Patient Disposition

Context:

With a surge, you may outstrip road ambulance or air Medevac systems. Receiving hospitals may also be overloaded and unable to take patients. ICUs will be full. The bottlenecks will result in patients boarding where they usually do not - a community facility.

Dealing with Loss of Medevac Capacity

You must consider:

• What other options exist for transfer?

  1. 1. 1. • Military? Makeshift ambulance? Truck?

If you cannot transfer:

• Where you will place and how you will treat many sick patients?

• What are your bedding options? Do you need cots? (Red Cross?)

• Do you need to use another facility, such as a school?

• Will you need to make meal provisions? Can you obtain community donations vs using a kitchen to decrease spread of infections?

• Bathrooms? Cleaning? Infection Control?

• Field hospitals? Military involvement?

Rationing: Materials, Medications

We know that death arises primarily from ARDS. There may not be enough ventilators in your facility.

Oxygen will be your only real therapy and, perhaps, some medication. And Proning.

• How much Oxygen do you have? Can you get more? A lot more? O2 Concentrators??

• Do you have enough masks, nasal prongs?

• Rationing: New York Ventilator Protocol

• Ventilator splitting

You will not have enough oxygen to treat everyone in an overwhelming surge.

• What will you do? How will you ration? These are terrible questions to have to answer and our colleagues in Italy and New York are answering them continuously.

• Would O2 Concentrators help? Can you get more?

• Ventilator splitting protocols are arising. To ration, refer to the New York Ventilator Protocol.

Palliative Care

This will be a very real issue, and a difficult one. Preparation for yourself and the population has the potential to ease some of the difficult discussions and decisions. Discussing the level of care can be helpful. Proactively reading and developing an understanding of common questions and concerns that arise during end of life care, particularly in the new reality of everyone being resource poor, will help prepare you.

More info forthcoming soon.

Palliative Care Treatmenet Guidelines

https://bc-cpc.ca/cpc/wp-content/uploads/2020/03/COVID-19-End-of-Life-Symptom-Management.pdf

Loss of Life

For patients who do not survive, you may outstrip funeral house capacity. You must prepare for a mass casualty scenario.

• • Where can you set up a morgue?

  • What infectious precautions must be taken in transporting bodies?

Psychological support

Psychological Support will be limited, yet we will need it more than anyone. We must take care of ourselves and look out for each other.