In most of our emergency departments the situation currently is one of nervous anticipation as we are facing a totally unprecedented situation.
We anticipate a huge surge in the number of patients infected with the Covid-19 virus in the next few weeks, many of whom we expect to become critically ill and are having to make urgent preparations.
As emergency medicine doctors, we are trained to resuscitate this type of patient but less familiar with using personal protection equipment (PPE) so frequently.
Nonetheless we are ready to do what we do best and help patients who are acutely unwell. We are sincerely hoping the worst case scenario is not realised.
What gives us some hope is that we have had a little longer to prepare for the coming surge of Covid patients that is inevitable in the next few weeks.
Another positive is the strong sense of common purpose helped by strong leadership regionally and management in Trusts, which are moving into action to implement plans which are creating extra capacity and dedicated wards for Covid patients and help us save as many lives as possible.
At different stages everything that happens in our hospitals will be different and this is the first time I have witnessed emergency plans on this scale being implemented and surprisingly quickly. The full importance of the NHS is now more apparent perhaps.
We know from the Italian experience and now with rapidly rising numbers in London what awaits us and therefore we have to work quickly as we are certain things are going to get worse for some time before getting better. Doctors, nurses and clinical teams outside the emergency department such as intensive care and physicians are rehearsing resuscitation using PPE and are daily training staff less familiar with some of their work in preparation. There are teething problems in the supply chains for things like PPE and extra ventilators so we hope these challenges will be overcome.
We need a huge expansion in the number of certain beds but this depends on trained nurses and doctors as well as equipment.
We also need colleagues in primary care to be fully equipped in time to meet challenge.
What is also difficult is trying to maintain staffing levels when many staff, medical and nursing, may be either personally or have family members unwell and are having to follow advice to self isolate. What is very welcome is the news this weekend that a facility for testing staff will soon be available, to identify who is infected and allow some to return to work. Laboratory testing is a good example of the many supporting services upon which the system is dependant but like the rest has a finite capacity and is trying to expand at short notice.
We hope the public will follow the advice on social distancing, washing hands, and resist the temptation to come to the larger emergency departments unless absolutely necessary which they do appear to be doing.
Reducing the scale of the first surge is essential to stop us being overwhelmed and in protecting the older members of our population.
I would also like to thank the businesses that have kindly donated food and sent messages of support for staff who are working long shifts.
Paul Kerr is consultant in emergency medicine and vice president Northern Ireland of the Royal College of Emergency Medicine