**6. The surgeon and COVID**

Elster et al. commented that surgeons responded by postponing elective surgery, however this was a misnomer. Most electives are time sensitive malignant cases [23]. At our facility we instituted the Covid scoring system (NDOH technical working group on COVID 19) as well as a vetting committee and as a result our oncological procedures and services continued.

With regards to COVID positive elective cases they were postponed to either when the patient was asymptomatic for 72 hours and two negative covid tests 24 hours apart [23]. At our facility we initially postponed to 2 weeks post covid infection and as evidence become available our protocols change to 8 weeks post covid, in keeping with the current literature [24]. No repeat covid tested were requested on patients previously tested positive.

In order to protect staff members from a prolonged MCI Elster et al., implemented a few protocols, namely, Screening of outpatients, testing patients before entering the hospital, limiting OPD and seeing only the medically needed and time sensitive cases, avoiding burnout and unprotected exposure to infected patients, encouraging telemedicine and all meetings to be done virtually [23]. These protocols have also been implemented within our facility except for the avoidance of burn out. Surgeons and interns were mobilized to work in COVID units. Critical care training is included in the curriculum for surgical residents as well as having experience with critical care in the wards due to the shortage of critical care beds within specialized units. These covid duties were in addition to their surgical responsibilities and therefore impossible to avoid burnout. Surgeons have skills that are geared towards dealing with the COVID pandemic, these skills arise from their experiences in MCIs in the combat and trauma setting as well as their critical care experiences [23].

Literature is populated with the surgeon's role in the pandemic [25, 26]. Acute care surgeons assisted by converting post operative recovery areas into ICUs to increase critical care capacity, which were managed by critical care trained surgeons. The less severe covid patients were managed by surgeons with no critical care experience as well as taking on acute care surgical responsibilities of themselves and the critically trained surgeons. Non critically trained surgeons were prepared for their covid responsibilities by undergoing a 1 week catch up course involving antibiotic and ventilatory strategies as well as specific covid protocols. There were times when they were teamed up with physician intensivists or small teams consisting of members from all specialties with one team leader [25, 26]. All electives and research activities were stopped to increase human resources [25]. The strategy of Giogola et al. involved weekly virtual meetings for updates, a tiered approach adapted from the SCCM which resulted in intensivist burn out as it was top heavy [25].

In a London Trauma unit, they anticipated a staff illness rate of 30%, to negate this they allowed high risk personnel to provide off site support virtually or telephonically which translated to a staff illness rate of 10%. Again, surgical responsibilities were decreased by stopping electives and the application of lock downs decreased the trauma burden [26]. OPD were done telephonically or virtually. With the covid pandemic social media played an important role, however there were concerns with patient confidentiality and therefore social media was sanctioned nationally and only

*DOI: http://dx.doi.org/10.5772/intechopen.103971 Trauma Resuscitation, Mass Casualty Incident Management and COVID 19…*

allowed within a hospital. These platforms were used to disseminate the latest peer reviewed information but at times humor and outburst were also shared, which can be expected from staff experiencing a prolonged MCI resulting in burnout with no time to debrief [26]. Social media may have assisted with information dissemination within a hospital, but difficulties were seen with communication from a central command to those on the frontline [26].

Due to the re-deployment of anesthetic and surgical staff to covid units, nonoperative management was favored, and theaters were transformed to ICUs, impacting training of fellows and residents negatively. To compensate for this deficit, many extended their training time [26]. In our setting surgical management remained according to surgical principles and protocols pre covid and not dictated by the patient's covid status.

To assist with healthcare professional well-being, which was affected by loss job opportunities, uncertainty, no training and redeployment to unknown areas, wellness programmes were initiated [26]. These included free wellbeing classes yoga, Pilates or meditation, free food donations and greater awareness on media – seeking mental health services were thus more accessible as it was not seen as a weakness [26]. This depicts the benefits of social media.
