Clinical Guidelines (Archived)

The COVID-19 pandemic will stretch hospital resources all over the world. This guideline is a framework for all Emergency Departments to work from as we plan and respond to the pandemic.

With our states, countries, metropolitan, rural and regional emergency care facilities all at different stages of community impact, and with markedly different workforce, infrastructure and resources available, local implementation of these guidelines will differ.

However, there are general principles of COVID-19 and non-COVID-19 emergency care that will apply to all workplaces:

• There is no patient emergency more important than the safety of our healthcare workforce.
• Appropriate, judicious use of personal protective equipment (PPE) is paramount.
• Planning for the increased numbers of patients requiring critical care services is important.
• Special consideration should be given to vulnerable people, both patients and staff, such as those who are older or have comorbidities, as well as Indigenous populations.

This Guideline has been developed to assist clinicians with decisions about appropriate healthcare in Emergency Departments in Australia and Aotearoa New Zealand during the COVID-19 outbreak. It is a framework for planning and responding to this pandemic, including the assessment and management of patients.

The Guideline is targeted at clinicians only. Patients, parents or other community members using them should do so in conjunction with a health professional and should not rely on the information in these guidelines as professional medical advice.

The Guideline has been developed by an expert team of practising emergency physicians, by consensus and based on the best evidence available. The recommendations contained do not indicate an exclusive course of action or standard of care. They do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type.

The Guideline is a general document, to be considered having regard to the general circumstances to which they apply at the time of their endorsement.

It is the responsibility of the user to have express regard to the particular circumstances of each case, and the application of the Guideline in each case.

The authors have made considerable efforts to ensure the information upon which they are based is accurate and up to date. However, the situation is rapidly evolving, and a certain amount of pragmatism needs to be employed in maintaining such a ‘living document’. Users of this Guideline are strongly recommended where possible to confirm that the information contained within the document is correct by way of independent sources. The authors accept no responsibility for any inaccuracies, information perceived as misleading, or the success or failure of any treatment regimen detailed. The inclusion of links to external websites does not constitute an endorsement of those websites nor the information or services offered.

The Guideline has been prepared having regard to the information available at the time of preparation and the user should therefore have regard to any information, research or other material which may have been published or become available subsequently.

Whilst we have endeavoured to ensure that professional documents are as current as possible at the time of their creation, we take no responsibility for matters arising from changed circumstances or information or material which may have become available subsequently.

ACEM would like to thank Safer Care Victoria for their collaborative efforts in the development of this document.

In addition, the College would like to extend its thanks to ACEM Fellows (FACEMs) Peter Cameron, John Bonning, Simon Judkins, Sally McCarthy, Mya Cubitt, Kim Hansen, Lai Heng Foong, Joanne Grindlay, Rob Mitchell, Simon Craig, Andrew Pearce, Stefan Mazur, Neil Ballard, Ashish Jaison, Glenn Arendts, Ellen Burkett, Carolyn Hullick, Peter Roberts, Guruprasad Nagaraj, Ryan Hodges, Andrew Tagg, Gabriel Blecher, Tim Baker, Daniel Ellis, Joseph Mathew, Christine Bowles, Tony Joseph, Paul Quigley, Sofie Yelavich, Kimberly Humphrey, Juan Ascencio-Lane, Peter Allely, Bill Lukin and FACEM trainee Amanda Rojek for generously providing input. Additionally, ACEM would like to thank Associate Professor Sarah Winch, healthcare ethicist from the University of Queensland, for contributing to the development of this document.
 

Pandemic modelling for COVID-19 has governments and communities working towards a common goal of ‘flattening the curve’ in order to give healthcare services the best opportunity to meet the coming acute demand of COVID-19 infected patients. Whilst the usual medical, mental health and trauma presentations may reduce, they will continue. This requires workforce planning that includes consideration of long-term sustainability, as well as a significant and unprecedented period of surge.

Emergency Departments (EDs), already operating over capacity, have the potential to be overwhelmed by both sheer numbers of mild to moderately unwell patients, as well as resourceintense critical patients (who may or may not benefit from critical interventions) and staff shortages due to quarantine requirements when exposed to COVID-19 infected patients.

This Guideline is a framework for all in EDs to work from as we plan and respond to the pandemic. With our states, countries, metropolitan, rural and regional emergency care facilities all at different stages of community impact, and with markedly different workforce, infrastructure and resources available, local implementation of these guidelines will differ.

However, there are general principles of COVID-19 and non-COVID-19 emergency care that will apply to all workplaces:

• There is no patient emergency more important than the safety of our healthcare workforce.
• Appropriate, judicious use of personal protective equipment (PPE) is paramount.
• Planning for the increased numbers of patients requiring critical care services is important.
• Special consideration should be given to vulnerable people, both patients and staff, such as those who are older or have comorbidities as well as Indigenous populations.

In this COVID-19 healthcare response, we must use the challenges of delivering equitable, safe, timely, rational, effective, patient-centred healthcare, to create opportunities in healthcare community building, communication and system reform. Our goal is to create a ‘living’ document for the generic planning and implementation that is occurring in duplication across multiple sites concurrently. To enable continual refinement of the document we hope you will share your feedback, resources, challenges, wins and local solutions here - ACEM COVID-19 Suggestions.

The next six months are going to be tough, but our skills, expertise, humanity, compassion, training, unity and strength will get us through it. Amid all of this, maintaining our wellbeing, both physical and psychological, remains more important than ever.

Please continue to look after yourselves and each other, our precious emergency healthcare resource.