The role of biomedical engineering during management of COVID-19 in resource-limited settings
A pneumonia of unknown cause was first reported on 31 December 2019 in China which was later named as COVID-19 (2019 Corona Virus Disease) by the World Health Organization (WHO) on 11 February, 2020. Exactly a month later, when the disease spread exponentially throughout the world without a known medication or vaccine to the mankind, WHO declared it to be a pandemic claiming thousands of lives across the globe.
With the spread of this disease in over 180 countries, most of the countries around the world are trying to manage the cases of COVID-19 – limiting its spread and towards clinical management. On the contrary, very few countries like Nepal are working towards taking the preventive measures and preparing themselves for the worst-case scenario of the disease.
In both the cases, where the condition is not discriminated countries based on the economy, the major two challenges that has been faced are preventing the spread of the infection and efficient management of the medical logistics like personal protective equipment (PPE), diagnostic and therapeutic equipment, etc.
The government of Nepal has also geared up with the preparation for the situation, which could be a “disaster”.
The preparations and decisions made so far reflects the government’s preparation in making health facilities functional for the anticipated situation during the outbreak of a disease but it is not clear on what will happen if an unexpected problem like the breakdown of testing equipment occurs during the management, or a person transporting the patient is not aware of the preventive measures to take while handling the patient. These kinds of the situation need some special attention during the preparation.
Similar to most of the diseases, management of the COVID-19 also requires the use of the various medical equipment starting from the phase of diagnosis to effective management of the critical cases.
In countries like ours, where the number of medical equipment is quite low for the regular clinical procedure, it is very challenging to manage a sufficient number of functional diagnostic and therapeutic equipment in the situation of mass casualty.
The responsibility of efficient use and management of these equipment should be done through the professionals who know the prerequisites of using any particular type of medical equipment, who has an idea on how to fix these equipment in case of breakdown, who can identify what are the requirements if an emergency field hospital is to set up and this is where one of the least used human resource of health “Biomedical Engineers” can contribute.
It has been vividly clear during various disasters, for example an earthquake where the biomedical engineers (BMEs) and biomedical equipment technicians (BMETs) actively contributed towards resuming the equipment-oriented services within the main building and in temporary shelters of the hospital that additional effort, from what is considered an auxiliary human resource of health, can significantly increase readiness and effective clinical management.
Along with tackling the technical issues of the medical equipment, BME and BMETs can make clinicians free from the stress of management and functionality of medical equipment and help to focus on the clinical care of the patient in the situation of disaster.
Taking a few case scenarios into consideration, like a small problem occurrence in a Real Time PCR machine, which is an essential equipment for diagnosis of COVID-19.
If this case occurs, there has to be someone who can diagnose and fix it. Similarly, the ventilator might have some error, and it might need immediately attention. Furthermore, one of the most important requirements of the patient with the COVID-19 is oxygen and the oxygen concentrator might not be giving the desired amount of oxygen or there can be some problem in the oxygen supply.
Therefore, there should be someone who is there to resolve these issues if something happens and the answer is BME and BMETs. It cannot be denied that there will be situations where alternative options will be needed to be explored for any particular equipment related service; or any particular service has to be delivered in higher volume with the limited resources in hand.
During such cases, Biomedical Engineers can provide valuable input, support and required suggestions to the concerned authority.
There are several human resources involved in diagnosis, treatment, transporting the patient, making logistics available, efficiently managing the contagious waste and so on. Along with them, serious consideration on resourceful use of Biomedical Engineers and Technicians should also be taken into account for a better management amidst this pandemic condition.
Likewise, the government and hospitals should also ensure that Biomedical Engineers and technicians along with all other healthcare workers are well trained and prepared to perform their duties in a safe manner during the outbreak of an infectious and highly contagious disease.
This will not only lift the confidence of the staff and motivate them and form a comprehensive team to face the pandemic, but also act as fuel for efficient workflow which is efficient in the health facilities during situations and disasters like this one.
Er. Ashish Chauhan, Biomedical Engineer, Nick Simons Institute
Er. Praksh Aryal, Biomedical Engineer, National Public Health Laboratory
Er. Sagar Singh, Biomedical Engineer, National Health Training Centre