Are our Emergency Departments Covid fit? Elizabeth Brown | Senior Communications Advisor
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survey of emergency specialists highlighted significant gaps in the preparedness of our EDs to deal with a re-emergence of Covid-19. With the arrival of the highly transmissible Delta variant, it provides some timely insights and lessons.
Emergency departments and their staff are stationed on the frontline of the Covid-19 pandemic. They triage cases through their doors, some obviously infected with SARSCoV-2, but others still presenting with heart attacks or sprained ankles who might also be. That puts them at the sharp end of exposure and transmission risk. In the first Covid-19 outbreak last year, Ministry of Health figures showed that one in every ten cases of Covid-19 were health workers. Unfortunately, there is no public information on whether they had become infected on the job or in the community. About a year ago, Northland emergency medicine specialist Dr Michael Howard looked across the Tasman and watched as Melbourne struggled with a Covid-19 outbreak in which half the cases initially were among healthcare workers.
therefore the ability of the system to care for people, so it’s like a vicious circle.” He adds that it was no secret that New Zealand’s health system risked collapse in the event of a major Covid-19 outbreak, so anything to shore up our defences would benefit everyone. Identifying and addressing weaknesses Dr Howard wanted to identify and address weaknesses in local hospital infection control in terms of department policies, PPE use and hospital ventilation and space, to reduce the risk of transmission and be ready for a Covid-19 re-emergence. Drawing on US and Australian research, he put together the New Zealand Emergency Department Covid-19 Preparedness Survey, asking emergency specialists about the levels of Covid-19
protection in their workplaces. He enlisted co-author Dr Charlotte Chambers (Director of Policy and Research at ASMS) to help create and distribute the survey to 422 ED specialists across DHBs. It was sent out through October–November 2020. A colleague, Dr Nicholas Mohr, lent his expertise to the project even as Covid-19 surged through his ED at the University of Iowa last December. It included questions on negative flow isolation rooms, shared/cohorted patient areas, segregated patient flow, and physical distancing. It also asked about policies for rostering, workflow, and breaches, along with the supply, fit testing, use and re-use of PPE equipment. A total of 137 surveys were completed – a 32% response rate and with all 20 DHBs represented.
“Even if rapid antigen tests become available, the level of PPE used will have to be reconsidered in all areas if we want to halt the Delta variant.”
The outbreak revealed deficiencies in hospital-level infection prevention and control, prompting authorities there to look at a model to reduce risk in the system. “This was a health system similar to New Zealand’s so I thought I could see our potential future, what weaknesses were present and the improvements which may be needed to prevent future New Zealand healthcare worker infections,” Dr Howard says. “If you put staff at risk and they are exposed or infected, you then have to take them out of the work environment, decreasing the number of available personnel and 6 THE SPECIALIST | SEPTEMBER 2021
Dr Michael Howard outside Whanga-rei Hospital ED
