The coronavirus (COVID-19) situation is rapidly evolving. For the latest from the College visit acem.org.au/COVID-19

  • About This Guide
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Pandemic Planning

All hospitals and health services should have a pandemic plan, which includes all aspects of the health service including EDs and critical care areas.

Maintaining Business as Usual

Controlling public anxiety and engendering trust in the healthcare profession is key to maintaining ‘business as usual’. Public messages from healthcare professionals should aim to reinforce public trust in medical care, resource capability, capacity and collaborative efforts with colleagues and government in reaching solutions.

Emergency Department Design Layout

The COVID-19 pandemic will mandate changes to ED layout and flow. This clinical redesign process is necessary to mitigate the risk of disease transmission.

Assessment Clinics

Risk assessment and consideration of testing for COVID-19 is not emergency care. Assessment clinics for community members concerned about the possibility of COVID-19 should be located away from the ED.

Triage and Reception of Patients

'When done properly, triage results in the best outcome for the greatest number of people. Without a triage plan in place, resources are likely to be wasted—and more people are likely to die.' - Pan American Health Organisation (PAHO)

Personal Protective Equipment (PPE)

The COVID-19 virus is primarily transmitted between people through respiratory droplets and contact routes.

Transport of Patients

Transport of patients with suspected or confirmed COVID-19 exposes patients to the usual risks associated with transport and clinicians to additional infective risks.

ED-Ambulance Interface

The COVID-19 pandemic has highlighted the importance of infection control and prevention at all stages during the patient journey.

Treatment

Treatment should be provided and escalated in accordance with patients’ needs and wishes, anticipated progress, prognosis and goals of care. We align with the Australian and New Zealand Intensive Care Society (ANZICS) Covid-19 Guidelines

Adult Cardiac Arrest Management

Based on experience from the 2003 Severe Acute Respiratory Syndrome (SARS) crisis, healthcare workers are at considerable risk of disease transmission, particularly during critical care procedures (Tran, 2012).

Experimental Treatment

There are no specific treatments available for COVID-19 at this stage.

Clinical Research

We recommend:

Imaging

At present, we do not recommend chest radiography (CXR), computed tomography (CT) or lung ultrasound (USS) to diagnose COVID-19.

Trauma

The ability to provide high quality care to major trauma patients should be maintained to the greatest possible extent during the coronavirus pandemic, while ensuring that critical resources are preserved as far as possible. - iv. London Major Trauma System Guideline

Older person-specific recommendations

Aging is associated with physiologic changes, impaired immunity and common comorbidities all place older persons with COVID-19 at higher risk of severe disease. However, even in those aged over 80 years where the crude mortality rate is approximately 22%, survival is more likely than death.

Paediatric-Specific Recommendations

The number of reported cases of COVID-19 in children is low. Current data suggests that they have a much lower mortality and morbidity with only a handful of reported deaths. Critical illness is exceedingly rare.

Obstetric-Specific Recommendations

Care of women in the first trimester should include attention to the same infection prevention and investigation/diagnostic guidance, as for non-pregnant adults.

Rural, Regional and Remote Recommendations

During a pandemic, EDs in large regional centres operate like urban EDs in most respects. Smaller rural emergency facilities face three additional problems: a smaller pool of resources; delays in replenishing resources; and lower community health literacy contributing to late patient presentations.

Palliative Care

Advanced age, comorbidity and immunological compromise put patients at increased risk of death. Most mortality will be associated with respiratory failure, however, there is also risk to the wider population as demand for healthcare outstrips resources.

Ethics in ED Decision Making

Ethically challenging decisions in relation to the COVID-19 outbreak are expected.

Workforce and Wellbeing

Emergency clinicians (doctors, nurses, administration and ancillary staff) are a precious, resilient, capable and expert frontline workforce.

ACEM COVID-19 Suggestions

Suggest edits and existing resources related to the ACEM COVID-19 site

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