Facing COVID-19 on the Front Lines
Health systems nationwide are working hard under very stressful circumstances as the COVID-19 pandemic rapidly expands across communities and states. Rather than adding to the information overload, I want to share the preparedness checklist we’ve updated for our more than 4,100 Vituity providers nationwide.
This checklist is geared toward emergency clinicians but appropriate for anyone with patient contact. As always, stay alert for specific and up-to-date direction from your medical director, health system, or local public health authorities.
COVID-19 Provider Checklist
Clinical Knowledge
- I know detailed clinical information about COVID-19.
- If I need to intubate a patient, I understand recommendations around NIPPV and protective gear.
Intake
- I know how our front end/triage/intake/RME process is changing to adapt to possible COVID-19 patients.
- I know how our EMS intake process is changing to adapt to possible COVID-19 patients.
- I know where these patients will be placed during their visit for testing.
Testing
- I know which patients should be tested.
- If your hospital has not provided clear guidance, reasonable criteria include:
- Healthcare workers, law enforcement, firefighters, EMS.
- Patients involved in an illness cluster in a facility or institution (e.g., healthcare, school, corrections, shelters).
- Patients with severe lower respiratory illness (hospitalized or fatal).
- Patients with worsening symptoms.
- Patients older than 60 years.
- Patients with underlying medical conditions.
- Pregnant women.
- I know whom at my hospital to contact 24/7 if I have questions about whom to test (e.g., infection control RN, on-call consult, administrator on duty).
- I know what type of testing is necessary.
- Now that testing is more common, I know whether I can order a test on my own or whether I need to call Public Health.
- If I am allowed to order a test on my own, I clearly understand who is responsible for following up on a positive test result.
Personal Protective Equipment (PPE)
- I know what type of PPE I need to wear.Note that some hospitals are following CDC guidelines; others are following the WHO guidelines.
- I know how to correctly don/doff PPE.
- If I am working in RME/intake/triage, I am typically wearing a mask for all encounters.
- If I am working in RME/intake/triage, I know which patients need to be immediately screened and isolated, and I know where the masks are located for those patients.
Quarantine/Work Restrictions
- I know my hospital’s guidelines around work restrictions for staff caring for COVID-19 patients.
- Note there is a difference between “work restriction” and “quarantine.” Most exposures should only result in work restriction and not social isolation/quarantine.
- I know which discharge instructions to give when patients are to self-quarantine.
Self-Care
- I have stocked up on supplies—food, medications, hygiene products—if my community or I am quarantined.
- I have a plan for child care if local schools are closed.
- I have canceled long-distance travel plans for the next 4-6 weeks, at least.
In Conclusion
COVID-19 is rapidly evolving, and many of these recommendations will likely change. To stay up to date, refer to CDC guidance for healthcare professionals. Be sure to wear gloves, wash your hands, don’t touch your face, and use masks!
Reading this checklist may be sobering. There are undoubtedly many challenging shifts ahead, and they will be made more frustrating by an evolving epidemic and a healthcare system that is learning on the go. The hard work you are doing under tough circumstances to care for patients truly makes a difference. We all chose a medical career to relieve suffering and bring healing to our communities. For our profession, this public health threat can also represent our finest hour.
