Medics raise concerns about staffing levels as HSE stocks up on ventilators

The HSE is stocking up on new ventilators to prepare for more people in respiratory distress from coronavirus, but medics have raised concerns about staffing levels to manage them.

In addition, the Irish medtech industry, one of the largest suppliers of ventilators in the world, are bidding to cut the risk of Covid-19 interrupting production of medical equipment.

A ventilator allows an affected patient’s lungs to rest and recover by supplying oxygen and simulating the actions of breathing. Without such support, patients with severe respiratory disease may not survive.

The rising number of coronavirus-related deaths in Italy where a well-funded health system has struggled to cope has heightened fears about the Irish health system's ability to deal with a sharp increase in cases.

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The HSE would not disclose the number of ventilators in the Irish system but said that it had purchased an additional 12 portable ventilators and 60 intensive care unit (ICU) ventilators, though a series of doctors put the number at 250.

Expand capacity

Dr Tony Holohan, the State's chief medical officer at the Department of Health, said the HSE would use €435 million of extra State funding to buy more equipment, expand capacity and hire more staff.

This was part of the Government’s strategy to reduce and push the peak of infections out as far as possible so that the health system has the “greatest capacity” to manage the worst of the crisis.

One of Dublin’s main hospitals has 16 ICU beds with 16 ventilators and five back-up ventilators in storage, according to sources. It has ordered six more at €30,000 each, though delivery will take three to six weeks.

This hospital has 10 operating rooms, each of which has its own ventilator. Eight of these rooms have an associated anaesthetic room, each with a ventilator.

If elective procedures fall away freeing up operating theatres, the hospital would have another 12-16 ventilators available for severe Covid-19 cases requiring ventilators as they fight infections.

Including sister hospitals, this hospital could triple its availability of ventilators. Doctors say the bigger challenge will come in finding enough staff to use them.

“We will run out of appropriate staff to operate the ventilators we have before we run out of ventilators,” said Michael O’Dwyer, head of department of anaesthesia and critical care at St Vincent’s University Hospital in Dublin.

“Qualified staff are limited to ICU medical and nursing staff and anaesthetic medical staff, and these have been in short supply for some time and take years to train up.”

Warning of the dangers ahead, Prof John Crown, consultant oncologist, said: "The situation could be potentially more difficult here because of the lower baseline provision we had for ICU infrastructure."

Ventilators have proved vital in Italy. “Every ventilator becomes like gold,” said Dr Daniele Macchini, working in Bergamo hospital in northern Italy. China has offered to send 1,000 to Italy.

Ironically, nearly half of the ventilators used in acute hospitals around the globe are made in Ireland. Galway-based Medtronic is one of the biggest manufacturers.

“The main thing for the medtech industry right now is that you have employees to make the devices and that you don’t have disruptions to production because that has big impacts for the global supply chain which comes out of Ireland,” said Nessa Fennelly, acting director of the Irish Medtech Association, which represents the Irish medical devices industry that employs 40,000 people.

Meeting demand

A spokesman for Medtronic said the company had seen no disruption to the production of ventilators in light of Covid-19 and “is meeting all current customer demand globally”.

Smaller-scale suppliers of medical devices such as nebulisers, which provide fast-acting relief for respiratory conditions, are seeing an unprecedented surge in orders.

"It is absolutely mental. We would normally sell 200 nebulisers a month, we sold 200 last week," said Brian Smith, co-owner of Mayo-based medical devices seller Mabtech Services.

“We have about 400 on order at the minute coming from two different sources in Italy so we don’t know whether they will get here or not the way things are changing by the hour.”

The HSE normally orders 30 nebulisers a month from the company but it had doubled its order, he said. His firm has never sold a ventilator before but has started to receive inquiries about them.

Unsure of the future, he said: “Is it all hysteria or is there more to this virus than we know of? I had a fella on to me who was a chemist-doctor and it was frightening that they are now making decisions over who lives or dies in Italy.”