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everyone. I hope this one is working. Okay, We're not like yet. Okay, I do think Just give a little second til it goes green. Maybe you Maybe you are if we are. I'm sorry, guys, but, um just okay. Hi, everyone. And my name is Jean Chen on And then currently 1/4 year medical student at the University of Glasgow in Scotland on for a second. Good. Today we'll have Doctor Mohammed Ali had a tear on. And he is a consultant in a CD in critical care in Glasgow. And I'll just give a short in. True. And then before we start questions, that sounds right. So and the title of the stroke is called carrying. Burke would quit patients during a pandemic on Doctor Mohammed Ali. Dad graduated medical school in Baghdad in 1993. He trained in anesthetic, some critical care in Scotland. And he has been a consultant in critical care. And it's easy and glasses. Since 2005, he has had many positions and postgraduate medical training and could incredible care back with the teacher on program director for foundation. He is currently associate. Put scratch it, Dean for quality in the specialties of anesthesia. Critical care on emergency medicines, gold and on program director for the MSE and critical care programs at the University of Glass do. He is the University of Glass, your undergraduate lead for anesthesiologist. He'll care, executive director editor for the European Society of Intensive Care Medicines Academy on deputy chair of the evening committee, a specialty editor, the Journal and a CT anesthesia and critical care medicine. So we'll be here to fill through some questions in the audience. So if you have any questions, please submit them in the chart. Books is before and but I guess before anything else, we'll get started with the questions that that's the case Doctor had. Thank you. Thank you very much for having me. Thank you for that very kind introduction. Thanks you. Thank you. So. And we know from reading a really interesting article from the British Medical Association and that talks about your career story. And it's been really interesting, perhaps my hands even a bit challenging. So you haven't always worked just the doctor here in the UK, and we're just wondering what it's been in like in terms of transition from life in Iraq and like your case? Well, yes. Ah, so no, I am. I went to medical school in back that as you said, Onda, um, I graduated from a medical school called Saddam College of Medicine. So try putting that on your CV and getting a job. But anyway, at it came over to the UK in the nineties on. But there is a, um a really nice elliptical by an initiative called and long from From Canada, about the experiences of international medical graduates in terms of lost disorientation on then, adjustment on that pretty much went through that phase both adjusting to life in the UK compared to where it came from on do the work environment a lot of details like, you know, bank accounts, driving. And and although details off life in the UK so much different to where I came from, Andre in terms of working with the work itself, I can't You know, I can talk about this forever, but, uh, to summarize, I think the two main things that that were different on I noticed straight away is first of all, the flatter hierarchy in the work environment in the UK compared to actually quite a significant number of other countries. And so you'd call your consultants by the first name, and and so one with you would never dare to do back back in Iraq. Um, and the other thing was the roll off the multi disciplinary team in health care provision on the prominence off the roll off, off nursing colleagues on but other allied health professionals. Compared to to a lot of other health systems on, I suppose one last thing is that the way we deliver care in the UK is very patient centered, which means that you're you've got the patient at the center off your consultation or your intervention or a consultation or or what have you while in in the Middle East that then it's often you talk to families and it's more family orientated, probably speaking to the to the patient. So it's just they're just a couple of things. That's that's a different, Uh, but yeah, that was a long time ago, and here I am Now that doesn't mean that that's really inspiring to hear Hi there. And we went from in practicing medicine, one place to just transitioning and being altered up so well in a place that you haven't been to, where that's great. And so the second question is, and if you could tell us a little bit up with the preparation for a code in 19 in the critical care setting on what about the quick and UK? What's their thing was were you doing in the department? Yeah, So it's it's it's really that's I can describe what what happened in our in our intensive care unit, which is the largest intensive care unit in in Scotland? Um, and it was It was very much helped by the's reports that we heard from China as the as thie pandemic started as the first cases emerged on the publication off the type off, um, illness or the heavy, the the range of symptoms that were that were presented in the natural kind of progression off the disease in severity, they're they have contagious. It wasn't on that that really was very, very helpful. And it was it was crucial, as well as theater in experience in late January. So to be, to be honest, we started planning, um before we we heard about before the situation in Italy because and it sounded like there was There was a, ah, a significant threat coming on in terms of planning. It's it's it is a fast range of things that changed or we plan to change on D. They're some of them would include, like the geography off off the critical care unit. So our critical care floor has, and so we normally have 20 intensive care beds on Do another, um, 40 what we call Htut. Bet So that's high dependency unit, which is a level of care between intensive care and the ward's on. We've also got the country care unit within our floor, So we very quickly plan to have an expansion plan to essentially make a little critical care floor potentially compatible