Management at Emergency Department (Ed) : A. Screening & Triage of Patients at Ed HRPZ Ii

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MANAGEMENT AT EMERGENCY DEPARTMENT ( ED )

A. SCREENING & TRIAGE OF PATIENTS AT ED HRPZ II


 A designated triage counter manned by dedicated staff will be set up in A&E
HRPZ II for suspected Influenza patients.
 Signage should be displayed at the entry of ED Department instructing
patients with ILI symptoms to inform the reception immediately on their
arrival.
 Attention to hand hygiene, respiratory hygiene and cough etiquette should be
reinforced by means of posters and provision of alcohol-based hand rub,
tissues, and waste bins.
 Patients should be instructed to stay in the designated waiting area only.
 Patients with ILI symptoms, who presented to ED HRPZ II should be
screened for PI.
 Patients with suspected PI should immediately be given surgical masks at the
triage counter to be worn with emphasis on the need and importance of using
face mask.
 Suspected PI patients are then accompanied by triage staff and immediately
directed to the designated Examination Room or Decontamination Room to
minimize transmission to others.
 Staff at triage counter should wear Personal Protective Equipment (i.e N95
masks, surgical caps with face shield, disposable gowns, non-sterile gloves
and plastic aprons).
 Staff must practice strict hand hygiene.
 Any staff in close contact with suspected PI must wear PPE.
B. ASSESSMENT OF PATIENTS IN A&E HRPZ II

 Patients are examined in designated Examination Room or Decontamination


Room. The Emergency Response Team (ERT) managing the patients must
wear PPE.
 A detailed history should be obtained (according to the PI clerking sheet)
 Assessment and stabilization of patients Airway, Breathing and Circulation
(ABC) take precedence.
 If the patient is stable, he/she is taken to the designated Examination Room.
The door must be kept closed at all times and number of staffs entering the
room should be limited.
 Operational Room (Bilik Gerakan) will be informed regarding the case of
suspected PI by ERT members; the Operations Center will then inform the
Emergency Physician-on-call.
 An authorized ED Medical Officer (MO) will review and examine the patient
assisted by paramedic.
 The ED MO /Emergency Physician will then inform the Medical Department
MO on-call/ Physician on call/ Pediatric MO/ Pediatrician/ Infectious Disease
(ID) Specialist on call.
 If admission criteria are fulfilled, the patient will be directly admitted to the
designated isolation ward (Respective ward staff should be informed prior to
patient’s transfer)
 The patient must be transported to designated isolation ward using dedicated
ambulance via a designated route.
 Patient will be accompanied by ED PPK.
 Chest x-ray (CXR) and other specimens/investigations will be taken at
designated ward.
 After sending patient, decontamination/disinfection process of staff,
equipment and transport must be carried out
 If the suspected PI patients is unstable or critically ill, he/she will be
resuscitated in the dedicated Red Zone area.
 The staff should be limited to 5 people during resuscitation. Staff involved
should wear proper PPE with respiratory protector/ face shield/ respirator.
 Patients that require ventilatory support must be referred to anesthetist
immediately and transferred to designated ICU through the designated route.
 The performance of aerosol generating procedures (intubation,
bronchoscopy, tracheostomy, nasopharyngeal aspiration and nebulizer)
should be minimized and only performed by the most skilled person without
compromising patient care.
 Dead bodies should be handled as per KKM Guidelines “Autopsy
Examination in Major Infectious Cases, Including Hendra-like Virus” and
“Transport and Disposal of Dead due to Hendra-like Virus Infection” released
in 1999.

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