key: cord-0768510-h5dsnex9
authors: Kulkarni, Sagar
title: The bone prone team
date: 2020-06-26
journal: J Clin Orthop Trauma
DOI: 10.1016/j.jcot.2020.06.031
sha: ac4b4fb0e177f6a1ea6f9b8d7961ff3cf1328eb0
doc_id: 768510
cord_uid: h5dsnex9

When the COVID-19 pandemic arrived in the United Kingdom, elective orthopaedics was halted. This article tells the tale of the orthopaedic surgeons who rose to the challenge of helping to treat coronavirus patients on the intensive care unit.

Authors: Sagar Kulkarni 1 I recall the first time we called the orthopaedic surgeons for assistance. A lone, lumbering orthopaedic consultant arrived, his eyebrows slightly furrowed, unsure of what was about to happen. He looked around the ICU, at the ventilators, the invasive blood pressure monitoring equipment and the infusion pumps. Like a boy on his first day at school, he was thrust into an unfamiliar environment.

Initially, proning was haphazard. The ICU would bleep a surgeon to request help with proning, only to find out that the surgeon was occupied. Once, an orthopaedic surgeon attended the ICU after a challenging trauma case, asking, "I got bleeped two hours ago; is everything okay? Do you need my help?" Some would say he was late, but his enthusiasm to help us was undeniable.

Quickly, however, they learned, morphing into a highly efficient proning team. With typical orthopaedic precision, proning would happen on a schedule -every day, the bone prone team, composed of several consultants, registrars and senior house officers, would attend the ICU at 8am and 5pm, ready to prone. Additionally, if proning was needed at any other time, we would bleep the orthopaedic registrar, who would immediately send their consultant (sometimes multiple consultants) to prone.

One morning, the bone prone team attended the ICU, like a sports team descending from a tour bus. Amidst chatter of tendons and joints, one of them called out, "We're ready when you are!"

As I was donning my personal protective equipment (PPE), I saw Mr Jones (not his real name), one of the senior surgeons, approach me. I wondered whether he was about to scold me for doing something wrong. To my surprise, he said, "Shall I do up your gown?" "Oh, that'd be great, thanks." I replied, surprised at this out-of-character offer.

Once we (the ICU and orthopaedic teams) had all donned our PPE, we entered the unit together. Mr Jones grabbed the pre-proning checklist and assumed his position.

"You take the left, I'll take the right. Ready, steady, slide!"

In a fluid motion, we proned the patient, like synchronised skaters. That day, we had a good round of proning, successfully flipping four patients. Six weeks later, all patients who were proned on that day survived ICU. We thanked the orthopaedic team for their help, to which one of their number responded, "We aren't the heavy-lifters here -you are."

As time went on, proning became a communal activity in the hospital. At our scheduled proning times, doctors from emergency medicine, haematology and surgery rubbed shoulders to prone, for the benefit of the patient. At times, we had too many hands on deck, and had to turn people away. When asked why they wanted to join in, they all had the same response, "It's the least I can do to help." By late April, our caseload began to decline, and proning was needed less frequently.

Eventually, the bone prone team was disbanded, its cause now defunct. However, the camaraderie behind it still persists. To me, proning came to symbolise our struggle against coronavirus -the doctors of my hospital, and indeed the nation, came together to defeat a common enemy.

The COVID-19 pandemic brought about a new sense of unity in the National Health Service (NHS). Hospital hostilities became collegial; expanded wellbeing services were offered to staff; and clinicians, like the orthopaedic surgeons, stepped into unfamiliar territory for the greater good. As the number of coronavirus patients wanes and we begin our return to normality, one can only hope that this spirit of kindness, generosity and teamwork will persist in the NHS.

Orthopaedic surgeons: As strong as an ox and almost twice as clever? Multicentre prospective comparative study