COVID-19: Hospital preparedness

• All hospital dependant, please check with your hospital administration for existing protocols

Prehospital Care

• ET-3 model

• Treat Onsite

Evaluation Pathway

• Divide the ED into different sections based on risk of having/transmitting COVID-19
  • Red/Dirty/Hot zone
  • Yellow/Intermediate/cool zone (optional)
  • Green/Clean/Cold zone
• Set PPE levels for each section IPC for COVID
• Control movement between sections by limiting ingress/egress routes.
• Consider having all patients wear surgical masks and perform hand hygiene despite symptoms.

Screening

• Preferably outside of the ER
• Goal is to prevent them from being cohorted with non-COVID patients
• Funnel into each of your zones
• Screening Criteria - Any of the following positive, route to "red/dirty/hot/infected" side of the ED
  • Symptoms - fever, respiratory symptoms, Chest pain, GI symptoms, malaise, fatigue
  • Signs
    • toxic appearance, AMS
    • If performing vitals at screening - fever, hypoxia, tachypnea
• All those without the above go to Yellow/Green

Triage/Risk Stratification

• Mild illness
  • Well appearing
  • No hypoxia (SPO2 ≥94%)
  • No tachypnea (RR≥22)
  • No concerning GI or Other symptoms
• Moderate/Severe illness
  • Hypoxia
  • Tachypnea
  • Ill-appearing + COVID Risk Factors
  • Other reasons needing admission

Evaluation for Disposition

• Mild illness
  • Discharge as appropriate
  • Consider Exertional O2Sat
    • 1 minute walking in place briskly.
    • Failure = 02Sat<90 OR inability to complete test
• Moderate illness
  • 02 via NC Sat>90%
  • Attempt bronchodilator use
  • Antipyretics
  • CXR
  • Evaluate for non-COVID causes of illness as indicated
    • Re-evaluate for discharge if improved
• Severe illness - Admission

Protocols

Consider creating standardized protocols for the following:

• Labs/Imaging
• Intubation
• CPR
• Asthma
• CV procedures
• Disposition

Surge Capacity

• Hospital Dependent

SARS-CoV2 Testing Strategies

Testing+Surveillance: COVID

Telehealth

• For information on telehealth, see Alternative Care Sites: COVID-19

Resource Allocation

• Ventilators

Personnel

• Return to work

Resources

Examples

• Topic Collection: COVID-19 Hospital Triage/Screening Resources
• Brigham & Women's Hospital Protocols-
• Massachusets General Hospital -
• Mount Sinai -

File:MSH covid Management

• Department of Defense Practice Managment -