This powerful insight into the effect of COVID-19 on the critical care workforce has been written by a TVS member who’s location and identity have been withheld to protect privacy.

“We have practiced the technique of proning critically ill adults for many years and always approach this method from a multidisciplinary team approach, with a sound evidence base. Our critical care workforce, although not experienced in caring for patients diagnosed with Covid-19, are therefore highly experienced and experts in the technique of proning patients. But what Covid-19 did was stretch and dilute our critical care workforce.

The stretch was created by the vast volume of patients who required proning, with bays upon bays of patients lying face down. If I think about the imagery of this scenario, rows of patients facing the floor, it makes me feel uneasy and I find this a truly unsettling thought. However for our critical care workforce this, practically overnight, became their norm.

The dilution came from gaps in the critical care workforce duty rota. These gaps were thankfully filled by staff redeployed from other areas and some having no critical care experience, and the vast majority absolutely no experience with caring for a patient in the prone position. With so many different factors to consider when caring for a critically ill adult, it is not realistic to teach redeployed staff the additional pressure ulcer prevention tactics required specifically to the patient in a prone position. Including, but not limited to, saliva management, the swinging penis position, and the importance of nipple taping.

Of course, as patients were turned over on to their backs, black necrotic holes on faces, chins, chests, abdomens, knees and toes became apparent. Thankfully, some of these wounds did and will resolve but what we, the tissue viability nurses know only too well, is that many of these will deteriorate to become significant pressure ulcers. Damaging and scarring faces, bodies, and limbs on the front of these patients’ bodies, exposed for the world to see.

The daily glance in the mirror will initially reflect back a wound and, hopefully, eventually a scar. This will serve as a visual reminder to them and their loved ones of the time they spent face down.”