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Time matters for resuscitation and COVID-19: double bind and duty of care
  1. Nicola Scott1,
  2. Rodric Vian Francis1,
  3. Pradhib Venkatesan1
  1. Infectious Diseases, Nottingham University Hospitals NHS Trust, Nottingham, UK
  1. Correspondence to Dr Rodric Vian Francis, Department of Infectious Diseases, Nottingham University Hospitals, City Campus, Nottingham NG5 1PB, UK; rodric.francis{at}

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During the coronavirus disease 2019 (COVID-19) pandemic, there has been divergent guidance on the aspects of personal protective equipment (PPE) to be worn during cardiopulmonary resuscitation (CPR). CPR involves first responders in clinical areas, often nurses, and arrest teams, comprised of junior doctors and senior nurses. They follow their instincts in responding rapidly, their training and local guidance. Public Health England (PHE) guidance advises that first responders can wear fluid-resistant surgical face masks.1 The Resuscitation Council UK (RCUK) guidance is that aerosol-generating procedure (AGP) level of PPE should be worn, which includes FFP3 (filtering face piece) respirators and long-sleeved gowns.2 3 Local Resuscitation Committees have had to grapple with divergent guidance and balance the duty of care to patients and to staff. To overcome this double bind, we consider the view that only one of these options can be followed and the counterview that an alternative, balanced approach is required.

View: Either follow PHE or RCUK guidance

Nurses and junior doctors require clear guidance on what to do in emergency situations. Human factors affect outcomes and it is important that the stress from uncertainty experienced by individuals is minimised.4 Furthermore, resuscitation is a team effort, and every member of the team should follow the same set of guidance. COVID-19 is presumed to be here for some time, and in that time staff may rotate from one hospital to another. Having a standardised approach between hospitals will facilitate the functioning of arrest teams. Ultimately, the duty of care to protect staff falls to the employing hospital trust, which has to decide which practice to follow.5 Both PHE and RCUK …

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  • Contributors NS and RVF are joint first authors for this piece, who contributed equally in reviewing the literature, gathering, analysing, discussing data and drafting the manuscript. PV conceived the project, oversaw the information gathering, analysis, interpretation and finalised the manuscript for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.