• About This Guide
  • Disclaimer
  • Acknowledgements
  • Executive Summary

Pandemic Planning

All hospitals and health services should have a pandemic plan, which includes all aspects of the health service including emergency departments (EDs) and critical care areas. Pandemics require whole-of-hospital and whole-of-healthcare responses with integration of ED plans into both of these. Last updated: 10 November 2021

The New Normal ED – Living with COVID-19

Since the onset of the COVID-19 pandemic, there have been rapid changes to processes in emergency departments (EDs) and the healthcare system. Last updated: 10 November 2021

Emergency Department Design Layout

The COVID-19 pandemic has mandated significant changes to emergency department layout and flow. This clinical redesign process has been necessary to mitigate the risk of disease transmission and optimise patient and staff safety. Last updated: 10 November 2021

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 emergency department. Last updated: 10 November 2021

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. Last updated: 10 November 2021

Personal Protective Equipment (PPE)

Knowledge regarding the transmission of the COVID-19 virus (SARS-CoV-2) has evolved since the beginning of the pandemic in January 2020. Improved understanding has reduced focus on aerosol generating procedures (AGPs) compared with possible exposure risk, within our current context. Last updated: 10 November 2021

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. Last updated: 10 November 2021

ED-Ambulance Interface

The COVID-19 pandemic has highlighted the importance of infection control and prevention at all stages during the patient journey. Last updated: 10 November 2021

Treatment of Adults with COVID-19

Treatment should be provided and escalated in accordance with patients’ needs and wishes, anticipated progress, prognosis and goals of care. Decisions regarding the type of therapy and where it is provided should balance the potential for patient benefit and the risk of cross-infection of others. Last updated: 10 November 2021

Adult Cardiac Arrest Management

The capacity of healthcare systems across Australia and New Zealand are expected to be challenged by the COVID-19 pandemic. Last updated: 10 November 2021

Clinical Research

We recommend that emergency departments lead and are actively involved in COVID-19 clinical research which aligns and integrates with international efforts for harmonisation and coordination of research. Last updated: 10 November 2021


We recommend the use of imaging when required for exclusion of other pathology from the differential diagnosis; when required to identify the cause of sudden deterioration in a patient; portable chest radiography preferentially over patient movement to radiology where possible. Last updated: 10 November 2021


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. Last updated: 10 November 2021

Older person-specific recommendations

Physiologic changes of aging, impaired immunity and common comorbidities increase vulnerability of older persons to COVID-19 and result in higher risk of severe disease. Last updated: 30 November 2021

Paediatric-Specific Recommendations

The number of reported cases of COVID-19 in children is low. However, many children will meet clinical criteria of acute respiratory illness and/or fever, and rates of asymptomatic carriage are thought to be quite high. Therefore, careful attention to infection control is critical. Last updated: 10 November 2021

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. Last updated: 10 November 2021

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. Last updated: 10 November 2021

Indigenous Community Recommendations

Emergency departments across Australia and Aotearoa New Zealand must strive to provide culturally safe, equitable access to care to vulnerable groups, in particular Aboriginal, Torres Strait Islander peoples and Māori, who are at greater risk of increased severity of disease and death from COVID-19. Last updated: 10 November 2021

Palliative Care

Regardless of the cause, in all acute life-threatening illnesses emergency physicians are expert in difficult ethical decisions which balance patient autonomy, the risks and benefits of invasive therapies such as ventilation, and resource stewardship. Last updated: 10 November 2021

Ethics in Emergency Department Decision Making

Ethically challenging decisions in relation to the COVID-19 outbreak are expected. Ethical decision-making is contextual; previous tools may cause harm if used out of context. Last updated: 10 November 2021

Workforce and Wellbeing

Emergency clinicians (doctors, nurses, administration and ancillary staff) are a precious, resilient, capable and expert frontline workforce. Last updated: 10 November 2021

COVID-19 Vaccines

The COVID-19 Pandemic has been global in its reach and infected millions of people. While its health and economic impacts have been devastating, the global cooperation that we have witnessed among scientists and clinicians has been extraordinary. Last updated: 10 November 2021