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A thank you from two doctors to the sometimes forgotten front line health care workers | COMMENTARY

The people of Owings Mills thought of a creative way to thank health care workers putting their lives at risk to care for patients during the pandemic.
The people of Owings Mills thought of a creative way to thank health care workers putting their lives at risk to care for patients during the pandemic. (Mark Wilson/Getty Images News via Getty Images)

The battle against COVID-19 has drafted health care workers as front line heroes. As sisters, an emergency medicine physician and an obstetrician-gynecologist, we have been overwhelmed with the amazing outpouring of support for health care workers amid the COVID-19 crisis. Food, personal protective equipment and housing donations, as well as extensive media praise, have all made us feel appreciated and we are grateful.

Health care providers such as doctors, nurses and advanced practice providers (including physician assistants, and nurse practitioners) are definitely on the front lines. But there are several hospital heroes providing essential services that often are overlooked. As the federal government considers proposals for hazard pay for health care workers, we feel it is important to recognize the role that these heroes play in the current crisis.

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To highlight this point, we provide a step-by-step summary of what happens when you come to the hospital during this crisis. While there may be some variations based on institution and jurisdiction and the timing of events may vary, the general processes are likely similar.

If you call 911, someone at the service center who came in from home to work will answer the call and dispatch it appropriately. Once receiving the call, first responders, such as paramedics or emergency medical technicians, transport you to the hospital. Members of the fire or police departments may be involved before transport. In many places first responders may be a largely volunteer force.

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If you arrive by private vehicle or public transportation, you are first greeted by a member of the security team; next your chief complaint and vital signs are assessed by a nurse or health care technician to begin the triage process. Registration workers will confirm demographic and insurance information. Once you are in the emergency department, a nurse and tech will see you the first of many times to gather clinical information to share with rest of the team. The resident, advanced practice provider and/or supervising physician will make their initial impression and form a differential diagnosis.

The health care team will begin diagnostic testing that may include a series of assessments such as blood work, radiological examinations, electrocardiogram and other ancillary tests based on presenting symptoms and signs on the physical exam. Tests require transporters, technicians, medical assistants, laboratory workers and interpretive providers to conduct the acquisition, analysis and reporting of these studies. Patients move through a complex series of steps from presentation to disposition to admission or discharge home, with many health care team members engaged in the provision of care.

If for some unfortunate reason a patient presents with acute signs such as respiratory distress and must be intubated by the physician, the respiratory therapist will be right there helping to ensure that the endotracheal tube is in place and that the patient gets adequate oxygenation managing the ventilator settings. No action occurs without a team approach.

With complex admissions requiring the intensive care unit, additional providers including intensive care specialists and nurses, anesthesiologists and a myriad consultants, technicians, respiratory therapists, physical therapists, pharmacists, phlebotomists and social workers compose the care team. Even uncomplicated admissions for observation require collaborated care. Disposition to home also requires a transition of care for follow-up in a local ambulatory center.

Every patient can recall the front-line team members who provide direct care, but few are aware of all of the behind the scenes essential workers who keep the hospital functioning. These include the supply chain workers who prepare and deliver materials including scrubs, PPE, medical products and meals. The food service workers provide sustenance for not only patients but also the staff. Environmental services workers are on the front end of exposure but the back end of recognition as they clean the rooms, dispose of hazardous waste and sanitize the hospital to prevent transmission of disease.

These unsung heroes deserve our recognition and praise since every exposure can lead to life threatening consequences in the COVID-19 pandemic. Providers are as vulnerable as patients given the contagion of the virus. At no other time in our recent history has the work of patient care been such a hazardous profession.

Even in submitting this perspective, we are sure that we may have inadvertently excluded many essential hospital staff, but our point is simple. It takes a team to make our health care system work and we offer acknowledgment and appreciation for every essential worker as vital health care heroes. We are all in this together and each step forward is a complex coordinated effort.

Janice Blanchard (jcblancha@gmail.com) is an emergency medicine physician at George Washington University Hospital. Anita Blanchard (ablancha@bsd.uchicago.edu) is an obstetrician gynecologist at University of Chicago Hospital. The opinions presented are their own.

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