English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

On day 1, while assessing the site to plan patient flow, a newly recruited doctor approached and asked, “where do we get PPE? how does the centre work?” The response given, “I don’t know yet, but we will figure this out together.” Patients had already arrived. In May 2020, Médecins Sans Frontières/Doctors Without Borders (MSF) opened three COVID-19 treatment centres (CTC) in Sanaa and Aden, Yemen [1]. We report our experience from rapidly setting up CTCs with intensive care units (ICU). Working in humanitarian crises presents numerous contextual and cultural issues [2], but providing critical care in a war-torn country during a pandemic has further challenges. In the first week of opening the Aden CTC, a surge of war-wounded resulted in a mass-casualty plan activation at the MSF Aden trauma hospital, which functioned as our COVID-19 response support base. Additionally, some hospitals were closed from fear of COVID-19, resulting in the Aden CTC becoming rapidly overwhelmed and a second CTC opening. Resource constraints, high influx of patients, and societal pressures were encountered in all 3 CTCs, requiring that lessons learnt be applied in real-time. MSF’s three CTCs included wards and ICUs. Invasive mechanical ventilation (IMV) received global attention but is only the visible “tip of the iceberg” for COVID-19 care. A full package of critical care includes, but not limited to, critical care trained staff, allied health and logistics staff, clinical mentoring for juniors, biomedical equipment, oxygen, medications, and a reliable supply chain. Our ICUs emulated a closed-unit model with local nurses and generalist doctors supervised by an international intensivist and nurse. Each ICU had contextspecific resource constraints resulting in differences in the package of care related to equipment (ultrasound), investigations (laboratory, x-ray), oxygen supply, nutrition, medications, and staff (specialist doctors, nurses, physiotherapists, social workers, pharmacists, logisticians). Due to limited ICU beds, many critically ill patients remained in the ward where the maximal oxygen therapy was a non-rebreather mask (NRM) combined with a regular nasal cannula. This double oxygen set-up, in addition to prone positioning, successfully treated some patients, avoiding the need for ventilatory support. All three CTCs had rapid increases in admissions and community/contextual pressure to open immediately leaving no time for pre-opening training. Local intensivists were not available and recruiting internationally was difficult, as the pandemic has increased the need for intensivists/ICU nurses worldwide, many who are obliged to work in their home country. Closure of airports/borders and security constraints limited the ability to move staff and supplies. This placed further pressure on local staff, many of whom had no or limited ICU experience. Routine ICU care, such as ventilator settings, ventilator-associated pneumonia prevention bundles, infusion pump usage, and early mobility, amongst others, were unfamiliar. Clinical protocols were developed and taught on-the-job. Prone positioning had never been

Critical care for COVID-19 during a humanitarian crisis—lessons learnt from Yemen