with yeah, admitting patients who require ventilation and so on. So the space, the geography. And then there's the business off. When you get your first patients where you put them on, then how you expand and so on, which, uh, for example, the A lot of patients who were coming Teo Hospital were coming to hospital. We're going to need hospital for for oxygen therapy. So then we had to. We've configure the whole hospital as to where the patients are going to go if they become unwell so that we can and then be prepared to take them to intensive care from a certain area rather than having to go all around the hospitals. All that required a lot of planning and a lot of what we called phase planning, depending on the number of patients that we're going to, um, encounter. So then that's the space, the geography. So then you have the the staff. Obviously, when you're stuffed to deal with 20 patients on a ventilator. That way we normally have a 1 to 1 ratio. So there's a one nursing ratios, and there's, Ah, there's one nurse for every ventilated patients, which is required for somebody with who's Who's that on Well, on with that level off, um, illness with that severity of illness. So then it's how you within a couple of weeks, and it nurses to to kind of cope with with the If we were essentially planning for a potential expansion from 20 to 80 ventilated patients, so again plans in place to increase your staffing capability on. But it was ah, we planned, and in reality there was there was a fantastic response from really, um, everyone around the hospital, especially nurses who normally work in theatre on anesthesia and critical. Alfie's is the closest kind of specialty that it it the intensive care. So we did use utilize a lot of the anesthetic, a kind of, um, human on other resource is S O. So they were fantastic. And again, we have a plan to how we're going to integrate them within the team who was going to supervise them and how they were going to fit in on what? When it really happened. They just did a remarkable job. As you can imagine, it's it's quite scary going to intensive care in the first place. But going to intensive care in the middle of a pandemic like this must have been really a challenging experience. But they're they're kind of a low a Dallas proud that they've done really well. Um, the other thing is, in terms of equipment, you know, you need to prepare equipment with only about 20 ventilators on, you need to plan for expansion in the number of ventilators. So we managed to acquire some ventilators. But as you know, with all the best thing with a pandemic, a worldwide pandemic, the's shortage of Bentyl eight hours it's worldwide, so you can't just import ventilators or you can just go buy them off the shelf. There were some spare, and we brought them in. But the other strategy wants to use the ventilators from the operating theaters in the hospital and from theoretic called Psych Hospitals. One of the problem with anesthetic machines is that the use oxygen to drive the ventilator, so that's sort of the ventilators in intensive care. Use electricity. Essentially, it's it's a circuit Elektronik circuit to to drive the positive pressure. When you're ventilating patients, the anesthetic ones use oxygen to drive it. And one of the problems that we were having or could potentially have had waas that you would use up the oxygen supply for the hospital if you're using all these ventilators to not only give oxygen to patients, but to drive your ventilators. So our medical physics team were tough with changing the modifying the ventilators so that they're driven by a rather than oxygen, and we kind of expected them to go and scratch their heads and think about it and so one. Within 48 hours, they managed to change all the old, uh, ventilated with the anesthetic room ventilators and operating room ventilators to ones that are driven by eso. When when we talk about a multi disciplinary kind of team, it literally was Every single person ah, within their area of work contributed to both the planning on. Also, as I said, carrying out what's required and the other things that you know you need to plan with supplies where you're going to get supplies for that. You know, there's a supply of medicines that you require in critical care. That's a worldwide shortage of that, um on obviously PPE is is another issue that has been highlighted in in the media, and I think people are aware of it on it's It's you know, I think I think you know that the government is doing their best to kind of source PPE and and so on. But I will be occasions at the look at local level when you just run out of something or the other on Do that required planning a swell the last. Yeah, the the last thing. Isaiah, you're kind of deliver your care when when you're got a lot of patients, new staff, you're normally you'd need months to teo furniture, foreign orientation kind of process to to work in intensive again. Here we are asking people who have never worked in intensive care to come and look after patients, and someone will have to quickly escalate our education and training on. Also, one of the things we did was try and standardized the way we deliver care so that it's easier for people to for staff to kind of get their head around what was what was going on? Um, so, uh, that's that's That's one stiff Some of the things that we that we probably for this and thus create I can clearly see Hari in the department of all how to take their own skills. Evening Captain was quickly as possible in order to make the response so effective. And it's amazing that classes didn't response to quickly. I remember, and I attended one of the Friday were current and grant one meetings on really upset and alternatively like a space between us, and that's in a lot of things on you to see height, well prepared people wear a chance or questions and just get things moving. So it's very inspiring. And I'll ask you a couple more questions before we open it to the floor to spit them being of the causes of time so the next one would be in. So I guess there is a lot of worry amongst family, of written of