UW DEM COVID-19 Guide

Preliminary Recommendations on Preparing Your ED for the US Red Zone

DISCLAIMER

This site is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. All information is meant for use by healthcare workers and not the general public. If you think you may have a medical emergency, call 911 or go to the nearest emergency room immediately. No physician-patient relationship is created by this web site or its use. Neither the University nor its employees, nor any contributor to this web site, makes any representations or warranties, express or implied, with respect to the information provided herein or to its use.

The ED COVID-19 Guide is a live web page and may be updated daily and even hourly. Last update: (1:02pm, 4/16/20)

OVERVIEW

Over the course of these past several weeks, our area system and hospitals (Harborview Medical Center, UW Medical Center-Montlake, UW Medical Center-Northwest, Valley Medical Center, UW Neighborhood Clinics and Airlift Northwest) have been crafting a set of rapidly evolving protocols to combat the spread of COVID-19, and develop best practices to care for our COVID-19 patients.

Since the outbreak began, our colleagues, locally and nationally, have been reaching out to us for assistance as they start to see cases. We hope that by sharing our work, we can assist your teams and facilities to prepare and move more quickly.

Though the protocols are frequently being revised as we learn more, there are several ways to ready your Emergency Departments and Intensive Care Units for these patients. These include: creative approaches to staff training, improving the physical space for isolation capacity, equipment to procure/inventory, and systems for providing patient care to minimize staff exposure.

We hope you can benefit from these recommendations while you have the time to prepare yourselves and your departments. The most important and time-critical component of COVID-19 response protocol is communication.

COMMAND SYSTEM

Consider activating your incident command system. Your incident command system should include communication early and often between Emergency Departments, hospitalist services, Intensive Care Units, local and state Departments of Health (DOH), Emergency Medicine Services (EMS), leads and outreach leads to vulnerable populations (eg. local SNF, jail, homeless). In our experience, Skilled Nursing Facilities (SNF) have been particularly vulnerable and have been the source of most patients and fatalities.

Developing communication links with local SNFs for the purpose of creating a transportation and hospital disposition plan prevents proximately located hospitals from being overwhelmed by a single SNF experiencing an outbreak.

PATIENT PRESENTATIONS

In general, patients have presented a wide variety of symptoms including: fever, cough, upper respiratory infection symptoms, and hypoxemia; rapid decompensation was seen in several patients. Generally, those who died were elderly, and some were immunocompromised.

Syndrome:

  • Some afebrile, some with high fevers lasting >1 week.
  • Shortness of breath, dry cough, some with GI symptoms, though not common.
    • Risk factors: older, comorbidities.
  • Respiratory Failure: ARDS/Pneumonitis, varying presentations on radiography.
  • Cardiomyopathy including elevated CKs has been seen.

GUIDE

The following Guide is a flow of ideas in the STAFF/SPACE/STUFF/SYSTEMS format of ideas to consider for department preparation.

UW DEM

STAFF

  • Initiate Staff Preparations
  • Communication

UW DEM

SPACE

  • Pre-planning
  • Movements
  • Diagnostics

UW DEM

STUFF

  • Inventory
  • Ultrasound Cleaning

UW DEM

SYSTEMS

  • Staffing
  • Training
  • Inter-facility Triage
  • Goals of Care
  • Crisis Standards of Care
  • ECMO
  • Intubation & Respiratory Support
  • Code Blue
  • Portable Radiography
  • Tracking Systems
  • Bundle Care

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