Equipped for the Next Wave

The wave of Covid-19 cases in Germany has so far been smaller than expected, but the one of people willing to help has been far greater: around 350 Freiburg medical students are currently on corona support duties, most of them in the University Medical Center. In total almost 1,500 students from the University of Freiburg registered for the campaign initiated by the Offene Fachschaft Medizin e.V. and the similar call by the Federal State of Baden-Württemberg. Two medical students report their experiences of working on the surgical intensive care unit.

Prospective doctors Pauline Hägele (left) and Anna Veenstra have been working for some weeks on the surgical intensive care unit. Photo: Jürgen Gocke

“It’s a godsend that the medical students are there,” says Dr. Thorsten Hammer, the disaster response officer at the Freiburg University Medical Center. Some 1,500 students wanted to help the initiative of the Offene Fachschaft Medizin. Around 350 of them are now involved, most of them at the University Medical Center, a few in care homes and at the health authority. “It’s sensational,” says the crisis expert, “We were only sorry that we couldn’t take on everyone.” The number of new Covid-19 cases fortunately remained smaller than feared and so the need for help also wasn’t as great. Hammer praises the excellent cooperation of the University Medical Center, the city, the university and the professional body: “It was a model of coordination.” One that has even received recognition from Berlin.

Setting up suitable structures in a flash

“We have plans for large-scale emergencies, but Sars-CoV-2 was an entirely new situation,” explains Hammer, who in normal times is the medical head of surgery in A&E. In order to manage the welcome flood of volunteers Hammer and his team of six had to set up suitable structures in a flash – for instance contact points, training plans and a platform for matching demand with supply. “The departments told us how many helpers they need and for how long,” says Hammer. The security service, which oversees hygiene regulations and visiting rules, needed additional personnel, as did the transport service, several clinics and other areas. Hammer’s team organized allocation and flexible, time-limited ‘lightning appointments’: “Both sides have the option of ending the employment relationship earlier.”

The Offene Fachschaft Medizin gathered the names and qualifications of the volunteers, including which semester they were in, experience of clinical internship, training as paramedic and so on. Pauline Hägele and Anna Veenstra are in their sixth semester of medicine and have been working daily shifts on the intensive care unit of the General and Visceral Surgery Clinic since 23 March 2020.

Taking blood, preparing medicines

Each shift – whether morning or evening – begins with the team handover. “We discuss every room then,” explains Hägele. After that she usually helps a nurse with the daily duties: taking blood, preparing medicines, taking patients to the operating theater. “A lot of caring duties, but on Intensive Care it also includes tasks that doctors do elsewhere.” The most exciting thing for the medical student is when she gets to do something for herself for the first time. Once she was able to fit a gastric tube. To do this you have to push a small tube up the patient’s nose into the stomach. “Not at all spectacular really,” says Hägele, “But it was the first time.” To begin with there were several introductory sessions: principles of ventilation, organization of the ward and hygiene. “You can leave any time if it’s too much for you, for instance if someone dies,” the students were repeatedly told. And there were deaths, but Hägele stayed. She talked about it with the other helpers. “That meant it touched me more than it burdened me.”

The plan was for Hägele and others to support ‘lighthouses’ – nurses who if there had been a flood of Covid-19 cases would have had to oversee up to four intensive care beds instead of two. But until now only a maximum of six of the 26 intensive care beds, including many new ones, has been occupied with Covid-19 patients. Working together went very well. Lecture knowledge has been made real, you can touch it, smell it: “Pharmacology comes to life in use,” says Hägele. The working method and perspective of the nursing team also impressed her. “The people have a huge amount of expertise on intensive care.”

“The first few night shifts took it out of me”

Pauline Hägele’s fellow student Anna Veenstra is also mainly carrying out nursing duties. Turning Covid-19 patients, washing and tending them is time-consuming. “Another pair of hands can really help here,” says Veenstra. Once she was able to assist at a tracheotomy, an operation to insert a breathing tube into the throat. “It was very, very impressive.”

The prospective doctor was astonished simply by the initiation. “There they said plainly and simply: taking care of yourself has precedence over helping.” Protect yourself before others. “I knew it, but I’d never really thought about it before.” At first the mood on the ward seemed tense to her, “Like the calm before the storm.” It didn’t come, but all the same there was intense activity. She was unused to the long periods of standing during the shifts and working at night-time and found it arduous. “The first few night shifts took it out of me.”

Emotionally she was touched by the fact that some patients who regained consciousness after a long period of artificial respiration knew nothing about having been ill with Covid-19. “I’ve learned a lot, gained confidence and now know that I can really help here,” the student sums up. At first she lacked confidence in her own abilities, “almost everything here was new to me.” But now she thinks it is highly likely that she will work in surgery later.

Solidarity and unanimity

Forecasts indicate that the next peak of corona infections here will come as the summer nears its end. “It will be a massive advantage then if we can call on trained helpers and proven structures,” declares crisis manager Thorsten Hammer. He has also been pleased about how the different hospitals in Freiburg which are normally competitors have stuck together, “In these times they have spoken with one voice.” He describes the coordination between the university, the University Medical Center and the city as showing “remarkable solidarity”. So Freiburg is in a strong position if new waves of Covid-19 roll in.

Jürgen Schickinger