patients on, but with restrictions and traveling such a distancing, it's really changed how we interact with those family members that might be in a hospital or even and the credit we go pretty feet 11. So what successful methods him have been used at last? In order to address this discrepancy in being able to see your family parents? Yeah, I mean, I mean, I have to see. It's not just for me, for but for everybody in the intensive care, not being able to see relatives off critically ill patients and speak to them face to face on a daily basis was one of the most challenging things off this whole last few weeks. It has left us, you know, at the end of shifts in tears. Um, it's it's such, uh, you kind of you don't you don't think about these things. I mean, we're kind of I mean, I think most people now know what what goes on in intensive care more than they did two months ago on. And, you know, the you kind of maybe get a night idea of the intensity of the work that we do on way. We we mean, obviously, we we communicate this toe it it the families And And so what about being never thought that taking that physical contact awake and have such a nymph act on the way we are able to deal with it, not just as professionals, but as human beings. So it was is just to put it up there. This is one of the most challenging things off the whole experience. So what we've tried to do is to, um first of all at the start that there was very strict visiting policies because we really just didn't know what was what was gonna happen. What was gonna face us, Uh, what we're going to basically be faced with. So we were calling families relatives every day on updating on. Obviously, we have ah, open kind of falling policies. Whenever people wanted to call. Then they were able to. Gradually, we started to think of other solutions out. One of the things is that once patients were slightly more awake, or even if they weren't able to speak, we would get the phones and put it next to the patients. A. So the the relatives could they loved ones. And, you know, families on both ones could speak to the patients. And, um, you see the or, you know, the the reaction of patients once they're here. Familiar voice is it was just wonderful to see. Um, we also had what we kind of introduced as something called V create, which is like an a synchronous kind of video recording. So we would record the, you know, the careless. There's other consultant and the nurse that the bedside and so one on, and we video off the patient on, upload it on a secure a place, and it's all kind of with consent. And with security, the necessary security kind of issues taken care off eso that allowed relatives to go on view these reviews, you know, in their own time. So it wasn't a live thing, and then and then recently, with we've introduced socks. So take the patient's phone on the relatives, control their phone on day through facetime or whatever they would have a live kind of chat with with with patients using the patients on phone and as as the as the time is progressed were kind of especially towards end of life. We're allowing one or two relatives took to come with a with the caveats, with all the precautions that that need to be taken because it's just it's just it was impossible. You know, Toe, have all this happening without relatives being there with the, um, loved ones, especially towards the end of life. So but some of the ways in which we kind of felt with this issue, thank you and again, yeah, and the Predators really appreciate all the essence me from the hospital in order to and be able to see. They're just it's just heartbreaking. I can't even imagine what you know what they're going through, You know, during the time like that, it's just, But you can imagine it must be just awful. Yeah, And you are that the pain will move to some pressure from the floor. There are those questions that you guys are going to start off with. Some people. Okay, So Georgina Morris's aspirin product as a medical student interested in anesthesia do you anticipate significant changes in the way the anesthetic departments run? Bearing in mind the Cupid prices like you think you're going to keep your skills, you recommend learning early on in your career that will help in the future. Um, great question. Always keen to encourage folk to shown interest in anesthesia. So, um, I think we're still trying to get our head round things At the moment. There is a ah change. We just starting to think about reintroducing are elective work in an anesthesia, and so one on. One of the things that we're doing is we're assuming everybody has called it. So we're wearing full pee pee, and and so the flow in in theater is not as easy as it was before when you're not wearing pee pee because it does take time to don't and off on. And so one on were also having so so that introduces a bit of the sluggish flow in theater and so one. But one of the things that we really keen on doing is to obviously train the next generation of doctors. We you know, if if anything, this is Jonas is the importance off doctors and nurses and and everybody Teo, look after patients. So one of things we're trying to do is to classify medical students is as clicky workers so that we're able to kind of re integrate them within the with in the hospital environment again. Because, you know, as you all know, you know that there has been limited contact from medical students at the moment so that I can't give you a black and white answer because it's an evolving situation. But we are kind of keeping training and education at the forefront off planning in terms of, uh, I don't know what stage you are, uh, in terms of skills that you need to prepare for. I think showing an interest is a great start. And then depending on the level that or the stage of training that you are, there's there's a lot of things that you can do on. The best thing I would advise you to do is go and speak to a friendly and the statistics critical care consultant. They usually are friendly on the heaven, and they keep you right because they're be different opportunities in different departments. So keeping