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06 July 2020

King's academic provides emergency care to critically ill COVID-19 patients

Dr Thomas Smith, Head of Aerospace Medicine Research at King’s and Honorary Consultant Anaesthetist at Guy’s & St Thomas’ NHS Foundation Trust (GSTT), is one of many clinical academics who was released from their responsibilities at King’s to support the NHS frontline response to the pandemic at its most critical time.

Dr Thomas Smith wearing PPE

On a normal week, Dr Smith dedicates several days to leading the MSc in Space Physiology & Health and one day in the operating theatre. When released to support the NHS response in March, he joined a ‘surge’ rota in critical care at GSTT, specifically the mobile emergency rapid intubation team (MERIT).

When a patient is critically ill and needs to be put on a ventilator, the MERIT team are called. MERIT is responsible for all emergency COVID-19 intubations in the hospital, whether in the emergency department, on wards or in intensive care. With GSTT admitting hundreds of patients to regular and newly created intensive care units, MERIT teams have been resident on-call 24-hours on both hospital sites.

These critically ill patients will not survive without being intubated and ventilated and can be difficult to manage clinically, especially with the added challenges of working in advanced personal protective equipment. What patients and families have had to go through has been horrific. Sadly, for those patients who don’t survive, we are the last people to speak to them. A personal low-point was when my family all had COVID-19. It sure is a horrible bug.

Dr Thomas Smith, Centre for Human & Applied Physiological Sciences

Aerosol-generating procedures like intubation are thought to carry the highest risk of serious illness for staff due to potential exposure to very high viral loads. Because of this, clinicians have to carefully modify their intubation and management techniques to minimise aerosol generation.

The GSTT critical care survival rate for COVID-19 has been well above the national average, and for most patients, it has been lifesaving, a credit to all staff involved. As new admissions have fallen, the MERIT team has become more involved in airway management for other interventions, such as insertion of tracheostomies in intensive care patients.

Now that we’re into a different phase, I’m very happy to have recently switched back to my usual role at King’s. I’m grateful to my colleagues who took over my teaching responsibilities and have really enjoyed coming back and seeing them – as well as my students – if only via Microsoft Teams for now!

Dr Thomas Smith, Centre for Human & Applied Physiological Sciences

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Headshot - Tom Smith

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