key: cord-0971501-e1otvkea authors: Li, Cecilia; Sotomayor-Castillo, Cristina; Nahidi, Shizar; Kuznetsov, Sergey; Considine, Julie; Curtis, Kate; Fry, Margaret; Morgan, Dominic; Walker, Tony; Burgess, Alaine; Carver, Hamish; Doyle, Brian; Tran, Viet; Varshney, Kavita; Shaban, Ramon Z. title: Emergency clinicians’ knowledge, preparedness and experiences of managing COVID-19 during the 2020 global pandemic in Australian healthcare settings date: 2021-03-27 journal: Australas Emerg Care DOI: 10.1016/j.auec.2021.03.008 sha: 11f5dc8b256666cbb5ac7d290431f08f1dc0d828 doc_id: 971501 cord_uid: e1otvkea BACKGROUND: Emergency clinicians have a crucial role during public health emergencies and have been at the frontline during the COVID-19 pandemic. This study examined the knowledge, preparedness and experiences of Australian emergency nurses, emergency physicians and paramedics in managing COVID-19. METHODS: A voluntary cross-sectional study of members of the College of Emergency Nursing Australasia, the Australasian College for Emergency Medicine, and the Australasian College of Paramedicine was conducted using an online survey (June-September 2020). RESULTS: Of the 159 emergency nurses, 110 emergency physicians and 161 paramedics, 67.3-78% from each group indicated that their current knowledge of COVID-19 was ‘good to very good’. The most frequently accessed source of COVID-19 information was from state department of health websites. Most of the respondents in each group (77.6-86.4%) received COVID-19 specific training and education, including personal protective equipment (PPE) usage. One-third of paramedics reported that their workload ‘had lessened’ while 36.4-40% of emergency nurses and physicians stated that their workload had ‘considerably increased’. Common concerns raised included disease transmission to family, public complacency, and PPE availability. CONCLUSIONS: Extensive training and education and adequate support helped prepare emergency clinicians to manage COVID-19 patients. Challenges included inconsistent and rapidly changing communications and availability of PPE. emergency clinician group. Survey questions were drawn from previous research examining the preparedness and experiences of healthcare workers during large scale infectious diseases outbreaks 11, [19] [20] [21] . The surveys were developed using the Research Electronic Data Capture (REDCap) application 22 Conventional content analysis technique was used to analyse data from free-text responses. survey were considered incomplete and excluded from data analysis. Therefore, data analysis for this study included 159 responses from emergency nurses (response rate of 11.4% from CENA members), 110 responses from emergency physicians (response rate of 1.5% from ACEM members) and 161 responses from paramedics (response rate of 3.2% from ACP members). All respondents worked in Australia ( for paramedics. Table 2 shows that within the emergency nurses survey, most respondents were registered nurses (50.3%, n=80), clinical nurse specialists (15.1%, n=24) and clinical nurse consultants (7.5%, n=12). A majority of emergency nurses identified that they worked in resuscitation and trauma (76.7%, n=122), and triage (71.7% , n=114), respectively, which was followed by 64 more than ten years post-fellowship (43.6%, n=48), FACEMs who were less than ten years post-fellowship (37.3%, n=41), and advanced trainees (11.8%, n=13). The majority of respondents from the paramedic survey indicated that they were paramedics (39.1%, n=63), intensive care paramedics (31.7%, n=51) and advanced care paramedics (21.7%, n=35). Insert Table 2 Table 3 . Insert Table 3 here Respondents were asked how easy it was to keep up to date with the constantly evolving 11 categories of information about COVID-19 ( Insert Figure 1 here Respondents were asked about how clear and timely communication on COVID-19 was during the pandemic ( Figure 2 When respondents were asked about their concerns about contracting SARS-CoV-2 at work, over half of respondents for each group expressed that they were 'slightly to somewhat concerned' (Figure 3 ). It was noted that, on average, approximately 10% of respondents from each group indicated that they were as equally 'not at all concerned' as they were 'extremely concerned' about the transmission of SARS-CoV-2 to them. Insert Figure 3 here 18.2%, n=20; PARA: 20.5%, n=33). For emergency nurses and emergency physicians, over half of the respondents in each group indicated that their workload had 'moderately to considerably increased' due to COVID-19 (Table 7) . It was further noted that 18.2% (n=20) of emergency physicians respondents stated that their workload had 'lessened'. This was echoed in the paramedics group, with 32.9% (n=53) of respondents reporting that their workload has also 'lessened'. These results were reflected when respondents were asked if they felt more stressed at work due to COVID-19. provided neither and around 20-25% of respondents from each group reported that they do not know if their workplace provided these services (Table 8) . Insert Table 8 here