Volunteering in an ICU – one foundation dentist’s experience

a foundation dentist's experience volunteering in ICUChandni Nakum, a current foundation dentist, speaks to one anonymous London foundation dentist who is working in a London hospital in the intensive care unit.

Why did you volunteer?

All maxillofacial dental care therapists (DCTs) were redeployed to ICU and other wards of the hospital. The hospital noticed a huge shortage of staff, so contacted the deanery for a call for volunteers. We then received emails around early March asking for volunteers, so I decided to put myself forward.

How many foundation dentists have volunteered?

There are around 40 foundation dentists at my hospital. Some have gone to the Nightingale hospital.

Were you apprehensive over volunteering?

We had an online team meeting with all the foundation dentist (FD) volunteers and the currently redeployed DCTs. This was quite useful because it answered a lot of my questions and settled my main worries. There were lots of FDs worrying about catching COVID-19 and passing it on to other family members in the ‘high risk’ groups. But the hospitals arranged accommodation such as nearby hotels for them.

I’m part of the minority who still lives at home. I didn’t want to stay in a hotel alone. I felt it was better for my mental health to still have some normality, like laundry and cooking facilities and people to come home to.

Do you have adequate PPE?

We do rely on PPE and you cannot go onto the ward without all PPE on. The PPE for the ICU staff is scrubs, a sterile surgical gown, a disposable apron over the gown, hair net, an FFP3 mask, visor over the mask and four pairs of gloves. All patients on the ICU ward are COVID-19 positive, critically and severely ill. So PPE is an essential.

What do you actually do in ICU?

I am part of the proning team and that is mostly what foundation dentists do. Proning is a technique where we turn the patient from lying on their back to lying on their stomach. They can remain in that position for up to 16 hours. It improves ventilation for patients and China and Italy use it heavily.

It involves a team of seven, where an anaesthetist stands at the head of the patient and three people on either side of the bed. We follow the lead of the anaesthetist who runs through a pre-proning checklist, such as discontinuing all non-essential lines, a time out and finally a sign to re-connect and re-establish all non-essential lines.

The team usually involves foundation dentists, DCTs, physiotherapists and speech and language therapists.

What training did you receive?

We all received training in proning through videos, reading, demonstrations and group activities. I also have had a mask fitted, but it was very busy, it took about five hours for the mask fit.

I had my training on a Thursday and my first shift in ICU was on Saturday.

Describe a typical day for yourself?

We meet in a room with the rest of the proning team and the anaesthetist for the day. We discuss how many patients require proning, deproning etc with the anaesthetist. They would have already completed their ward round. We then get the PPE and go to the ward.

It is advised to take regular breaks. I have done about three and a half hours without a break, it can get quite tiring. We also help turn patients on their side so nurses are able to wipe them down.

What are the hours like?

My hours are 9am to 8pm for day shifts and 9pm to 8am for night shifts. I do a cycle of two day-shifts and then two days off, two night-shifts and then two nights off. Shifts are busy depending on how many patients need proning, but the ICU ward is very well staffed and managed.

Has this been mentally challenging?

Yes, it has been very overwhelming to see so many patients and to see how unwell they are.

It is particularly sad to see because you aren’t able to talk to patients. They are often heavily sedated to make the ventilation more comfortable. The majority of patients in ICU are connected to a ventilator, so it is likely that if there was no ventilator these patients would not survive.

Has there ever been a situation out of your scope of practice and how did you deal with it?

Luckily, I haven’t been in this situation. Everyone has so much experience. There are so many people around like doctors and nurses that if a situation did occur, they could manage it very well.

Has there been any memorable experience, good or bad, that you’ve had?

There was a patient whose oxygen saturation was depleting, it was around 70, so we needed to prone quickly. We managed to complete the proning and luckily the oxygen levels started increasing. It definitely goes to show how quickly things can change from patient to patient in ICU.

What advice would you give for a dental volunteer who is beginning in hospital or ICU?

To appreciate the team around you. All staff are so welcoming and grateful for your help. It feels very humbling to be part of something that will be remembered in many many years to come.

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