ER Procedural Guidelines on Handling SARS Suspect / Probable SARS
AT THE GUARD’S FRONT DESK
1.
The guard-on-duty asks all patients and companions
entering the Emergency Room for history of:
a.
Fever
b.
Respiratory symptoms – cough, colds, dyspnea or
shortness of breath
2.
If with fever or respiratory symptoms, the guard
directs the patient to the Triage Area.
3.
If without fever and respiratory symptoms, the
guard directs the patient to the Main ER.
THE TRIAGE/HOLDING AREA (ISOLATION ROOM)
1.
The Room will be used to isolate SARS SUSPECT to
prevent exposing majority of the hospital staff and other clients to the
disease.
2.
The room will be divided into:
a.
Triage Area where all patients presenting with
fever will be triaged before they can be allowed to proceed to the Main ER.
b.
Holding Area where the following will stay:
i.
SARS Suspects or Probable SARS awaiting conduction
to Research of Tropical Medicine (RITM) or San Lazaro Hospital (SLH)
ii.
SARS Suspect awaiting CXR and other diagnostic
examinations.
iii.
Special cases of Probable SARS who are admitted at
MDH and awaits transfer to 11F.
c.
Comfort room
Note: The Triage and
Holding Area are separated by a sliding glass door. This will deter mixing SARS SUSPECT with PROBABLE SARS.
3.
The room will contain the following:
i.
O2 tank
ii.
E-cart (separate from the main ER)
iii.
Chairs for the patients
iv.
Stretcher
v.
Sink with soap and water / alcohol based hand rub
at the entrance
vi.
Hand dryer
vii.
Exhaust fan for ventilation or provision to attain
negative pressure inside the room
viii.
Intercom to communicate with the main ER
THE MEDICAL TEAM
1.
The Triage Officer (TO)
a.
The Postgraduate Intern as agreed by MANCOM is
assigned the position.
b.
His functions will encompass the following:
i.
Interviews the patient to elicit the following:
1.
History of travel to endemic areas for SARS
2.
History of contact with confirmed cases of SARS
ii.
Completes the TRIAGE SCREENING QUESTIONNAIRE form
then logs the patient’s name in a separate logbook which contains the following
information:
1.
Date of consult
2.
Name, age, sex, and contact numbers of the patient
3.
Date of arrival from SARS and/or date of exposure
4.
Disposition made at the ER
iii.
If the patient is diagnosed as “SARS SUSPECT”, the
TO will:
1.
Provide the patient with a surgical mask.
2.
Advise the patient that he will be transferred to
RITM or SLH.
3.
Facilitate transfer to the referral hospitals using
the following MDH transport facilities:
i.
Bida van for stable patients
ii.
Ambulance for unstable patients
4.
Endorse the patient to the institutions to which
they will be transferred.
5.
Inform the Radiology Department, if the patient
wishes to have a chest x-ray done prior to the transfer.
6.
Inform the ER Consultant-on-duty of the following:
a.
Admission if the patient is unstable for transfer
b.
Inquiries/complaints
iv.
If the patient is diagnosed as a “non-SARS”, the TO
may now direct the patient to the Main ER for further evaluation and
management.
c.
He will conduct the interview with a patient
through the intercom while staying at the Main ER to minimize exposure to SARS.
2.
The Emergency Room Officer (Consultant)
a.
Aside from his usual functions, he will be
responsible for the following:
i.
Inform the following personalities in case a “SARS
SUSPECT” is admitted at the ER:
1.
Medical Resident-on-duty to admit the patient under
the combined services of Infectious Disease and Pulmonary Specialists.
2.
Admitting Department to assign rooms at the 11F.
3.
Nurse Supervisor and Nurse-on-duty at the 11F.
4.
Dr. Velmonte, Chair of the Infection Control
Committee
5.
Dr. Joson, Chair of the MDH Task Force SARS
6.
Dr. Rex Mendoza, OIC Hospital Administrator, who
will take charge of any media coverage, if a need arises
7.
Dr. Dante Morales, Medical Director
8.
Miss Rita Wanninger, Assistant Hospital Director
ii.
To train and impart necessary education and
training to the ER personnel and security guards regarding SARS.
iii.
To be the principal resource person to answer
queries, provide advices to clients who will call at the MDH SARS Hotline.
3.
The Emergency Room Officer (Resident/Intern)
a.
Aside from the usual functions, they also act as
alternative resource persons to entertain calls at the SARS Hotline.
4.
The Medical Resident-on-duty
a.
He is a senior resident of the department with the
following functions:
i.
Admit SARS suspect patient to assigned room.
ii.
Informs the assigned Infectious Disease Consultant
and Pulmonary Consultant of the admission.
iii.
Accompanies the SARS suspect during ambulance
conduction when necessary.
5.
The Nursing Staff
a.
The Shift Leader
i.
Aside from his usual functions, he checks the
supplies needed to attend to a Probable SARS patient who is admitted at the ER,
i.e.: N95 masks, disposable gowns with hood, disposable gloves, googles,
disposable footwear.
ii.
He informs the following personnel of the
admission:
1.
Nurse supervisor on duty
2.
Staff nurse of the 11F
3.
Radiology Technician on duty for CXR
4.
Medical Technologist on duty for blood extractions
5.
Respiratory Therapist if patient is intubated
iii.
Makes sure that the intercoms are properly
disinfected every shift.
iv.
Updates SARS advisory located at the facade of the
ER daily.
b.
The Staff Nurse
i.
Aside from his usual functions
1.
he carries out the orders of the physician
admitting the probable SARS patient
2.
he does the charting
LOGGING OF PATIENTS
All
patients with fever or respiratory symptoms interviewed at the Triage Area will
be logged in a logbook separate from the ER logbook. The logbook will contain the following information:
1.