it personalized, showing your interest is really important. And then you'll be guided away. Yeah, I think I'm definitely bias and Sinus. But I do think that this is a coupon with the friendliest specialty. I know, anyway, and yes, great. From Glasko perspective, there are definitely I mean, I'm getting us back into place in the sense pulse, pulse, and they contact you. Okay, then you kind of a cramp. So we've got a question from Angelika Sharma's. So she said Hi, Doctor had a great talk. Thank you with your wealth of experience with it for the components you have taken from working on the front line. Yeah, I think I think, um, one of one of the key things is, um is the importance of of teamwork and it's it's the sense of you, kind of. I mean, it's all fine and well, talking about different things. But at the end of the day, you have patients with everybody's trying to social distance from patients who may or may, or people who may or may not have covert and so on. And here you are dealing with a patient who is. If you don't do something, they're going to die. You're going really close to them. Your reassuring them, your putting an indoor track, your tube in the trachea. So you're right there where all the all the viruses, the nurse at the bedside is suctioning all the secretions. And so when there's a lot of detail that that is involved, the the cleaning staff are cleaning areas that we know is fully contaminated with with with Corbett there cleaning PPE and equipment that's holding with with the virus, there's a sense off, Um, come really describe it off of a seriousness and a life threatening seriousness of of what we're doing, which is was really intense on it kind of brings you all together on It's really important that year. Then when you come out of the you know and you're on break source bump into each other in kind of the corridors and so on, you look after each other and looking after, um ah, the well being off off every member off the team Brecca gone izing. It's okay to feel scared. It's okay to be anxious. Um, it's okay to have these feelings and stuff to failure. It's human. Teo have these things on. Um I suppose for me that that the most important thing is is that kind of this situation that we're in highlighted the need for us to look after each other at times off. Um, yeah, stress, which can be different for different people. So it's really important to, uh, to maintain communication, maintain an open dialogue, look after each other. Yeah, thank you very much for that answer. And we want to the next one. So this might be potentially dip a question. What have you had to face? Any ethically challenging situations? So, for example, resourcing things eventually to allocation threat the last few weeks on what's your experience being like with these resource sort of shortages is from Iowa cash shopper. Yeah, uh, it's it's It's not a difficult question to answer because the answer is easy. It was no. We had prepared to go up to 80 ventilated patients. As as we said then we didn't even hit half that number at the peak, which was early kind of April. So, um, I know people look in retrospect and eventually critical, criticized and the government for opening extra hospitals. And so one for us kind of put an extra work to increase the capacity. But it's because off those things that we were able to be in a position not to make those decisions as to, uh, I've got one ventilator I've got 75 year old on. I've got an 18 year old who do I give it to? You didn't we didn't have to make their was. Luckily, we didn't have to make them. And if if if we did, it would have been it's just incredibly ah, uh, more challenging than than it already has been. Eso uh so So that's that's the answer. Thank you. So And we have one here from the a wood. And, uh, if 10 is, um, of the evidence that has emerged on is continuing to merge with respect to increase with you and be eight mg people. Probably took in any additional measures for such staff on it. And he says, thank you for talking so candidly and spin a fascinating talk. Thank you. Thank you very much. So I'm in. Uh, I think I'm probably, um a risk of, um, one of the being be any kind of frontline health workers. Um, to be honest with you, we haven't taken any specific precautions because the idea is that we all take precautions on although we're kind of information is emerging. And, oh, that there was definitely a disproportionate number off being me health workers who are being affected. It's really difficult to know why. The quick answer is we're not taking anything any specific, the precautions, because we're all taking the same precautions, which is sensible on, uh, a must. But in time that there's a lot of patterns that that that that are emerging people with low socioeconomic kind of post codes in that's the address for for for people are not familiar with postcard. So, depending on the area that you live, you're more at risk. So if you're low social economic class as as defined by income and and so one, then you're more at risk off of becoming critically unwell and going on the ventilator. I'm sure there's a there's a racial kind of difference. Genetic susceptibility is going to be different, and I think that's one of the reasons why, and the virus is behaving in such a different way in different locations around the world. I think people attach a lot to the policies of the's, a lot of importance to the policies of of governments within these cut different countries. In my in my mind, I think it's not just policy. There is definitely the way of life. The way society's organize the racial on genetic mix off off the population is having has a huge impact on on your susceptibility. And once you're affected, how severe it kind of then manifest itself the disease. Um, yeah, thank you. And with the question here from lawyer on, she's wondering. See, you mentioned about my mental health earlier, and they're being biggest thing. That's in general around the UK. So she says, Ah, what sorry. I mentioned what So you mentioned a bit about the effect from the mental health of stuff really has and the but more of a