SWAB team instead of SWAT team: Medical students as a frontline force during the COVID-19 pandemic.

Abstract

A Special Weapons and Tactics (SWAT) team is trained to deal with troubling situations. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic confronted health care systems with different challenges. In Europe, the first coronavirus disease 2019 (COVID-19) patients presented in late February 2020. Our region was amongst the most severely affected in central Europe. Therefore, frontline operations, such as emergency departments (ED), were highly stressed by immediate demand for diagnostic swab-testing, and additional personnel were urgently needed within a short time. In the meantime, clinical activities of medical students were on hold, and teaching had to be restructured to online formats. However, we expected that medical students would benefit tremendously from learning opportunities through active involvement in the COVID-19 pandemic. The Corona Task Force (CTF) established a trained team (ie, the SWAB team), ‘armed’ with swabs in a nearby Triage Test Centre (TTC) to evaluate hundreds of patients per day with appropriate structural and personal protective equipment (PPE). This TTC was set up in the church next to our ED, with the structure to ensure social distancing. The first SWAB team consisted of physicians from different specialties and nurses. As these professionals were urgently needed for other duties, we actively asked medical students from Years 2 to 6 via email for their volunteered support in the workforce and experienced great willingness to help. To cover medical students' needs, they received a working contract with appropriate insurance. Working in two shifts of 12 students each, a total of 936 shifts were staffed by medical students. The CTF developed a training curriculum on history taking, testing with nasal and oropharyngeal swabs, including knowledge of social distancing, disinfection, hygiene, self-protection and careful handling of PPE. Furthermore, teaching on the spot was provided daily by one clinician, who remained as a supervisory team member, focusing on COVID-19, triage processes, test strategies, clinical manifestations and therapeutic options. From 9 March to 15 April 2020, the SWAB team provided over 6700 swabs. Although we recognise restructuring of medical education to online formats as an inevitable approach in a pandemic, the active involvement of medical students as frontline support confirmed our expectations of a valuable learning experience. Reflecting on this intervention, we draw several conclusions. First, this intervention was feasible and safe. The number of tests the SWAB team provided was very high, but no incidence occurred. Particularly, we did not discover any medical student with symptoms of COVID-19. Second, similar to a SWAT team, a SWAB team can be continuously trained and adjusted to be able to respond quickly to changing situations. To meet these training challenges, we established a supervisory system, where more experienced team members took care of less experienced staff. Third, we judged the inclusion of medical students in these demanding situations as adequate, as we saw motivated learners in an unusual environment. Staying in daily contact, we were pleased by the optimism and the willingness to comply with regulations and difficult frontline scenarios. Although we cannot foresee how these encounters will influence medical students going forward, the impacts of this experience on the individuals’ emotional well-being and also clinical competence in their role as health advocates merit further investigation, which we plan as a next step.