Pandemic: Dr. Marquis answers your questions

Dr. François Marquis, Chief of Intensive Care at Hôpital Maisonneuve-Rosemont, answered questions about the pandemic from Patrice L’Écuyer.

As a guest at the À Votre Santé! event, Dr. François Marquis, Chief of Intensive Care at Hôpital Maisonneuve-Rosemont, answered questions about the pandemic from Patrice L’Écuyer. Read on.

Patrice L’Écuyer: How is this second wave going?

Dr. François Marquis: It is very different from the first one. The first wave put a lot of pressure on the entire Hôpital Maisonneuve-Rosemont. The second wave is more like a marathon, a long-distance race that forces all teams to keep a high pace. It’s like running on a slope: as long as you keep the pace, it’s okay.

P. L.: Is the allocation of COVID cases more equitable among institutions today?

F. M.: Yes, Hôpital Maisonneuve-Rosemont is the hospital that received the most patients at the beginning of the pandemic. Now the allocation is better. More facilities are receiving COVID patients, but that means we have to virtually cut the hospital in half, into COVID zones and non-COVID zones.

P. L.: Isn’t it simpler?

F. M.: Not necessarily, because when the whole hospital is affected by COVID, it’s simpler. Today, to prevent the spread of the virus, you can no longer transfer staff or equipment from a hot zone to a cold zone. Managing absenteeism, patient movement and the sharing of spaces; everything is more complicated.

Maintaining daily activities in the hemato-oncology department, for example, while at the same time treating COVID patients, the patients in the cancer department, those awaiting surgeries, those at the intensive care unit, and in the emergency department—one of the busiest in Canada, is an ongoing challenge.

P. L.: And how is it going in the Intensive Care Unit?

F. M.: Right now, everything is under control. We have room. We have resources. It’s important for the population to understand that we’re in a marathon and that we have to continue to work together, but we’re doing well. We have divided the care areas into hot zones and cold zones.

We have another space in the hospital. We are adapting. If there were more cases, we would move partitions, reassign ventilators, change the ventilation system, etc.

P. L.: Is it fair to say that the medical teams are better prepared than they were for the first wave?

F. M.: Yes. A lot of work was done. During the period that people referred to as “summer”, we called it “getting ready for the second wave”. All the concerns about the lack of equipment, the lack of respirators, all those things, are pretty much resolved.

But the big challenge is that we are not rested. We are facing the fall in a state of fatigue. And, like everyone else, we’re also tired of COVID. So, the real challenge is more about managing the staff, or the equipment. Some of these were reaching the end of their life-cycle, and their intensive use only accelerated this process.

P. L.: One of the first victims was your simulation dummy?

Transdisciplinary Acute Care Skills and Simulation Centre (CASSAT) dummy

F. M.: Absolutely. In the Intensive Care Unit, I am in charge of the simulation center and we use this extremely sophisticated mannequin. For our medical teams, it acts a bit like a flight simulator does for airline pilots.

You have to understand that in medicine, there are procedures that we perform on patients for which we have no margin for error. You have to be good the first time. That’s why we train on this dummy, that we control by computer and which can simulate different conditions.

When COVID hit Europe, we understood that it would come here afterwards. We started intensively training a lot of nurses and shortening the training time. Normally, it takes about 40 days to train a critical care nurse. We reduced that time to 12-13 days by implementing triads; a team in which an experienced ICU nurse continuously coaches and trains nurses coming from other departments to help out. But, to train these nurses, we used a lot the mannequin before it broke down.

P. L.: It was already there before COVID?

F. M.: Absolutely. We use it to train young doctors, to prepare staff for rare situations we see only once or twice in our careers. This mannequin was not new, but we used it so much that it was the first victim of COVID, and we need a new one.

If you would also like to ask Dr. Marquis a question, please send it to us at: info@fondationhmr.ca.

To be continued…