First Line Covid-19, 10 things... from ER to the times of Corona

How to deal with the COVID-19 emergency
Operational Guidelines for Emergency Care
10 dos for doctors and nurses, 10 don'ts, 10 positive and warning signs from patients, 10 things not to overlook or allow to happen
"Emergency room staff is working increasingly without protective medical equipment. If emergency room staff contracts the virus, we will lose one of the main filters in place to contain its spread"
Emergency care professionals, working well beyond their normal capacity in every hospital in the country to deal with the Coronavirus emergency, continue to support the ongoing clinical analysis of the situation and the organizational efforts to optimize the outcome of treatments for patients and the response of medical emergency teams.
The Italian Emergency Medicine Society (SIMEU), in collaboration with the Italian Group for Clinical Research in Emergency Medicine (Fenice) has published a series of practical information on its website for the management of Covid-19 patients based on the experience gained in the field in recent weeks and currently in progress. This is a clinical and organizational guide that attempts to provide some order to the management of an emergency situation that our hospitals have never witnessed before.
The information assesses situations to be avoided and interventions to be implemented, positive signals that show improvment among patients and warning signs of a worsening clinical situation that requires prompt intervention and, in conclusion:
10 red flags
  1. Exhaustion  of stretchers in the emergency room;
  2. Exhaustion of beds for ICU admission;
  3. Exhaustion of beds for hospital admission;
  4. Exhaustion or inadequate supplies of ventilation devices;
  5. Exhaustion or inadequate supplies of medical equipment (ABG syringes, drugs, etc.);
  6. Exhaustion of oxygen supplies;
  7. Lack of a clear chain of command;
  8. Lack of information or instructions from the Crisis Response Units;
  9. Use of different therapeutic protocols in the same healthcare facility;
  10. Numerical increase of healthcare workers presenting symptoms due to physical or psychological problems.
"The 10 red flags – states Salvatore Manca, national president of SIMEU - are the things that should not be lacking in our facilities or situations that should not occur. Nonetheless, over the last few days, emergency room staff is increasingly working next to patients without using protective medical equipment. If the doctors and nurses working in the emergency room contract the virus, we will lose one of the main filters in place to contain its spread".
Signatories to the document "Prima Linea COVID - 10 COSE", whose full version is available AT THIS LINK:
Stefano Paglia - ER Complex Operative Unit Director, ASST Lodi
Andrea Magnacavallo - ER Operative Unit, Short-Stay Observation and Emergency Medicine Director, AUSL Piacenza
Roberto Cosentini - Highly Specialized Emergency Operative Unit (ER) Director, ASST Bergamo
Antonio Voza - Highly Specialized Emergency Operative Unit (ER) Director Humanitas, Rozzano (Milan)
Vito Cianci - Admissions and ER Operative Unit Director, AO Padua
Tiziana Perin - Emergency Medicine Operative Unit (ER) Director, AUSL Romagna, Rimini
Francesca Cortellaro - Admissions and ER Director ASST Santi Paolo e Carlo, Milan
Andrea Bellone - ER Operative Unit and Emergency Medicine Director, Niguarda Hospital, Milan
Anna Maria Brambilla - Emergency Medicine and ER Operative Unit Director - ASST Fatebenefratelli Sacco - P.O. Luigi Sacco, Milan
Giorgio Costantino - Emergency Medicine and ER Operative Unit Director  IRCCS Cà Geanda Foundation, Maggiore Polyclinic Hospital, Milan
Ciro Paolillo - ER Operative Unit Director, ASST Spedali Civili, Brescia
Giovanni Buonocore - ER Operative Unit Director, Merate Hospital, ASST Lecco
Guido Bertolini - Mario Negri Pharmacological Research Institute IRCCS, Covid-19 Crisis Response Unit, Lombardy Region
Gian A. Cibinel - ER/Emergency and Admissions Department Area Coordinator Covid-19 Crisis Response Unit, Piedmont Region


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