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Letter to the editor
An orthopaedic surgeon’s experience at COVID-IFEMA Hospital during coronavirus pandemic in Spain
Experiencia desde el punto de vista de un traumatólogo en el Hospital COVID-IFEMA en Madrid durante la pandemia del coronavirus en España
B. Alcobía-Díaz
Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">A priori</span> it could not have been more antagonistic&#58; infected and breathless patients with bilateral pneumonias under the care of an orthopaedist&#46; However&#44; events often simply happen and there is no room for manoeuvre&#46; Also&#44; if we think about it properly&#44; our actual situation can be simply considered in orthopaedic terms&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Because what has happened and what is happening now &#40;I am writing this during the tense calm we are experiencing in Pavilion 9 of the Hospital COVID-IFEMA&#41;&#44; is a genuine social health-related &#8220;polytrauma code&#8221;&#46; As orthopaedists we know very well that the mortality of these cases is divided into 3 phases&#58; <ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0015" class="elsevierStylePara elsevierViewall">Firstly&#44; immediate mortality&#44; during the first few minutes after the accident&#46; There is very little we can do for this type of patient&#46; Unless the accident occurs right next to a trained medical resource&#46; And this&#44; dear reader&#44; is what has happened to us&#44; we have to admit it&#46; We were not trained&#46; Despite the fact that for years we had theorised about the risks and consequences of a possible pandemic&#44; and the need to be prepared&#46; This is why the impact against COVID-19 has done away with much of our social structure and thousands of our people&#58; parents&#44; grandparents&#44; children&#44; friends&#8230;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0020" class="elsevierStylePara elsevierViewall">Secondly&#44; early mortality&#46; During the first 24&#8239;h after trauma&#46; This largely depends on the actions taken during the first hour&#44; in cases where&#44; even if the patient has not succumbed after the accident&#44; they have potentially mortal injuries&#46; This is the point where we can save more lives and protocols like &#8220;ABCD&#8221; advocated by the ATLS are vitally important&#46; This is the point at which we find ourselves&#44; when medical actions such as the creation of medical protocols and healthcare management are key&#58; re-structuring spaces previously designed for other purposes&#59; channelling all available human resources&#59; creating new devices such as this new COVID-IFEMA Hospital where I am now&#46; Thanks to the impetus of the entire healthcare sector in this country this disaster has been curbed&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0025" class="elsevierStylePara elsevierViewall">This is where we as orthopaedists come in&#46; We are qualified&#44; versatile personnel and we are trained in the application of protocols&#46; We constantly apply clinical decision algorithms in our daily lives&#46; This seems to be a simple task&#44; but it is no such thing&#46; Being able to apply an accurate decision protocol and sticking to it is no simple matter&#46; It requires training and as orthopaedists we have this training and are able to help&#46;</p></li></ul></p><p id="par0030" class="elsevierStylePara elsevierViewall">All we need is the &#8220;ABCD&#8221;&#44; the score&#46; The intensive care specialists&#44; internal medicine specialists&#44; primary care physicians and specialists of other branches of medicine are in charge of this&#46; And believe me when I say that sharing these difficult working days with them has been incredibly enriching&#46; For them as well&#44; because working under these circumstances has been&#44; as they have reminded me on many occasions&#44; a discovery from the aid we offer them&#46; Although it is obvious that as orthopaedists we have our limitations in treating severe medical conditions&#44; by applying a consensual systematic approach we have been able to manage those with mild and moderate conditions&#46; From here we reiterate the importance of creating protocols and the possibility of the orthopaedist being another person involved in this fight we are now up against&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Thirdly and lastly&#44; in all polytraumatised patients there is a later phase of mortality&#46; This occurs between day 7 and 10&#44; from a state of hyper-inflammation&#46; This may be accompanied by organ failure which is distinct from the previous lung failure or the patient&#8217;s disease&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Facing up to COVID-19 on a personal and professional front&#44; has been an enriching and indeed unforgettable experience&#44; which with difficulty may be summarized into 3 points to be shared with all of you&#58; <ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">It is vital to overcome fear&#46;</span> And the key to opening this door is by acting in conscience&#46; When I offered to be a volunteer for this task&#44; I admit I was afraid&#46; However&#44; I knew that this is what I had to do&#46; It was my duty as a physician&#46; In the end&#44; this is what we swear to before donning our white coats for the first time&#44; when we finish our University degrees&#58; to be on the side of the patients&#46; In addition to this&#44; it is only by the sum of our individual actions that we will achieve a global response and establish a better society&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Any task is important&#46;</span> During these weeks I have assessed patients exclusively suffering from COVID and others with orthopaedic conditions such as acute fractures or those in follow-up or have performed musculoskeletal scans for relieving those patients who had something in addition to the COVID&#46; I have also been a secretary writing up reports&#44; a hospital attendant transferring patients&#44; have examined vital signs and reviewed drugs supplies like a nurse&#44; configured computers and printers &#40;what a nuisance they are&#33;&#41; like an IT technician&#44; configured CPAP&#44; and each one of these tasks was just as important as the first because I was helping to unburden others&#44; so that between us all the best care could be given to all these people that needed it&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Everything has an end&#46;</span> Or will have&#46; We simply have to wait till the storm passes over&#46; Don&#8217;t worry&#44; the sun will come out&#46; Be aware though&#44; next time we need to make sure we have an umbrella&#46; We cannot be complacent and have the moral obligation to be prepared for the next occasion&#46;</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">Society needs us&#46; Orthopaedists have to have the tools as well&#44; know how to use them&#44; dismiss our fears&#44; and be prepared to take our place when catastrophe strikes&#44; because we can all fill a gap and it&#8217;s important&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">I would like to finish by thanking everyone who worked there for their efforts&#46; Also&#44; to the whole human resources team and the management of this hospital of incredible dimensions and highly satisfactory outcome&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Wherever we are needed&#44; as orthopaedists we will be there&#46; Measuring up&#46; As the motto of our society says &#8220;<span class="elsevierStyleItalic">Cogitare et Recte Ambulare&#8221;</span>&#44; think and stand strong in the face of adversities&#46;</p></span>"
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