A hot take on Hot One, Two, Three: the COVID-19 protocol keeping doctors and patients safe


For the doctors committed to saving as many lives as possible, fighting the spread of the Coronavirus pandemic has meant adapting to unfamiliar roles. The way in which a local team at Groote Schuur Hospital did that has been shared across the globe, impacting thousands.

All across the world, the high degree of transmissibility of the Coronavirus and its impact on morbidity and mortality has required that many new protocols be developed to protect doctors and minimise the risk of contamination for patients. And because a global pandemic is generally a once-in-a-lifetime event, it makes sense that the world's healthcare services were, on the whole, unprepared for the challenges to come.

According to Professor Ross Hofmeyr, Head of Anaesthetics at Groote Schuur Hospital in Cape Town, one of the most serious challenges that South African health services faced was manpower.

To ensure they'd have as many hands on deck as possible, hospital management, helmed by Professor Hofmeyr, pooled together all of Groote Schuur's human resources and began rolling out a specialised training programme for the treatment of COVID-19 patients.

Watch how Professor Ross Hofmeyer and his team developed a protocol to help combat COVID-19:

Upskilling staff equally on procedures and priorities

To better equip everyone who could help, Dr Hofmeyer's team ran life-like simulations to train staff on how to manage stressful, high-risk procedures. Professionals from all disciplines were trained to do everything, and they offered exactly the same intensity and quality of training to the interns, nurses and porters as that given to the professors and specialists who stepped in.

The team also developed a set of protocols with step-by-step checklists, similar to emergency protocols followed by those in the aviation industry. Their checklists like "Hot One, Two and Three'' played a pivotal role in protecting doctors and patients alike.

Hot One, Two, Three: what it is and why it works

According to the recommendations of the South African Society of Anaesthesiologists (SASA), when COVID-19 patients need to be intubated, it's essential that doctors do not bring infections into the operating room, and they do not carry Coronavirus out of the operating room.

In severe cases, such as when high-flow nasal oxygen therapy is no longer effective and a patient has to be intubated, it's essential that doctors take the utmost care to not become contaminated. To ensure this, the inside of the operating room needs to be kept "hot." Basically, anyone or anything that is inside the operating room and is in contact with the virus is "hot." Anyone outside the operating room is "not hot."

The three doctors working with the patient and inserting the tube into their airways are called Hot One, Hot Two, and Hot Three. Their job is to ensure they are well protected and follow all COVID-19 protocols while in theatre.

Two other hospital staff members, who are called Not Hot One and Not Hot Two, are stationed outside the operating room. Not Hot One makes sure that no one enters or leaves the operating room while the procedure is underway. Not Hot Two functions as a messenger and delivery-person, fetching any tools or materials that the "hot" doctors may need.

Making COVID-19 treatment safer for everyone, here and abroad

Safety protocols and checklists like Hot One, Two, Three are critical in stressful medical environments like those experienced by doctors on the frontline during the pandemic. Their effectiveness has been proven - Groote Schuur recorded zero Coronavirus infections in their COVID-19 team through the first two waves of infections.

Since then, Professor Hofmeyr has received queries about the protocol, developed right here in South Africa, from all over the world. The systems and procedures have been shared widely and freely among industry professionals, because he believes in democratising access to vital information. "The only way to truly take ownership of knowledge is to give it away," he says.

This is the embodiment of what it means to combat a global pandemic, together: thought leaders sharing their innovations and insights to ensure a safer and healthier future for everyone.

Discovery Health wants to recognise and applaud all healthcare workers on the frontlines of the COVID-19 pandemic. Find more hope-giving examples of resilience, innovation and thought leadership in South Africa's healthcare sector here.

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