Mumbai has witnessed a significant rise in the number of COVID19 cases within the last few weeks; while most Mumbaikar’s have become accustomed to the work from home situation and have adapted themselves to the self-care regimen;medical emergencies still strike panic amongst many. It is important that housing societies and resident welfare associations be equipped to handle COVID19 cases amongst its residents, for a short period of time, till medical aid is made available and the patient is hospitalized.
The average time to get to a hospital bed is now a few hours. In such cases, if a patient requires oxygen support then precious time may be lost while making hospitalization-related arrangements. Hence, society members, housing societies and resident welfare associations should maintain the following contingency plan that bridges the gap for patients, i.e. for a few hours, till the patient is hospitalized:
− An emergency holding medical area should be created at the society’s club house/ office/ Gymnasium; this designated area must have an attached bathroom and must function as an isolation area
− Have a simple mattress and pillow placed where the person could lie down
− Arrange for a Pulse Oximeter to measure blood oxygen saturation of the patient
− Arrange for an Oxygen Concentrator machine (which can be rented) to give up to 5 liters per minute of Oxygen to the patient. Don’t get oxygen cylinders,they should be strictly reserved for hospitals
− Arrange for Hand Sanitizer, a box of gloves, N 95 masks, normal masks and an Infrared Thermometer
To maintain this designated in-house Facility:
− The area should be sanitized and cleaned every two days (if not occupied)
− In case of an emergency, person in charge of management of this designated area should be contacted immediately; other residents should be alerted to avoid any panic
− A single committee (of 4-5 persons) should ideally be formed for management of this holding area. Two people from the committee should be the point of contact for residents to request the use of the holding area. These members should first enter the holding area, wear N 95 mask and gloves, then call the suspect/confirmed resident to the designated are, the patient must himself/ herself be wearing a simple cloth mask. Keep a distance of at least 2 meters from the patient all times and do not touch your face, eyes or mouth. Measure patient’s temperature with the Infrared Thermometer, by the no touch technique. If patient is able to help himself, then instruct the patient to measure oxygen saturation, if patient needs assistance then ideally the patient’s family member should step-in; he/ she should wear N 95 mask, gloves and help measure oxygen saturation. If the saturation is below 95% then committee members should instruct and guide the patient/ the family member to start oxygen concentrator and apply Oxygen Cannula or mask to the patient and keep flow at 4-5 Lit/min
− Keep measuring Oxygen Saturation every 15 mins and keep a note of all measurements on a simple note pad
− The two committee members should ensure that no other resident or person visits the holding area, to avoid unnecessary exposure
− The other two members of the committee and ideally someone from the family, should seek medical assistance and arrange a hospital visit for the patient
− Once the patient is successfully moved to a hospital, the area should be sanitized as per the Brihan mumbai Municipal Corporation standards. The area is only ready to use again once it is sanitized
− The idea behind this is, if any resident of a society showcases any symptoms of COVID19 and is short of breath, then he/ she can be shifted at this allocated area, where temperature and Oxygen Saturation is monitored. If oxygen saturation is low, below 95%, supplemental Oxygen can be administered to the patient via Nasal Cannula or Oxygen Mask at 4-5 Lit/Min using the Oxygen Concentrator.
This however, is only a stop gap arrangement until a hospital bed is arranged. This is by no means a solution to stay there for more than a few hours, but simply a place to get basic care and oxygen until a hospital bed is arranged.
Last but not the least, do not stigmatize patients who are having symptoms of, or have tested positive for COVID19; this is a treatable infection and ostracization of people only adds to the family’s woes. Also, celebrate those who have beaten the infection!
(Disclaimer: Dr Rahul Pandit, Director-Critical Care, Fortis Hospital, Mulund. Views expressed are a personal opinion.)