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Adaption of the emergency department decontamination room for airway management during COVID-19
On December 31, 2019 the first cluster of cases of pneumonia was reported in Wuhan, China later confirmed to be due to the novel coronavirus 2019-nCoV [1]. The first case in the United States was reported on January 20, 2020 [2]. In early March 2020, our hospital took care of one of its first COVID-19 patient. It was during this time that we also had our first COVID positive cardiac arrest. Given good communication from the patient's family to the public safety answering point, appropriate warning was provided to the emergency medical services (EMS). This information led to crews notifying the emergency department of impending arrival of infectious patient allowing staff to don appropriate personal protection equipment.
With the quick thinking and innovation of emergency department (ED) staff, a stretcher was quickly moved into the decontamination room. The code was then conducted in this room. Following this event, a plan was quickly mobilized to permanently convert this room into a resuscitation bay during the COVID-19 outbreak. We offer our suggestions on how to quickly set this up in your own Emergency Department in order to protect staff.
Occupational Safety and Health Administration requires emergency departments to have the ability to decontaminate patients [3]. Most EDs have a dedicated room or area with a portal to the outside which is often located near the ambulance entrance. If a potential COVD patient presents to our ED, EMS is able to easily enter the room with the patient. This prevents a potentially infectious patient from travelling thought the ED and contaminating other areas. As found in a typical resuscitation room, we placed a stretcher in the room along with basic medical equipment (Image 1 ) such as bag valve masks, intravenous access sets, and suction. Oxygen is supplied by a portable tank. The code cart is kept just outside the inner door leading into the ED. Seen on the bed is a patient respiratory protection unit that we designed to help limit aerosolization exposure to staff [4]. In order to limit breaks in care and equipment contamination, the EMS cardiac monitor and defibrillator is left connected to the patient and used as the monitor during the resuscitation. If return of spontaneous circulation is obtained, the patient could then be transferred to hospital monitor. In order to limit contamination of other routinely used equipment such as video laryngoscopy and ultrasound, we switched to portable devices that can be easily cleaned and decontaminated after use.
Image 1 Decontamination room setup.
Blue arrow: Patient respiratory protection unit. Additional units stacked behind.
Yellow arrow: Portable oxygen tank.
Purple arrow: Adult bag valve mask with viral filter attached.
White arrow: Infusion pump.
Red arrow: Tackle box containing code medications.
Following patient treatment, the room can either be cleaned physically or easily rinsed with water thanks to drain in floor. Another option we have used for cleaning is an ultraviolent light emitting disinfecting device.
We hope by sharing this information, staff can be better protected when having to manage these potentially infectious patients in heightened risk patient care scenarios.
Funding
None.
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