On February 28, a 27-year-old female nurse suffered a sudden cardiac arrest in the buffer zone of the isolation ward of 2019 coronavirus disease(COVID-19) in Wuhan, China. And this is not the only case that medical staffs who worked in the isolation ward suffered from medical emergency. Ever since the breakout of COVID-19, thousands of medical staffs and paramedical staffs have been involved in the fight against COVID-19. Wearing heavy personal protective equipment (PPE), continuously working at least 4 to 6 hours, or even 8 to 12 hours without eating or drinking, the staffs in the isolation ward were very vulnerable populations. Healthcare staffs wearing PPE are prone to breathing difficulty, suffocation and heat stress. Especially with the rise of temperature in Wuhan, the risk of heat exhaustion or even heat stroke has greatly raised. Actually there was an eye-catching photo popular on Chinese internet showing a nurse hugging a great piece ice in an isolation ward in Wuhan to cool down herself. Therefore, it is important to take measures to prevent and to properly handle such medical emergencies.
Based on the rescue plan of emergency collapse in Huoshenshan Hospital, we proposed a management procedure to rescue the medical staffs who collapsed in the isolation ward . In the procedure, once a staff is found collapsed in the isolation ward, a brief evaluation should be conducted immediately. Based on the vital signs (consciousness, breathing and pulse), the severity of the victims was divided into three levels, namely moderate, emergent and critical. For the critical condition, the victims might suffer from sudden cardiac arrest, airway obstruction caused by vomiting or other life-threatening events, which could lead to death in a few minutes if without intervention. Thus, life-saving interventions are needed immediately, and the PPE should be removed even in the contaminated area if necessary. Some hospitals in Wuhan have set up special units for rescuing staffs in the isolation wards. While for the moderate or the emergent conditions, before receiving further monitoring or treatment, all PPE should be removed and the victims should be evacuated from the isolation ward according to the standard procedure. Note that, when life-threatening conditions occur during decontamination, emergent intervention should be given on the spot immediately. Figure 2 shows the layout of the decontamination room and the transfer route of the victim. Figure 3 shows the step-by-step process of decontamination. Some details in the procedure might vary slightly depending on different hospitals, and the principles and the procedures are similar.
To protect staffs in isolation wards, in addition to effective coping strategies, active measures should be taken to detect and prevent medical emergencies. Some Chinese experts have reached specific consensus on protecting medical staffs in the isolation wards. According to the COVID-19 healthcare planning checklist of the US department of health and human services(HHS), medical units are recommended to develop guidance for staff monitoring for signs of illness. In an effort to detect emergency collapse in the early stage, some medical staffs in Wuhan even wear smart bands to monitor the vital signs in a real time manner. More efforts and more measures should be given to cope with staff collapse in the isolation wards of conditions like COVID-19.
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