By Sarah Kleinschmidt, M.D.
Faculty Editor: Elizabeth Mitchell, M.D.
Corona virus is here. Given our current numbers and community transmission, there is no avoiding the significant pandemic that will affect all of us as emergency providers. In many parts of the country there may still be time to prepare for crisis mode. Our administrators are working on supplies, staffing and hospital capacity, and much of our profession is busily researching diagnostics and therapy for this illness.
One of our most limited resources will be ourselves: healthy and functional medical providers. Many of us will be exposed and some, unfortunately, will become sick. Our schedules and logistics will be stressed, and our emotional resilience will be tested. Our relationships and communities will be essential but also strained by the crisis.
From studying crisis situations we know that intangible human factors can impact outcomes at least as much as the tangible ones, and preparing now can remove barriers to helping out in the future. This list is a guide to this complex and intangible preparation. It is informed by my experiences as an emergency provider in a well resourced ED, as well as limited-resource or crisis settings such as global health work, practice and teaching wilderness medicine, and practicing and teaching survival skills. Use it as a checklist or to jumpstart your own process as we become critical actors in an uncertain future.
- Where and when will I change clothes after shift?
- How will I store shoes, jackets, and clinical supplies?
- How will I store PPE that needs to be reused?
- Shave facial hair, consider haircuts or buying a washable scrub cap to protect hair.
- What and when will I eat on shift? Which restaurants are still delivering? What snacks will provide enduring energy on shift?
- What is my personal and also my hospital’s threshold for provider testing and staying home? Do I own a thermometer?
- What supplies do I need at home if I become sick or exposed?
- Do I have a primary doctor? Am I optimally managing any ongoing conditions to minimize risk?
- If I am sick or exposed, who in my life is high risk? How can I minimize or eliminate physical contact if needed?
- If I become more severely ill, do I know who would make decisions for me? Have I expressed my wishes regarding intensive care interventions?
- Do I have transportation to work and essential needs without using public transit?
- Do I have documentation that I am an essential hospital employee, either via badge or letter?
- If/when I am asked to work extra shifts, what policies or practices will guide this? Are there limits to length or number of shifts? How will I be paid for this work?
- If/when I am asked to work extra shifts, what are my own constraints or boundaries? Do I have childcare or family responsibilities? How much time off do I really need to stay healthy and functional?
- Do I have an alternate place to stay if someone I live with becomes sick, or if I need to be closer to the hospital?
- If I needed to stay at the hospital, or closer to the hospital, what items would I need? Consider having an “essentials” bag pre-packed.
- Who do I want to stay connected to? How can I update family and friends when I am busier?
- Who am I worried about? How can I express my love and get updates on their health?
- Who do I rely on? Who can I talk to after a long day?
- How can people in my life help? How do I receive love and support?
- Who at work is a support person? How and when can I connect with them?
- Who at work feels like a challenge? How can we work better together over the next weeks to months?
- How was I doing before Covid hit? Was I tired, burned out, inspired, bored?
- What emotional needs or processes will be de-prioritized? What questions was I answering? What relationships needed work? How can I keep track of those needs so I can return to them when the crisis is over?
- What was I looking forward to? How can I mourn the loss of those expectations?
- How will I find joy and gratitude as this crisis continues?
- How do I respond to stress? What are my warning signs? How will I or others know if I’m burning out?
- What practices and habits help my mental health? How can I set habits for sleep, eating, exercise, meditation and reflection as things become more challenging?
- If I am in distress, what is my plan for seeking help? What support people can I call? What emergency resources are available?
The Coronavirus epidemic will challenge us in many ways, but we can prepare like the BAFERPs we are. That means defining what needs to be done, then triaging and getting to work so we can take the best possible care of ourselves and our patients in the coming months.