Recognizing that EDs around the country will be hard-pressed to manage the kind of surge in patients that epidemiologists are predicting, the American College of Emergency Physicians (ACEP) quickly put together a National Strategic Plan for Emergency Department Management of Outbreaks of COVID-19.

The plan is comprehensive, including a range of checklists around everything from supplies of personal protective equipment and critical infrastructure to enhanced security, staff screening procedures, and lab testing protocols. ACEP reports the plan was adapted from the federal template for biological threat management, and covers five key areas:

  • situational awareness;
  • protection of ED infrastructure and personnel;
  • prevention of disruptions in service delivery;
  • organized and timely surge medical response;
  • recovery to previous steady state.

Howard Mell, MD, MPH, CPE, FACEP, an emergency physician in Illinois and spokesman for ACEP, tells ED Management that establishing effective communication both internally and with local and regional agencies is particularly important.

“Coordination between the ED and the rest of the hospital, state and local public health officials, and others is essential. Hospitals should have a protocol already in place, but there is no one-size-fits-all approach to preparedness,” Mell stresses. “Leadership should consider existing resources and evaluate needs for optimal care delivery, information-sharing, and resource allocation. For many hospitals, that conversation starts with ED readiness.”

In a statement, William Jaquis, MD, FACEP, president of ACEP, acknowledged the health system is likely to be strained as the country seeks to mitigate the impact of the virus, and that careful planning and preparation are vital. ACEP is urging EDs to consider how COVID-19 will affect business practices and critical infrastructure.

Worker absences, shortages of resources, and slowdowns in transportation of supplies and support services are likely to become particularly pronounced. Indeed, there have been critical shortages of PPE, and healthcare workers have become ill in several states. ACEP has established a COVID-19 page for the latest updates regarding assessment, testing clinical management, and other news on the outbreak. 

The Emergency Nurses Association (ENA) established its own COVID-19 page to convey the latest information about the pandemic and to provide links to available resources.

Mike Hastings, MSN, RN, CEN, president of ENA, tells ED Management he is urging nurses to stay informed. “ED nurses must know what the local policies/procedures are for the organization they are working with. The information changes so rapidly that people must take the time to seek out the most current updates,” he explains.

Hastings also urges nurses to stay involved in planning and preparations in their own units, and to relay important information about the outbreak to others. “Nurses need to communicate with the public ... about the realities of this outbreak and the most common-sense ways to potentially limit COVID-19’s spread,” he says. “Nurses are the most trusted profession for a reason, and it is time that nurses use this trust to educate the general public.”

ENA is working with ACEP and other healthcare organizations to advocate for the funding and resources needed to tackle the virus. “We are also sharing some lessons learned from those in the hot zone to give important perspectives to our members who might not be facing this right now,” Hastings says. “ENA prides itself on the network it has and the knowledge our members share with each other.”

The Centers for Medicare & Medicaid Services (CMS) issued a blanket waiver regarding COVID-19 as it relates to the Emergency Medical Treatment & Labor Act (EMTALA) on March 30.

For questions on Section 1135 waivers for EMTALA, send an email to 1135waiver@cms.hhs.gov. Include the city and state of your location so CMS can route the inquiry appropriately.