question to ask you this. We've been asking how much of an effect do you think the repercussions of this pandemic will have on the mental health of medical staff on she's wondering. How do you think stuff can be supported for this. Yeah, great question. Um, I think the mental health burden is significant. Um, it's, I think, one of one of the things. One of the things this is This is my own personal passion about raising awareness of mental health on Belding Off people, I think in general, up until now, we haven't discussed mental health as we discuss our physical health. So you have a cold. You talk about your cold, you know, you have a broken bone, you see, broke it doing this or that. But you don't talk about, you know, the anxiety that you've had. You know, the last couple of days, you didn't sleep very well cause you were occupied. You know, you've been feeling really low. We don't talk about it. Uh, and I think, and underlying the you know, the statistics off mental health is a huge, um, number off off, uh, people, What's not a huge, I think is part of the of the human condition toe have a wheeze things, and obviously it manifest in different kind of two different extent. So So I think there will be inevitably on impact on on mental health and already there are things that are being done to to teach address some, some of the mental health on board, mental well being a burden that that stuff a face. So there there are. There is counseling and services on D support networks that are emerging. And even I know a group of therapist in Edinburgh have set up ah, national online free service for frontline workers for counseling, essentially to support thumb through this I I hope that and this will be one of the one of the positive that we can take from this is for. And it's for people responsible for allocating resource is and planning health care to really take mental health much more seriously than than has been on that put more resources into it. So some things that definitely an impact things that are happening already there's definitely a lot more that could be done. Yeah, and with the mental health wearing this week, this week is really great to use. That word and raises rate is wearing this And just the final question For the last 15 minutes we have from the freedom a week on, she's been asking with the coupon 19 situation. We're hearing reports of increases and you told him about events due to cope it on. I see you and she's wondering about your experience of this on if there are any other complications that be able see, and I see absolutely. I mean, it's it's it's that there's definitely a prothrombin sick element to tear the disease. We see it all the time. We have seen clots in lungs and kidneys and liver. As it's it's a very hyper collectible kind of state that are severe wrist severely ill patients are. And so what? What? I'm seeing a lot of complications of the handle. Where to start on it It's been I mean, you're you're typically a year critically ill patient comes with high poxy and respiratory failure on D. Initially, we were kind of putting people on the ventilator very quickly. But now we've taken to just sitting tight and giving them oxygen and so on, because once you're on the ventilator, your chances off of dying are very high there, you know, over 50% especially if you're a man and you know that puts you at a very high risk off death. So then there are other patients who then develop ah, multi organ failure in the form off kidney failure on about the third of our patients have developed acute what we call acute kidney injury or renal failure requiring green or replacement therapy. Well, you know, the vast majority have needed what we call an atropic support. That's medicines that's keep your BP up like your adrenaline and adrenaline on day. So on eso a Z, I talked about the thrombotic events, and, you know, paradoxically, there are folks who have had bleeding complications like intracranial bleeds and so on. It's ah, it's It's a disease that we are still learning a lot about on patients with this disease behaving away. That's very, very different to anything else we've seen before. So we're still learning, and that's it's really important that people share. They're kind of even what we call low level evidence, which is just describing your population. Describing what's happened is really, really important at this stage to start building the basis off the evidence based pyramid, I'm aware of time. That's well, so just go. So this. Thank you so much for being here with today, and it's been so nice to hear from. It's actually right at the front of the front line in the UK, and one of the biggest also lessens government. And so I just really want to thank you. Very welcome. Thank you very much for inviting. He's been a pleasure. And honestly, sweetie, thank you. Thank you. Don't drop that. Thank you. Thank you. That's what I'm what I'm gonna do. An eye is we're going to stop streaming on down on. Then we're gonna have a coffee break. We're gonna have coffee. Break until until 11. 20 on down, please head over to the networking area. It's at your own risk. You will meet someone in the conference and they can share their video with you. So it's at your own risk. If you're happy to do that, then and then please head across to the networking area. And if if you can also check the posters and there is a link in the reception area to the poster whole on the password is gonna be in the chat box. My on does just use that password on. I've just typed in the chat books to enter the poster whole have a look at the posters. And if you match with someone who's got booster in coffee, break on your meeting them in networking. Please ask them about their poster. Asked them to til you a little bit about their poster. Ongoing. Have a look at it afterwards on gonna be starting right back at 11. 20 with Dr Mark Sherlock, who is from medicine. Some frontier going to be talking to us upright at managing pandemics in next resource or challenging settings on. Have a wonderful coffee. I'm sorry, we can't provide it for you, but Yeah, we'll see you sharp. 11. 20.