Date of consult
2.
Name, age, sex, and contact numbers of the patient
3.
Date of arrival from SARS and/or date of exposure
4.
Disposition made at the ER
The disposition will
depend on the DOH SARS guidelines, i.e.
SARS SUSPECT -
send to referral hospitals
NON-SARS SUSPECT -
advice regarding personal surveillance
-
provide MDH SARS Hotline
Another logbook will be
provided for those patients transferred to a SARS REFERRAL HOSPITAL with the
following information logged in:
1.
Date and route of transport
2.
Duration of patient transport
3.
Names, contact information, and specific duties of
transport personnel
PATIENT CONDUCTION
DOH
mandates “NO self-conduction” for SARS SUSPECT, thus, suspected cases of SARS
will be conducted to either the RITM in Alabang or SLH in Manila using the
following vehicles for conduction:
1.
BIDA van of MDH for stable patients
2.
MDH ambulance for unstable patients
This aims to ensure that the SARS SUSPECT will
proceed to any of the aforementioned hospital for further evaluation and to
prevent further spread of the disease to possible contacts like the taxi
driver, passenger of public vehicle, and others.
SARS SUSPECT patient will be charged a conduction
fee of PhP 100 for conduction to SLH and PhP 500 for conduction to RITM.
To keep the exposure of the MDH Driver to SARS to a
minimum while conducting the SARS patient:
1.
He is provided with an N95 mask, disposable gloves
and gowns.
2.
The patient is made to wear a surgical mask which
the ER has earlier provided.
3.
The passenger area of the vehicle will be enclosed
to separate the driver from the patient.
In conducting toxic or unstable patients, the
assigned Medical Resident-on-duty and an ER staff nurse will accompany the
ambulance conduction to the aforementioned referral hospitals.
ADMITTING A PROBABLE SARS PATIENT
As a general policy, MDH will not admit SARS SUSPECT except when the SARS
SUSPECT is in severe respiratory distress and needs intubation and transfer to
any of the referral hospital is not plausible.
Once admission of a SARS SUSPECT is inevitable, it
the ER policy to:
1.
Admit this patient only at the HOLDING AREA.
2.
Minimum number of MDH Staff will attend to the
admission, i.e.:
a.
Medical Resident-on-duty to admit the patient
b.
Staff nurse-on-duty to assist the physician
c.
Radiology Technician on duty for CXR
d.
Medical Technologist for laboratories
If additional staff is
necessary, the ER intern on duty and another staff nurse will provide the
needed personnel.
3.
The aforementioned staff will have to be properly
attired, i.e., N95 mask, goggles, disposable gown with hood, disposable
footwear and gloves.
4.
The patient must be transferred immediately to the
designated room at the 11F which has been arranged by the staff at the main ER.
5.
During the transfer of the patient from the Holding
Area to 11F, the ER Staff at the Main ER must wear their N95 masks.
6.
Once vacated, the Triage/Holding Area will be
closed temporarily until proper decontamination by the housekeeping will be
made.
DECONTAMINATION
Thorough and proper decontamination will be
provided by the housekeeping in the following scenarios:
1.
SARS SUSPECT leaves the Isolation Room.
2.
Admitted Probable SARS is transferred to 11F.
3.
As soon as the MDH Ambulance returns to MDH from
conducting SARS SUSPECT/ PROBABLE SARS
The ambulance will be initially decontaminated by
the ambulance driver as soon as the patient is transferred to the referral
hospital before he leaves the place.
The driver will be provided by the Housekeeping Department with the
needed chemicals for decontamination and instructions on the decontamination
procedure.
REFERRALS OF SARS SUSPECT TO MDH
The MDH ER will NOT ACCEPT SARS SUSPECT referrals
from other hospitals.
SARS HOTLINE
523-69-13 will be designated as the SARS Hotline
for the hospital. The phone is situated
in the Conference Room of the MDH ER.
PROTECTION FOR THE ER STAFF
The ER Staff will be provided with an ordinary
surgical mask for daily use. The N95 mask
and other needed personal protection equipments (PPE) will be provided when a
particular staff will attend to a SARS SUSPECT and PROBABLE SARS at the
TRIAGE/HOLDING AREA.
The Security Force personnel guarding the front and
back doors of the ER will be provided with an N95 mask to protect themselves
since they will be the first personnel to interview the patients.
The Ambulance Driver who will conduct the SARS
SUSPECT AND PROBABLE SARS to referral hospitals will also be provided with an
N95 mask and other necessary PPE to protect them.
PROTECTION FOR THE PATIENTS
SARS SUSPECT will be provided with surgical masks
prior to transport to referral hospital.
To further protect the patients at the Main ER from
possible exposure to SARS, only 1 companion for unstable patients, i.e.,
patients brought in via stretcher and wheelchair and for pediatric patients
will be allowed. Otherwise, under no
circumstances shall a companion be allowed inside the ER.
When possible, all OPD cases will be directed to
the clinics of available MDH consultants and to the IMSD.
Blood donors who are seen at the ER when the IMSD
is closed will be examined at the Laboratory Department instead to prevent
possible exposure at the ER.
TRAINING
Frequent updates and training for the ER Personnel
and Guards will be conducted by the designated ER Training Officer at the
Conference Room.
These policies are made to guide to protect our
hospital staff and clients from possible SARS exposure in every effort that we
can.
Prepared by:
Raquel Artuz de Leon, MD
Training Officer, Department of Emergency Medical
Services
Noted by:
Roberto L. Ruiz, MD
Chair, Department of Emergency Medical Services
Melecia Velmonte, MD
Chair, Infection Control Committee
Approved by:
Reynaldo O. Joson, MD
Chair, MDH Task Force SARS