Purpose: Describes the appropriate personnel, PPE, and steps necessary for safe and efficient emergent ED to OR transport.
Scope: Emergency Department and Perioperative Services
Approval Pending: ICC Safety/Med Tech and Infection Prevention
Date: 5/20/2020
Scope:
Inclusion:
o All injured patients being transported to the OR for an emergent surgical procedure
Exclusion:
o Any patient being transported to the pre-op/PACU in preparation for an operative procedure
Definitions:
· ED: Emergency Department
· OR: Operating Room
· COVID-19: Coronavirus-19, SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
· AIC: Anesthesiologist-in-charge
· REBOA: Resuscitative Endovascular Balloon Occlusion of the Aorta
· ECMO: Extracorporeal Membrane Oxygenation
· ECLS: Extracorporeal Life Support
· Pre-op/PACU: Pre-operative area or Post-Anesthesia Care Unit
· Emergent Surgical Procedure: any life/limb sparing procedure being performed within one (1) hour of presentation to the ED requiring expedient transport from the ED to the OR
Guidelines:
Emergency Department Transport Necessary Personnel
o Primary ED Nurse
o ED Technician
o Respiratory Therapist
o Chief Surgical Resident or designee
o Trauma Surgery Attending
Personal Protective Equipment
o Patient
-Intubated: in-line Hepa filter
-Bag-valve-mask: in-line Hepa filter
-Supplemental Oxygen (non-invasive): surgical mask to be placed over the non-invasive supplemental oxygen device
o Necessary Personnel
-N-95 mask
-Face Shield
-Surgical Cap
-Protective Gown
-Gloves
Notification
o Operating Room Charge Nurse/Bridge (x21061)
-OR notification lights turned on upon determination of need for emergent OR transfer
-Call to be made by Trauma Surgeon or designee
-Brief summary of injuries
-Necessary Operating Sets to open
o Trauma set
o Vascular set
o Hand set
o Specific Retractors
o REBOA
o ECMO Team
-Room to be assigned by the OR Charge Nurse/Anesthesiologist-in-charge
o ECLS Specialist for Hypothermic Cardiac Arrest Case (x27455)
-Specialist will transport the ECMO machine to the OR
Route
o Elevators
-ED elevator to 2nd floor
-Right turn into the Operating Room
-Predetermined Room assigned
OR Necessary Personnel (in appropriate PPE as stated above)
o Anesthesiologist
o CRNA/Anesthesia Resident
o Surgical Technician
o Circulating Nurse
o OR Charge Nurse
o Trauma Surgeon
o Surgical Resident(s)
o ED Transport Personnel – please exit the Operating Room promptly following patient transfer to OR table – OR doors are to close and remain closed upon exit.
Patient being intubated in the Operating Room
o Follow standard intubation protocol as set out during the COVID-19 changes outlined in the operating room procedures listed in the DHHA Related Documents.
o OR doors are NOT to be opened and no one is to enter/exit for 10 minutes following intubation
-No need to pause the OR progression during this time
DHHA Related Documents:
1) Operating Room Instructions for Non-suspected COVID-19 Patients
2) Operating Room Instructions for Confirmed or Suspected COVID-19 Patients