COVID-19: Hospital preparedness

All protocols are hospital dependent, please check with your hospital administration for existing protocols

Hospital/ED Readiness

See COVID-19: Example hospital protocols for example hospital protocols from various institutions.

  • Resources
    • ASPR Tracie ED Resources [1]
    • PAHO readiness
      • Checklist [2]
      • Instructions [3]
    • MGH Hospital ToolKit [4]
    • ACEP ED Readiness [5]

Prehospital Care

  • ET-3 model
  • Treat Onsite
  • Resources
    • EMS Resources - ASPR [6]

Evaluation Pathways

  • 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[7]

  • 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
    • Exposure to COVID patient recently with symptoms
    • 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

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

Surge Capacity

  • ASPR TRACIE Surge resources [8]


SARS-CoV2 Testing Strategies

Testing+Surveillance: COVID

Telehealth

Resource Allocation

Personnel

  • Exposed Healthcare workers - CDC [9]
  • Return to work for Healthcare providers - CDC [10]
  • Sustaining Healthcare workforce - ASPR [11]


See Also

References

  1. ↑ https://asprtracie.hhs.gov/technical-resources/123/covid-19-emncy-department-resources/99
  2. ↑ https://www.paho.org/hq/index.php?option=com_docman&view=download&alias=51716-hospital-readiness-checklist-for-a-novel-coronavirus-ncov&category_slug=scientific-technical-materials-7990&Itemid=270&lang=en
  3. ↑ https://www.paho.org/hq/index.php?option=com_docman&view=download&alias=51761-hospital-readiness-checklist-for-covid-19&category_slug=scientific-technical-materials-7990&Itemid=270&lang=en
  4. ↑ https://www.massgeneral.org/assets/MGH/pdf/disaster-medicine/SARS-CoV-2%20(COVID-19)%20Toolkit%20Version%203.pdf (2)
  5. ↑ https://www.acep.org/globalassets/sites/acep/media/by-medical-focus/covid-19-national-strategic-plan_0320.pdf
  6. ↑ https://asprtracie.hhs.gov/technical-resources/114/covid-19-pre-hospital-emncy-medical-services-ems-resources/99
  7. ↑ https://asprtracie.hhs.gov/technical-resources/119/covid-19-hospital-triage-screening-resources/99
  8. ↑ https://asprtracie.hhs.gov/technical-resources/113/covid-19-critical-care-surge-resources/99
  9. ↑ https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
  10. ↑ https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhealthcare-facilities%2Fhcp-return-work.html
  11. ↑ https://asprtracie.hhs.gov/technical-resources/120/covid-19-workforce-protection-sustainability-resources/99
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