It’s been more than a year since Intermountain Healthcare treated its first COVID-19 patient. During that time, clinicians, physical therapists and physical therapy assistants from across the Intermountain system had to take on new tasks unique to the pandemic, including learning ways to help keep the sickest COVID-19 patients alive in the ICU.
Those caregivers worked alongside doctors and nurses on specialized, multidisciplinary teams that repositioned patients in the ICU, moving them from lying on their backs to their stomachs to improve their breathing. They are called proning teams.
Prone positioning, or 'proning' is an arduous process that uses precise and safe movements to turn a patient over from their back to their belly – and then back again several hours later.
In an ICU, a patient may be sedated or have trouble moving, so it often takes at least five caregivers to safely turn a patient over and can take between 30 to 45 minutes.
“It can be exhausting work at times when we turn 12 patients two times a day. You can see the real toll COVID-19 has on people,” said Bambi Carr, a Intermountain physical therapy assistant on the proning team at Intermountain Medical Center in Murray. “It’s work that we’re not used to in our field, but we know it’s important.”
In the past, clinicians in hospitals would use complex prone positioning beds for turning patients but the high volume of COVID-19 patients in the ICU has required caregivers to do the heavy lifting.
Research has shown that proning improves oxygenation and survival in COVID-19 patients with severe acute respiratory distress syndrome, also known as ARDS.
Intermountain caregivers first saw how efficiently proning teams could work and the improvement seen in patients while in New York helping overwhelmed clinicians in hospitals there during the peak of the pandemic. 100 volunteer caregivers from Intermountain traveled to NYC in April 2020 to help teams there.
Dixie Harris, MD, pulmonary and critical care physician at Intermountain Healthcare, was one of the caregivers who traveled to New York. She saw how caregivers in a desperate situation helped mold a better process.
“They were hit so hard they had to find something that worked and these proning teams showed to have a major impact on outcomes,” said Dr. Harris. “We’ve been able to keep our mortality rate lower because we learned proning can help prevent a patient from needing to be intubated.”
Dr. Harris said proning works by allowing the lung sacks to open up while relieving pressure from liquids and tissue in the body. While it does benefit patients on a ventilator, Dr. Harris says it’s especially important for preventing a patient from needing one in the first place.
The process of proning isn’t just about turning someone over but ensuring they’re in a safe position on their stomach. It’s why nurses in the ICU have been thankful for the expertise PT’s and PTA’s have brought to COVID-19 teams.
“They know so much about proper muscle placement and movement and our nurses are learning new ways to ensure patients are safe and comfortable,” said Pamala Brown, Respiratory ICU nurse manager at Intermountain Medical Center. “Most of all they’ve been there to help our nurses with whatever they need, and it’s been a huge relief.”
Proning has other benefits which help with the care of a patient. Once a person is on their stomach gravity goes to work – improving blood circulation, caregivers can also bathe them, while checking for and preventing bed sores.
The proning team was developed not just for the safety of the patients but also the safety of the caregivers. Lifting patients several times a day can be hard on the body and if caregivers don’t take precautions it can lead to injuries.
Many of the therapists have been helping on the proning team since May of 2020, and they expect to continue for the next several months.
Dani Brady, a PTA working in the Intermountain Medical Center COVID-19 ICU, says she hopes the vaccine and a focus on safety guidelines will help turn the corner on the pandemic.
“Even when things seem to be slowing down, they always spike again and we see our ICUs fill up with more COVID-19 patients,” said Brady. “If people could see what we deal with day in and day out I think they would know why we continue to ask for their help following guidelines.”