The transition between pre-hospital care providers and the ED needs to be carefully managed in order to:

  • Reduce the infection risk to pre-hospital and ED staff.
  • Ensure appropriate “streaming” of patients based on their risk for COVID-19.
  • Maintain high standards of clinical care, which is particularly important for patients with time-critical emergencies.

We recommend the following principles

  1. Transport to hospital should only be initiated after appropriate assessment of risk versus benefit for staff and patients.
  2. Patients should only be transported when there is a clear benefit to the patient and where it is safe to do so.  If it is decided that transport to hospital is not an appropriate outcome, it should be ensured that alternative arrangements for care are made in consultation with community providers.
  3. Pre-hospital assessment for COVID-19 risk according to local screening guidelines. These are likely to include (a) epidemiological factors (such as recent overseas travel, close contact with a person known to have COVID-19), and (b) clinical features (such as respiratory symptoms, fever, anosmia). * It is acknowledged that case definitions, testing criteria and recommendations for streaming patients into high-risk and low-risk areas have been changing frequently. Decisions should be made according to the latest health department advice.
  4. Pre-hospital notification of critically ill patients.
  5. Communication and confirmation of COVID-19 risk status as soon as possible:
    • During pre-hospital notification for critically ill patients.
    • Immediately upon arrival for all other patients.
  6. should be moved into an ED cubicle as soon as possible after arrival. They should not wait for a prolonged period of time in the ambulance or ED corridor. There is likely to be less risk of infection transmission between patients if waiting occurs in the ambulance vehicle until a bed is available.
  7. Delays to triage should be minimised by verbal handover from ambulance paramedics to triage staff while the patient remains in the ambulance.
  8. After triage, there should be an agreed mechanism by which ambulance paramedics can communicate with ED staff in order to notify a change in clinical status, and/or to escalate due to delays to handover and offload.

We advocate for:

  1. Review and where possible, automatization of the transition of patient information from prehospital to hospital environment. This will limit health care worker (HCW) interaction and streamline processes when systems are overwhelmed.
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