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Don't be afraid of the ED: Seeking Care During the COVID-19 Pandemic

April 29, 2020
Published in: COVID-19, Emergency

Female doctor wearing a mask and gloves, examining a patient's face

The steady advice for the past several weeks has been consistent: To reduce the spread of COVID-19 and to keep yourself and your family as safe as possible, maintain a social distance of six feet, or better yet, stay home.

For most, this is sound advice. For those who are experiencing true medical emergencies—it is a risk too great to take.

"Nationally, Emergency Departments are seeing much lower volumes," says Adam Rochman, MD, Medical Director of Augusta Health's Emergency Department, "and our experience here at Augusta Health aligns with the rest of the country. It's understandable. We've asked folks to stay home, and they are following that advice. They are fearful that if they do come to the Emergency Department, they'll contract COVID-19. There are many reasons, though, why you should not be afraid to come to the Emergency Department and should seek care when you need it."

First, medical emergencies persist even during COVID-19.

Outside emergency department entrance"While COVID-19 is a concern, the fact is that heart disease is the leading cause of death in our area and stroke is the leading cause of disability. Unfortunately, these emergencies (among others) have not gotten the message about a pandemic and continue to afflict patients. Many of these emergencies are dependent on rapid treatment to ensure the best results and therefore it is critical that everyone understand that if you are having signs or symptoms of a heart attack, stroke, or other emergency that you call 911 and go to the Emergency Room," says Dr. Rochman. "You need to be examined and treated as quickly as possible."

Signs and symptoms of a heart attack include chest pain; shortness of breath; and discomfort in the arms, back, neck, jaw or stomach.

Signs and symptoms of a stroke include balance problems; blurred or double vision; a drooping face, especially on one side; arm weakness; and speech difficulties.

Dr. Rochman adds that acute confusion, severe abdominal pain, and many other conditions can underlie an emergency condition and if patients have concerns related to having an emergency condition they should be evaluated as soon as possible in the Emergency Department.

Second, delays in treatment lead to poorer outcomes.

"One of the very concerning trends we are experiencing in the Augusta Health Emergency Department is what we call 'late presentation'. It means someone has delayed the decision to come to the ED, so they are arriving later than they should to have the best chance of recovery. We've seen this with patients who are having strokes, those with chest pains, and those with pulmonary embolism," explains Dr. Rochman.

With all these conditions, delaying care means more damage—to the brain in the case of stroke or the heart muscle in the case of heart attack. There are life-saving interventions that can be done for both, but they need to be started relatively soon after symptoms begin.

"Delaying a trip to the ED for these serious symptoms and conditions can have a considerably negative impact on the outcome for the patient," says Dr. Rochman.

And third, Augusta Health has taken many precautions to ensure the ED is a safe place to be treated despite COVID-19.

"We've redesigned both the physical Emergency Department and our processes to greatly reduce the risk of exposure to COVID-19," explains Dr. Rochman. "Physically, we've created a separate negative-pressure COVID unit to care for patients with respiratory conditions. Patients being evaluated and treated for other conditions are in a completely separate area of the ED. We've also eliminated any air recycling in the entire Emergency Department. Fresh air is brought in from the outside and then blown out to the exterior."

Patients are screened at triage, and if there are any respiratory concerns, the patient is 'direct bedded' to a negative pressure room. The waiting room has been eliminated. Staff is also screened at the start of each shift, including temperature checks, and each must pass the screening in order to work his or her shift.

Dr. Rochman also adds that the ED has adopted universal masking of both patient and provider to contain spread of droplets, and staff is wearing eye protection. The ED has partnered with local Emergency Medical Services (EMS) agencies to ensure safe transport of patients to the hospital and safe transfer from ambulance into the ED. Thorough protocols for cleaning and disinfecting all rooms, surfaces, and equipment have been reinforced and standardized.

Visitors are restricted: one visitor is allowed for non-respiratory patients and no visitors are allowed in the COVID/Respiratory section. To ease the stress on patients and families caused by the policy, patient-family liaisons have been established to keep everyone connected during treatment and possible admission.

"We've been very fortunate in our area of Virginia because we've had fewer cases of COVID-19 than in many other areas of the state. We've also learned a lot in the past several weeks about the best practices for containing the spread of COVID while continuing to treat non-COVID patients," says Dr. Rochman. "So honestly, I can say that right now, your risk of death or harm from delaying coming to the ED for treatment of a heart attack, stroke or other emergency condition is greater than your risk of contracting COVID-19 in the ED. Please, pay attention to what your symptoms are telling you and seek care as early as possible."