is or is not infected upon entry.
I was in pain and breathing hard. A nebuliser to administer pain relief meant I could not always wear a face covering. It also occurred to me how many potential visual clues regarding patient condition might be lost behind a mask. I reached a point where I needed a break from the face covering. I was breathing hard. I know the rules. Wearing face protection is not for my protection but for the protection of those around me. I felt conflicted but at the same time I also felt quite unwell.
Having been so heavily involved with a variety of businesses to get them back to work safely I was struck by the impossibility of physical separation and the risks from patients coming in without clear history, at short notice, needing care right away. There were more people in this space than I have personally been around since March 2020. Care professionals would wander in pairs through the department, past my cubicle deep in consultation with each other. It felt “normal”.
Following my tests and treatment I sat with a broken, damaged thumb in a sling on one side and a stitched arm on the other. Back in the A&E waiting room I saw two police officers crouched in front of an elderly gentleman reassuring him as he waited for care. A group of friends arrived concerned about one of their group clearly in pain. I also watched cases arrive which might have been treated by a GP in normal circumstances.
We cannot, any of us, eliminate the risk from the virus without a vaccine. There is a risk that other illnesses will go unchecked if we create a health care system so locked down it cannot be accessed or becomes a frightening place to approach. Health care professionals have a vast amount of experience in managing infectious disease hazards. This is a horrible disease with devastating consequences and those taking care of us are right to expect to be able to work safely.
IOSH have just released findings from research they have funded on reducing aerosol infection risk from patients[i]. The research looks at how health care workers are potentially exposed from a patient’s exhalation. It identifies some measures which are worthy of closer consideration, especially for those on the front line dealing with Covid infections. There are many airborne pathogens. As we focus on the virus and OSH controls for carers, the research has looked at how personal positioning during care and ventilation systems can reduce risk.
It really is all about the humble risk assessment and one size can never fit all. Health care cannot be given at a distance, so the hierarchy of risk control is critical when determining controls to care for those carers who care for us.
I will be back on my bike in due course. Perhaps with a little more padding, some trepidation, a new cycle helmet and a first aid kit. I certainly have a few accidents to prevent to make up for my experience, but it’s what we OSH professionals do – protecting health and saving lives one conversation at a time.