Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients

Coronavirus Disease (COVID-19): A primer for emergency physicians

“…68 Emergency medical dispatchers should consider whether callers describing risk factors and symptoms concerning for COVID-19 should be identified as a potential PUI. 30,68 If so, EMS personnel arriving on-scene as well as HCP at the receiving hospital should be notified immediately to ensure proper personal protective equipment (PPE) use and confirm that appropriate isolation facilities are available. 30,68 Once contact is made with the patient, initial triage and assessment should be done at least 6 feet away and minimized until the PUI dons a facemask.…”

“…30,68 If so, EMS personnel arriving on-scene as well as HCP at the receiving hospital should be notified immediately to ensure proper personal protective equipment (PPE) use and confirm that appropriate isolation facilities are available. 30,68 Once contact is made with the patient, initial triage and assessment should be done at least 6 feet away and minimized until the PUI dons a facemask. 68 In addition to limiting the number of EMS personnel in the patient compartment, personnel providing any direct patient care should follow standard, droplet (surgical mask), and contact precautions (gown and gloves) while wearing eye protection (face shield or goggles).…”

“…Intubation is a high-risk procedure due to the aerosolization of respiratory droplets. 30,72 Rescue intubations should be avoided whenever possible as complete adherence to PPE respirator and placement of the patient in an AIIR. 70 Based on prior cases of HCPs infected with SARS-CoV while using N95 respirators, some experts recommend using a PAPR.…”

“…70,72 To reduce inadvertent contamination by touching one's face or hair, a full face shield and head cover is recommended if a PAPR is not used. 30,72 Wrist exposure can be minimized by using longer-sleeved gloves or vertically taping gloves to the gown. 30 Applying tape circumferentially makes removing PPE more difficult and does not have added benefit.…”

“…14,23,27 Patients are felt to be at highest risk of spreading the illness when they are most symptomatic. 23,27 Limited data support viral shedding in asymptomatic patients while increased levels of viral shedding may be more pronounced in those critically ill. [28][29][30] Current epidemiologic patterns of COVID- 19 in China indicate that it is highly contagious with sustained spread; the extent of person-to-person transmission within the U.S. was initially limited and continues to evolve daily. 23 The current R 0 or basic reproduction number is estimated to be greater than 2.2; for every case of COVID-19 identified in the population, more than 2 additional cases are possible in the absence of adequate isolation.…”