For each group, the majority of respondents reported never having attended a staff debriefing J o u r n a l P r e -p r o o f Insert Table 9 here This study examined the knowledge, preparedness and experiences of emergency nurses, emergency physicians and paramedics in Australian healthcare settings during the COVID-19 pandemic. We report challenges experienced by these emergency clinicians and note that supporting acute care healthcare workers during a global pandemic is multifactorial and support of physical and mental well-being is essential to an effective pandemic response [24] [25] [26] . As an emerging and novel disease, the COVID-19 situation continues to evolve on a rapid scale as more information comes to light. As such, it is essential for emergency clinicians to have accurate and up-to-date information. it onto family was a common concern raised by respondents in our study. SARS-CoV-2 has been shown to be predominately spread via direct, indirect or close contact with infected respiratory droplets 42, 43 . To protect and limit the spread and transmission of COVID-19 to healthcare workers, appropriate usage of PPE has been strongly recommended and encouraged 44, 45 . Following the 'second wave' of COVID-19 in Victoria, Australia, it was reported that approximately 17.6% of the COVID-19 cases in Victoria were linked to healthcare workers 46 . Availability of and access to PPE stockpiles has been a critical issue throughout the COVID-19 pandemic 15, 47-50 and this was also a major concern for the respondents in our study with mentions of PPE being either inadequate or not readily accessible. Workflow management in the ED was a top challenge and concern for emergency nurses and physicians in our study, in that the structure and layout of the EDs made it extremely difficult to isolate suspected/confirmed COVID-19 patients from other non-COVID-19 patients. This was a source of increased stress and anxiety for the emergency nurses and physicians. Emergency department overcrowding, including a lack of appropriate space to treat patients, was identified as significant markers of stress for emergency clinicians during the 2009 influenza H1N1 pandemic in Australia 11 . Hospitals, especially EDs, must find practical strategies to manage potential surge during outbreaks and prevent further transmission 51 . Frontline healthcare workers who are directly treating COVID-19 patients have been reported to be at higher risk for depression, anxiety, insomnia and distress [62] [63] [64] . To support healthcare workers, many facilities have now initiated staff debriefings and are offering other psychological support services. During the Ebola virus disease outbreak, it was reported that provision of staff debriefings and other support services was critical for the safety and wellbeing of staff and helped to reduce distress and anxiety 65, 66 . While the majority of respondents in our study did not use these services, a handful from each emergency clinician group did state that they found the staff debriefings to be 'slightly to moderately useful'. Our findings support international calls for sustained mental health services for healthcare workers during pandemics 67, 68 . However, questions about the effectiveness and utility of clinical debriefings have been raised. A recent systematic review reported that due to factors, including lack of time, informal debriefing with family and friends was found to be useful for paramedics outside of work settings 69 . During a period of promotion for 'hot debriefs' following cardiac arrest incidents in an Irish emergency department, the authors found that staff appreciated debriefing as a helpful tool for quality improvement and quality of patient care. However, it was noted that it was difficult to maintain high and consistent participation rates due to unawareness and/or forgetfulness 70 Findings from this study indicate that due to extensive COVID-19 specific training and education and adequate support, emergency clinicians in Australia felt prepared to manage and treat patients during COVID-19. However, significant challenges included inconsistent messaging and lack of clear communications from management, the quality and availability of PPE, and concern about transmission of the disease to family members. It is essential that Australian healthcare facilities continue to provide appropriate and adequate support services to improve safety and well-being for emergency clinicians. RZS conceived and designed the study. CL, CS, SN and RZS drafted the study protocol. This study was an investigator-initiated research project and did not receive financial support from funding agencies in the public, commercial or not-for-profit sectors. 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We thank Dr Keren Kaufman-Francis for her assistance with this study. We also thank the College of Emergency Nursing Australasia, The Australasian College for Emergency Medicine and The Australasian College of Paramedicine for their support of this study and their assistance in distributing the survey to their members.