The triage of patients with and without suspected corona has high priority in the emergency department at the University Hospital Zurich. The recording procedure has become more complicated, which affects the mood.
The emergency rooms fill up the most between 10 a.m. and 11 a.m. That’s what the statistics say, worldwide, as Dagmar Keller explains. She is the head of emergencies at the University Hospital Zurich. On this morning in January, her prediction is also correct. She is already hurrying away, serious and highly concentrated. The emergency doctor is needed in the shock room.
Patients who are critically injured or ill are treated in the shock room. Right now there is a man who was flown by Rega to the University Hospital Zurich (USZ) with the most severe Covid 19 symptoms. His lungs are obviously massively affected and he has severe shortness of breath. The patient is in Switzerland as a tourist. He has a pre-existing condition, suffers from diabetes and his immune system is weakened.
The viral infection was too much for his body. When the rescue helicopter brought him to the USZ, he was still barely conscious. The team sedated him in the shock room, then intubated him and he is now being artificially ventilated. “He is now being taken to the CT,” says Dagmar Keller when she is back in the emergency room. Computed tomography will accurately show the extent of the inflammation in the lungs.
There are two roped teams in the emergency department who travel together in unpredictable terrain every day: The team of doctors is headed by Dagmar Keller, director of the Institute for Emergency Medicine. Her counterpart in the nursing team is Patrik Honegger, the head of nursing at the institute.
During the past two years, the two teams have climbed various steep peaks. Every rash of the pandemic cost her special efforts. And now that, according to the task force, a “superinfection week” may still be ahead, they are preparing for another tour de force. “The numbers have been stable and high since the New Year’s Eve celebrations without a massive increase,” says Dagmar Keller, although she is careful with precise forecasts. “Of course, I continue to hope that the number of infections will not continue to increase, but will decrease.”
Pregnant, unvaccinated and positive
Omicron apparently causes less severe courses and fewer hospitalizations. The emergency teams are still under a lot of pressure. Many patients who come here with Covid-19 have panic written all over their faces: if you can no longer breathe properly or cough until you drop, you will have to deal with fear. Just like the young woman who is being treated in an isolation room this morning with complaints of a different kind.
The 33-year-old is pregnant, unvaccinated and Covid-19 positive, as she says. In the last few days she had had a strong cough and fever. Now she is sitting on the hospital bed, her husband and two older children are waiting at home. She presses the FFP2 mask against the bridge of her nose and says: «In the morning I suddenly had pain in my leg, which grew into cramps; a possible sign of thrombosis.”
The young woman grabs her leg, looks worried and explains that the doctors did an ultrasound scan of the vessels, but found no blood clots. Now she can go home soon. When asked why she didn’t get vaccinated against Corona, she replies: “I was aware of the danger all the time,” and then says: “But I had even more respect for the vaccination.”
Like all other patients who tested positive and the suspected corona cases, the young woman is strictly shielded. The triage takes place in front of the emergency station, outside in a container, where all arrivals are received and questioned. They are equipped with fresh masks and instructed to disinfect their hands. This is to prevent staff or patients in the emergency room from becoming infected. “As far as I know, it has worked flawlessly so far,” says the head of care, Patrik Honegger.
“Material battle” because of Corona
The effort involved in caring for patients who are positive or who are suspected of being infected with the corona virus is huge: they are isolated and smuggled into the emergency by nurses and doctors wrapped in blue protective coats, wearing FFP2 masks and goggles treated there. The “material battle” is correspondingly large. Honegger estimates that an average of twenty protective coats are used per patient. The bunks or rooms in which the treatments take place are then meticulously cleaned and disinfected.
Since the corona virus began to circulate, more than 12,000 confirmed and suspected corona cases have been treated in the USZ emergency. Only those who are most seriously ill are admitted to the hospital as inpatients. “In an emergency, we see patients with very different symptoms,” says Dagmar Keller. There are patients who are objectively not in danger but feel dying. “And then there are rare cases that, while they’re here, get so bad that the patients have to be intubated and taken to the intensive care unit.”
What has also been new since the beginning of the pandemic: Relatives are also intercepted in the triage container. Since the virus appeared, you are no longer allowed to go to the emergency room, but have to wait outside. This sometimes leads to problems, as Patrik Honegger admits. Not all relatives understand the procedure; Fear, insecurity and impatience drive some to rash actions.
“The aggression of relatives and patients towards the hospital staff has increased – it ranges from verbal abuse to physical attacks,” explains Honegger. In all of these cases, a zero-tolerance strategy applies at the USZ. “Our teams are trained on how to de-escalate, and they can also bring in the security service.”
USZ statistics show that the number of incidents involving the security service in an emergency has roughly tripled in a five-year comparison. While a total of 121 such operations were recorded in 2015, in the last two years there have been 347 (2021) and 365 (2020) respectively. However, according to the hospital, the increase is also related to intensified staff training and changed internal instructions.
Always on the phone
On this January morning Patrik Honegger is working as a coordinator and can be recognized in this function by his blue top. There are two cell phones in the breast pocket. Around lunchtime, Honegger is almost constantly on the phone. “USZ emergency, Honegger,” he says. «Yes, we will isolate. When are you there?” The emergency services teams call the coordinator when they are in the ambulance vehicles and announce their patients.
A woman in her twenties who recently had a lung transplant is wheeled into the ward by two paramedics on a wheeled stretcher. There is a suspicion of complications from a Covid-19 infection. The woman has been taking immunosuppressive drugs since the transplant, her immune system has been weakened by the drugs and she is therefore particularly at risk.
The paramedics inform the team at the handover in an emergency that the woman had choking attacks at home and is suffering from a severe cough. A resident and a nurse don protective clothing, then step into the bunk where the patient is lying and pull the blue curtain behind them.
Tripping on the stairs
In another bunk, an almost 40-year-old woman is being treated, who was also taken to the hospital by the ambulance. She fell on a flight of stairs and feels severe pain in her ankle. She has no corona symptoms such as a headache, cough, breathing problems or diarrhea. Accordingly, she is not isolated, but must wear a mask.
Nursing specialist Barbara Maurer takes care of the patient. She has been working on the emergency services for 27 years and has already experienced the peak times with the open drug scene here. «We are always close to social events; I like that,” she says.
The patient is given painkillers and has to wait until an X-ray seat is available. Barbara Maurer has a short time to scroll back through the computer entries of the past few days. The journals show a diverse picture with all sorts of different emergencies.
An electrical engineer was electrocuted in a work accident and had his heart function checked; a 20-year-old came with kidney stones and severe pain to the point of vomiting; a 66-year-old man suffered from gastrointestinal bleeding and sought help from the USZ.
In between, there are several cases of patients with mental health emergencies. Barbara Maurer says that the longer the pandemic lasts, the more she notices how young people in particular suffer from isolation and hopelessness. She had seen several boys at the emergency who had talked about depression and anxiety disorders.
The nurse hopes that the situation will soon improve in the long term. The doctor Dagmar Keller, head of the Institute for Emergency Medicine, is confident that her team will master what may now be the last stretch of the pandemic well – even if another summit had to be conquered.
And Patrik Honegger, Head of Nursing, emphasizes that he and his team are not yet at the limit. “But I wouldn’t say I could easily do another marathon.” In his eyes, after two years of the pandemic, it would finally be time for a breather.