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

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