Preparation for Emergency Infectious Outbreak in your ED – Coronavirus

The current outbreak of the novel respiratory pathogen Coronavirus is an opportunity to remind ourselves of how to properly and adequately prepare for an emergency outbreak in our EDs. Although the mortality rate in patients with Coronavirus in this outbreak is less than 1% (which pales in comparison to Ebola or SARS), historically these types of outbreaks have been occurring every 5-6 years (SARS 2003, HINI 2009, Ebola 2014, Coronavirus 2020), so they are somewhat predictable and we should know how to prepare for them in our EDs. In this special edition EM Cases podcast Dr. Megan Landes, a Global Health expert, researcher and EM educator runs us through how you can best prepare for an outbreak like Coronavirus, including screening, PPE and the protected code... Podcast production by Anton Helman Written by Megan Landes, edited by Anton Helman, February 2020 Preparation for a novel respiratory pathogen outbreak in your ED Recently, the World Health Organization has declared a public health emergency of international concern for the outbreak of a novel Coronavirus in China.  As a frontline provider, what do you need to think about in the ED?  We all need to be experts in screening, proper personal protective equipment (PPE) and performing protected critical care procedures.   1. Screening for an emergency infectious outbreak in your ED Screening procedures need to be both reinforced and constantly reassessed as right now it is based on both symptoms and epidemiology.  Both may change over time, so  follow your institutions directives on countries of concern or case definitions. Patients meeting the screening definition at triage, should immediately be given a surgical mask and placed in a designated isolation room, ideally with negative pressure.  You could consider information gathering through a window at this point via a whiteboard and or calling the patients cel phone to collect triage and registration data.   2. Personal Protective Equipment (PPE) in preparation for emergency infectious outbreak in your ED Make sure to protect yourself and your team with appropriate PPE.  While the guidelines for PPE may evolve, currently the recommendations are DROPLET/CONTACT, with some ERs adding airborne precautions for aerosol generating procedures. Your PPE should include a gown, gloves, mask, and eye protection (which is not your regular glasses but instead goggles, or a visor).   CDC PPE donning and doffing sequence pdf   http://youtu.be/nbUQV8CSDCY   Donning should be straightforward but have instructions posted by the PPE and isolation rooms.  A few more tips: * Make sure your gloves cover your sleeves. * If you are using an N95 mask, make sure you are fitted for it. * Figure out what eye protection works for you before you see your first patient. Most will fog somehow and you don’t want to have to adjust it and contaminate yourself.   Doffing technique is extremely important and this where you are at most risk of contamination. A few key tips: * Go slowly and pay attention. Be careful and conscious of how you take everything off. * Consider a buddy - one person that can observe your doffing and help you follow the checklist for safe removal. * Practice taking off your gloves properly, your eye protection and facemask from behind. * What do you do if you have been contaminated? Do not rush or panic.  Take a pause, clean or sanitize the area.  Call IPAC. https://emergencymedicinecases.com/emergency-ebola-preparedness/ “What about PAPRs?” Or a power air-purifying respirator?  PAPRs are much more comfortable over long durations of exposure, but you must be trained on them or you are actually far more likely to contaminate yourself in doff...