key: cord-0839517-2hwf9niu
authors: Wang, Tzu-Yi; Liu, Hsin-Liang; Lin, Chun-Yu; Kuo, Fang-Li; Yang, Pei-Hsuan; Yeh, I-Jeng
title: Emerging success against Covid-19 pandemic: Hospital surge capacity in Taiwan
date: 2020-05-06
journal: Ann Emerg Med
DOI: 10.1016/j.annemergmed.2020.05.001
sha: ac46e23784da39789b925b102485fa0da9d33f9b
doc_id: 839517
cord_uid: 2hwf9niu

nan

To the Editor:

Surge capacity of emergency departments (ED) is crucial to prevent health care worker infection and hospital collapsed during pandemic crisis 1 . Coronavirus disease 2019 showed higher inter-human contagious rates base in the absence of hallmark clinical presentations, higher transmissible capacity, and asymptomatic carriers that challenged hospital response capacity 2 .

After the severe acute respiratory syndrome epidemic, the Kaohsiung Medical University Hospital's ED designed an indoor infection isolation area, including 2 negative pressure isolation rooms and 2 isolation areas with an independent ventilation system and 4 beds each. Those facilities seemed to be appropriate during early stage of pandemic. However, learning from the worldwide outbreak and its clinical presentation 3 , huge influx of suspicious cases is expected, which might overwhelm the initial indoor setting, so we installed 10 well-ventilated single room tents at outdoor parking lots immediately outside the ED entrance. Moreover, outdoor concrete chemical decontamination area is turned into a radiograph room, personal protective equipment (PPE) removal corridor, and shower service. High-risk patients with oxygen demand or critical conditions were transported to indoor infection isolation areas for any resuscitation support. Stable patients were led to individual tents. In response to the worldwide spread and the presence of sporadic native cases in Taiwan 4 , tent numbers were flexibly increased to 15, and enough time was allowed to build a modular house with 14 isolate rooms. A parking lot before the ED entrance is another key element to offer a buffer area for urgent tents and to engage perfectly with our prefixed patient flow (Figure1A).

Additionally, we implemented a reverse triage strategy 5 to hasten the discharge of low risk patients for untoward events and quarantine them at home by simple but essential screening protocol (interview, chest X ray and swap collection). Audiovisual devices and acrylic shield were used to accelerate interviews process and offering safety swap collection, respectively. Both measures also reduced the use of PPE.

During the global uncontrolled COVID-19 outbreak, we managed the surge capacity by temporarily establishing outdoor individual tents that can rapidly expand according to the incidences in a timely manner and offer individual space for preventing infection during ED stay. Totally, 1496 cases in tents and 270 cases in indoor isolation areas were recorded from January 22 to April 19, 2020. Three COVID-19 cases were detected, free of nosocomial infection. However, massive community spread may threaten people with multiple comorbidities that require large space with sophisticated medical devises. Thus, we proposed dividing ED ventilation system into sub-compartmentalization to handle critical infected/non-infected patients ( Figure 1B) . By integrating the original facility and tent area, along with smooth screening of patients and avoiding rapid consumption of essential but shortage logistic inventory add proactive and dynamic strategies to enhance surge capacity, thereby preventing nosocomial transmission.

Surge capacity principles: Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement

Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia

Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan

Taiwan centers for disease control. Taiwan confirms one more confirmed cases. CECC continues to undertake contact tracing and investigation before illness onset

Developments in surge research priorities: A systematic review of the literature following the academic emergency medicine consensus conference

Title page Manuscript Title: Emerging success against Covid-19 pandemic: Hospital surge capacity in Taiwan Authors

ijengyeh1@gmail.com Mailing address: No. 100 Tzyou 1st Rd., Kaohsiung city

Grant or Funding: None Conflicts of interest: no potential conflict of interest relevant to this letter was reported

Author contributions statement

IJY conceived the concept and design. TYW, HLL and IJY drafted the manuscript. CYL, FLK, PHY supported critical revision of the manuscript for important intellectual content. All authors contributed substantially to its revision