COVID19  – Information for the Off-Service Rotator

 

Given our current Coronavirus crisis, it is more important than ever that off-service rotators to the Emergency Department protect themselves and their patients.  Expert guidance on this is changing daily, so please check this site routinely during your rotation for the most current recommendations. Below are links to critical reference documents.

 

PPE REQUIREMENTS (3/12/2020)

IN-HOUSE COVID TESTING (3/23/20)

NYP COVID19 TRAVEL GUIDANCE AND FAQs

EBMedicine Monograph on COVID19

General Principles for Working in the ED

  1. Regardless of chief complaint, treat all patients as infected with COVID at first contact. Our collective experience is that you cannot exclude a COVID patient based on chief complaint, vital signs, triage note, or even absence of infectious symptoms.
  2. As such, face mask must be worn at all times in the ED, even when not engaging in direct patient care. 
    • Eye cover – either goggles or mask with face shield – must be worn at all times when interacting with patients. If you are given goggles or protective eyewear, do not throw these out. They are meant to be used throughout your ED rotation.
    • Eyeglasses do not count as eye cover.
    • Yellow gowns with gloves must be worn as well while evaluating patients in rooms. 
    • Ask your senior resident or attending about the indications for N-95 mask.
  3. NOT SEE A PATIENT IF YOU DO NOT HAVE THE APPROPRIATE PPE TO KEEP YOU SAFE. 
    • This is the equivalent of BLS/ACLS scene safety – you must be safe in order to provide care.
    • If you cannot find the right equipment, speak to your senior resident, attending, or contact an EM chief.
  4. Place Iso droplet/contact orders as early as possible.
    • Be extremely liberal with these isolation orders.
    • These orders protect our nurses, techs, downstream providers, and our hospital system.  You can always rescind them.
  5. There are no restrictions on which providers can see possible rule out patients.
    • If high risk procedures are being performed (intubation, bipap/high flow/BVM/trach exchange/nebs) off-service providers should not be in the room.
  6. Supplies are extremely limited in the ED.
    • Residents need to conserve their PPE while working in the ED, especially the goggles, facemask, and/or N95.
    • We’d also greatly appreciate it if all upstairs/Milstein providers bring their own PPE to the ED when coming to admit/evaluate/round on patients.
  7. Please include in your initial evaluation note the following information:
    • PPE you were wearing, PPE the patient was wearing, and that these precautions were used at all times.
  8. Use your senior EM resident as a resource.
    • He or she (or the attending) will likely know the most current practice patterns and recommendations. 
    • If you have questions or concerns, you can always contact the chief on call (917-410-1056 or nypemchiefs@gmail.com)
  9. CORNELL ONLY: Ask your senior resident for the COVID acronym expander that PPOC expects in the ED disposition note. This must be included for all admitted patients.
  10. If you become symptomatic on shift, please let the senior resident and attending know. 
    • If you are symptomatic at home, please let the EM chiefs and your home service chiefs know as soon as possible.
    • We do not want you working sick.
  11. As all the above explicitly and implicitly stresses, stay safe in the ED.
    • Thank you for helping us care for our patients during this difficult time, and we appreciate all the team work and support.