EMERGENCY MEDICINE CORONAVIRUS CAUTIONS

Terrance L. Baker, MD, MS, FAAEP, FAAGM, FAAFP
Sollay Medical Center
Baltimore, Maryland

EMERGENCY MEDICINE CORONAVIRUS CAUTIONS

Minimum Necessary Precautions for Staff Safety

Emergency medicine physicians and nurses are working the front line of the massive wave of patients sick with coronavirus. In order to protect emergency department staff members minimum necessary measures must be taken. A quick review of emergency departments across the nation from state to state, city to city and inner city to rural demonstrates that no consistent approach to emergency department safety exist. Different departments and different agencies as well as emergency department organizations all offer remarkably different approaches to protecting emergency department physicians and nurses from becoming contaminated and sick from the coronavirus. Amazingly, many departments across the United States in fact are offering no mask, no goggles, no uniforms or protective equipment of any type. Physicians and nurses are left on there own to improvise protection.

The purpose of this white paper is to establish the minimum necessary protection that emergency department physicians and nurses must take in order to provide the minimum necessary protection against coronavirus infection. The following steps are required:

• All staff must arrive at home dressed in clean street clothes that reasonably are not expected to be infected as they have been recently laundered and dried. The coronavirus is sensitive to washing with most laundry detergents in hot water and has not shown resistance. Additionally, coronavirus is susceptible to killing by operation of a standard dryer.
• Upon arriving at the emergency facility, the staff member from home must shower from head to toe with soap and water. If the hair is not to be shampooed for personal reasons the hair must be placed in a clean, fresh covering.
• Following a hot water shower from head to toe emergency department staff will place on scrubs and a white coat provided to the healthcare worker by the hospital.
• Eye covering with over the glasses goggles or smaller goggles for emergency department workers without glasses will be provided. Eye cover is an essential part of protecting oneself from the coronavirus.
• N95 mask or similar mask will be provided for the medical shift lasting 8-18 hours.
• The entire protective gear including hair net, goggles, face mask, scrubs and white coat will not be removed for the entire shift.
• Gloves will be utilized as needed on an individual basis.
• Wash hands frequently or use 60% alcohol-based hand cleanser.
• At end of shift the healthcare worker will retire directly to the shower room.
• Entire uniform and white coat will be placed carefully in a laundry basket to be cleaned and provided on the next day for the worker. The worker will complete a head to toe soap and water shower.
• Clean clothes from home will be applied. Healthcare worker will retire to home clean. If this protocol is followed daily the chances of infecting self and/or family are limited.
• Healthcare worker will be tested initially for coronavirus and subsequently every three days throughout the coronavirus pandemic. Despite reasonable precautions staff members can become infected at home and/or in the community when returning home from stopping and picking up groceries, etc.
• This process should be repeated every shift for the duration of the pandemic.

For high volume emergency departments, High Alert Institute and I have sent a proposal to President Trump to supply biohazard suits and ventilators that can be refurbished daily.

Each physician would receive one suit and one respirator. Suits can be cleaned daily. Respirators can be rebuilt daily.

Only by protecting front line healthcare workers with a comprehensive uniform approach to healthcare workers safety can we ensure that adequate numbers of well-trained emergency room physicians and nurses will survive this pandemic to continue their service to America. Additionally, physician assistants and nurse practitioners working in the emergency department setting must be protected in a similar manner.

I strongly encourage all emergency departments across the nation to embrace this minimum level of staff safety. A coronavirus is an RNA viron surrounded in a capsid of fat. Through dedicated cleaning of the ER and ICU treatment environment and by controlling the coronavirus from falling onto the skin, eyes, nose, mouth, face of workers we will be able to control the spread of the disease and to prevent the spread of this disease process to our healthcare workers. Measures outlined in this notice when followed as instructed can and will increase emergency department staff safety. For any questions, contact Terrance L. Baker, MD, MS, President of the American Association of Physician Specialties at (410) 592-9889.

Respectfully submitted,

Terrance L. Baker, MD, MS, FAAEP, FAAGM, FAAFP
President – American Association of Physician Specialties