Many of the requirements for ED layout have been considered in the earlier section ‘The New Normal ED – Living with COVID-19’. This chapter provides more specific guidance on zoning and the use of treatment spaces.

As a principle, we recommend that EDs develop clear processes to identify and isolate patients who may be a source of disease transmission. A risk stratification approach is necessary, as per the example in Figure 1. The triage section of these guidelines further expands on this concept.

In the setting of high rates of community transmission, all patients should be considered as potentially infectious. Some will present with atypical symptoms (especially children and older persons), such that they fall outside of case definition criteria. For this reason, clinicians should exercise a high degree of suspicion and vigilance at all times.

Figure 1. Example of a simple risk stratification system

Note that these definitions will differ between health services, and may change as the pandemic progresses

To minimise transmission risk within the ED, close attention should be paid to ventilation. Strategies should include increased air flow and the use of High-Efficiency Particulate Arrestance (HEPA) filters. Wherever possible, negative rather than positive ventilation strategies should be used for high-risk treatment spaces  (ie, those intended for use by patients with confirmed COVID-19).

We recommend that all EDs undertake a ventilation review to ensure that air flow and air filtration arrangements are designed to mitigate transmission risk. Consideration should also be given to the use of portable air filters. These interventions will minimise the chance of patient and staff exposure to aerosolised virus.

  • Waiting areas
  • Zoning
  • Selection of specific treatment spaces
  • Prioritisation of treatment spaces based on infection prevention and control needs
  • Patient cohorting
  • Temporary treatment spaces
  • Resources
  • Section disclaimer