Blair Bigham is resident physician, Emergency, McMaster University
On May 31, 2013, at 6:09 a.m., my cell phone woke me up. I remember feeling annoyed; I was a flight paramedic, and I had an evening shift and had planned to sleep in. My annoyance dissipated when the voice of my manager shattered my heart: “I just want you to know we haven’t heard from 793 for five hours.”
It was code for “we have a helicopter down.” Military search and rescue paratroopers would confirm an hour later, as daybreak came, that the Sikorsky S-76 air-ambulance helicopter had crashed in the woods in Northern Ontario, killing four of my colleagues.
That crushing feeling has been rekindled amidst news that a New York registered nurse died March 24 of COVID-19 after working the front lines of the coronavirus war. Kious Jordan Kelly, a 48-year-old registered nurse at Mount Sinai hospital in Manhattan, died after a week-long admission.
I knew this was coming; 3,300 health-care workers have been infected by the coronavirus in China, and at least 18 have died. in Italy, France and Spain, more than 30 have died; Spanish data indicated 14 per cent of coronavirus patients are health-care workers. A dentist in B.C. is thought to have died from COVID-19, and several other Canadian health-care workers have tested positive. It’s only a matter of time before more Canadian medical workers die on the front lines.
It’s time for health-care organizations across America to start preparing for a term few health-care workers have ever used before: line-of-duty death, or LODD.
LODDs are not uncommon for first responders; in the U.S.,146 police-officer deaths at work were logged, along with 57 firefighters and 13 EMS responders. Canadian data is more difficult to lock down, but nearly all Canadian public-safety organizations have protocols in place to not only honour the sacrifices made by first responders, but also to support their family and their peers.
This is not a matter of appearances; moral distress and post-traumatic stress impacts can be mitigated by adequate LODD preparations. Peers of workers feel immense loss, guilt and dread after the death of a colleague, and quick, co-ordinated intervention by employers is required to limit the impacts on worker burnout and service delivery.
When my colleagues died in the helicopter crash, offers poured in from other agencies to fill shifts so we could all attend the memorial; our CEO was at the crash site in hours; pins, T-shirts and sweaters commemorating our friends were sold to support the families of those who died. It was emotional, but it also brought us all together in a way I never thought possible. The nature of this pandemic will be different; we won’t be able to gather at memorials or take time to grieve. We will have to power on. That makes LODD planning even more critical.
Plans must include access to mental-health support. As I arrived for my helicopter shift 12 hours after finding out about the crash, I was met by my manager and a trauma psychologist. The psychologist sat down privately with me to evaluate how I was doing. She then met with the entire crew – two paramedics and two pilots – and we worked through our fears. We talked about coping mechanisms and ways to keep each other safe, and acknowledged how distracted we would be and how that threatened the entire crew. Once she “cleared” us all to work, we taxied to the runway and took off. My partner and I looked at each other. Never had we felt more committed to our work of bringing critical care to those in need, wherever they happened to be. We were family, and we were on a mission.
Now, I’m on the front lines of the COVID war as an emergency physician. I see the stress being worn by my team of nurses and respiratory therapists. We are scared and tired, for ourselves, for our families, for each other. A line-of-duty death will crush us, but we must be able to bounce back.
That’s why hospitals must begin planning now, learning from first-response organizations that have been through this too many times, to ensure that the next health-care worker to die battling coronavirus is honoured and that their death is commemorated in such a way that we on the front lines double down to fight, rather than quit and stay home.
In this war, retreat is not an option. That’s not how we honour our fallen brothers and sisters.
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