Ventilators may not work on frail coronavirus patients – they should free them up for others

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As a GP working in the urgent care service, could I offer a tiny glimmer of hope? The NHS has for some time deployed a system for people with frailty or ongoing heath issues, known as DNAcpr (do not attempt cardiopulmonary resuscitation). These are forms which are kept in the fridge of all individuals whose prospects of recovery from additional acute illnesses are very poor. When the patient still has the capacity to decide the level of their own care, a frank and difficult conversation will have taken place with their doctor, to decide what they wish to happen in the event of a sudden or rapid deterioration of health. The forms exist to guide ambulance workers or emergency callout doctors as to the appropriate steps to be taken in such an event.

There will often be an additional form called an advanced care plan which will outline the patient’s wishes as to whether they would like to have active treatment in a hospital or to remain in their residence, whether it be their own home or a nursing/residential home during their final illness. This is usually kept with their medical records and can be referred to by all medical and nursing staff

The benefit of these forms is they can help avoid a frail patient spending their last hours being shipped off to a busy and alien A&E department for heroic, often very invasive, medical treatment if there is little chance of survival, and of ever having CPR performed on them in any situation. Instead, the patient can remain in familiar surroundings and be nursed and made as comfortable as possible with minimal suffering, hopefully with their family nearby.

As the Covid-19 pandemic spreads, thanks to these forms, there will be many situations where the decision not to escalate medical care will have already been taken, thus easing the pressure on intensive care beds and ventilators. Much has been made in recent weeks of a perceived shortage of ventilators within the NHS, which are now seen to be the fix-all cure to Covid-19. In fact, putting infected patients of the type described above on a ventilator is futile, and will compound suffering – they are extremely unlikely to recover, and the ventilator could be better used on critical patients with better prospects.

With any luck, the fact that we have this system in place could help Britain avoid witnessing the kind of scenes that have unfolded in hospitals in Italy and Spain.

Anonymous

Selfish employed

So parliament is breaking for four weeks for its Easter break, while teachers, other key workers and of course all NHS staff are working above and beyond to keep the country going.

Five of us in my family are self-employed. As of yet, we are being offered nothing to support us, but are expected to stay at home.

Public transport, especially in London, has been reduced so that those who are desperate to keep working if they can, try and do so to keep food on the table. No wonder we are witnessing scenes of overcrowding on tube trains.

The government has attempted to cover those who are employed. For the 15 per cent who are not, because they are self-employed or have lost their jobs because of the situation, there seems to be nothing. While our leaders have their four-week Easter break, what will happen to those who will find themselves with no support?

Deborah Mabbitt
Bognor Regis

Sophie's Choice

Like Vince Cable, I too am fit, healthy and over seventy, but he seems to have missed the point. The reason us oldies should stay at home, in isolation, is so that we won’t get the virus and clog up the NHS when they could be treating younger citizens. Sophie’s Choice is not what we would wish on any of our medics.

Adrienne Fitzwilliam
Tunbridge Wells

'Death toll'

I see that, in common with other newspapers, you have used the misleading and alarmist term “death toll” on your front page. The figure represents the number of people with coronavirus who have died, not the number who have died from coronavirus. This may seem like a trivial point while the numbers are small but on average over 10,000 people die in England and Wales each week. If coronavirus spreads to half the population, that means the "death toll" would be 5,000 people per week, even if none of them dies from the virus.

Chris Condon
Uxbridge​

Coronavirus decampments

Can I be alone in wondering why it is acceptable for members of the royal family to decamp to their respective alternative homes out of London when other members of the same society have been pilloried in the press and on social media for doing likewise?

Dominica Jewell
Bazoches au Houlme​, France

Retrainees

Matt Hancock has just announced that additional student doctors, nurses and returnees are joining the NHS.

I do wonder why the UK has not done the same as Sweden, where laid-off cabin crew, who already have customer care and first aid skills, are being offered a free three-day course to adapt their skills for hospital use as temporary NHS healthcare assistants?

Alan Hutchinson
Address not supplied