Was macht eine Notaufnahme schlagkräftig gegenüber einer Pandemie?

Das effektive Management medizinischer Notfälle in der globalen Pandemie mit SARS-CoV-2 rettet Leben. Um umfassend vorbereitet zu sein, müssen in allen Leistungsbereichen eines Krankenhauses entsprechende Anpassungen erfolgen. In diesem Artikel liegt der Schwerpunkt auf Maßnahmen, die im Fall einer anhaltenden pandemischen Situation in einer Notaufnahme wichtig werden, um diese essenzielle Struktur funktional zu halten.

Abstract

The emergency department (ED) is one of the crucial parts of the hospital infrastructure during all phases of the pandemic. The ED plays an important part in detecting an increasing number of new contagious diseases, which could potentially lead to an epidemic or pandemic.

During a pandemic, the ED’s main task is to detect infected individuals. These patients then need to be isolated and an adequate treatment is required. The ED must be prepared in order to perform well in such a situation. One major part for readiness is communication in an open manner to all partners within the department, as well as with emergency medical services and other departments of the hospital.

The ED must be restructured to withstand the rising number of infected patients. These patients must be separated from other critically ill patients. Strategies for a diagnostic workup depending on the kind of infection have to be put in place. Pathways for the outpatient and inpatient management must be defined to avoid overcrowding in the ED. Depending on the number of patients, escalation and de-escalation strategies have to be set up within the hospital.

Over the whole course of the pandemic, all staff members are the key resources for the ED and the entire hospital. The ED can only cope with a pandemic situation if staff are working together as a whole. This implies several important steps to get the staff prepared: Recurring, open conversations about fears, problems, and successes are critical for staff morale. Training must be continually provided, and protection strategies implemented. In the chronic phase of the pandemic the focus should shift more towards strategies on how to create possibilities for recuperation, domestic support measures, and mental health care for staff.

Schlüsselwörter

Pandemie - Notaufnahme - COVID-19 - Kommunikation - Strukturierung

Key words

pandemic - emergency department - COVID-19 - communication - structuring

Publication History

Article published online:
06 May 2021

• Literatur

• 1 Robert-Koch-Institut. Nationaler Pandemieplan (3.2.2017). Im Internet (Stand: 14.03.2021): https://edoc.rki.de/handle/176904/187
• 2 US Department of Homeland Security. National Prepardness Goal – Second Edition – FEMA. Im Internet (Stand: 14.03.2021): https://www.fema.gov/sites/default/files/2020-06/national_preparedness_goal_2nd_edition.pdf
• 3 Ramshorn-Zimmer A, Pin M, Hartwig T. et al. Coronapandemie: Rolle der Zentralen Notaufnahme. Dtsch Arztebl 2020; 117: A-1040/B-880
• 4 Rieg S, Busch HJ, Hans F. et al. COVID-19-Versorgung – Strategien der Taskforce Coronavirus und Erfahrungen von den ersten 115 Fällen am Universitätsklinikum Freiburg. Dtsch med Wochenschr 2020; 145: 657-664
• 5 Dommasch M, Gebhardt F, Protzer U. et al [Strategy for university emergency room management at the beginning of an epidemic using COVID-19 as an example]. Notf Rett Med 2020; 23: 1-9 DOI: 10.1007/s10049-020-00759-8.
• 6 Wang D, Hu B, Hu C. et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus – Infected Pneumonia in Wuhan, China. JAMA 2020; 323: 1061-1069
• 7 Honda H, Iwata K. Personal protective equipment and improving compliance among healthcare workers in high-risk settings. Curr Opin Infect Dis 2016; 29: 400-406
• 8 Barnicle R, Bracey A, Zahid B. et al Prioritising intubator safety in a pandemic: the details matter. Emerg Med J 2021; 38 (03) 217-219 DOI: 10.1136/emermed-2020-210362.
• 9 Krause G, Gilsdorf A, Becker J. Erster Erfahrungsaustausch zur H1N1-Pandemie in Deutschland 2009/2010. Bundesgesundheitsbl 2010; 53: 510-519
• 10 Einav S, Hick JL, Hanfling D. et al. Surge capacity logistics: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 2014; 146: e17S-e43S
• 11 Slagman A, Behringer W, Greiner F. et al. Medical Emergencies During the COVID-19 Pandemic. Dtsch Arztebl Int 2020; 117: 545-552
• 12 Senek M, Robertson S, Ryan T. et al. Determinants of nurse job dissatisfaction – findings from a cross-sectional survey analysis in the UK. BMC Nurs 2020; 19: 88
• 13 Aoyagi Y, Beck CR, Dingwall R. et al. Healthcare workers’ willingness to work during an influenza pandemic: a systematic review and meta-analysis. Influenza Other Respir Viruses 2015; 9: 120-130
• 14 Sperling D. Ethical dilemmas, perceived risk, and motivation among nurses during the COVID-19 pandemic. Nurs Ethics 2020; 28 (01) 9-22
• 15 Adams A, Hollingsworth A, Osman A. The Implementation of a Cultural Change Toolkit to Reduce Nursing Burnout and Mitigate Nurse Turnover in the Emergency Department. J Emerg Nurs 2019; 45: 452-456
• 16 Hanfling D, Hick JL, Cantrill SV. Understanding the role for crisis standards of care. Ann Emerg Med 2012; 60: 669-670
• 17 Chalfin DB, Trzeciak S, Likourezos A. et al. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med 2007; 35: 1477-1483
• 18 Walton M, Murray E, Christian MD. Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic. Eur Heart J Acute Cardiovasc Care 2020; 9: 241-247
• 19 Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin. Entscheidungen über die Zuteilung intensivmedizinischer Ressourcen im Kontext der COVID-19-Pandemie Version 2. Im Internet (Stand: 14.03.2021): https://www.divi.de/joomlatools-files/docman-files/publikationen/covid-19-dokumente/200417-divi-covid-19-ethik-empfehlung-version-2.pdf
• 20 Bundesärztekammer. Stellungnahme der Bundesärztekammer. Im Internet (Stand: 14.03.2021): https://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/pdf-Ordner/Positionen/2020-12-10_STN_d._Bundesaerztekammer_BVerfG_AZ_1_BvR_154120.pdf
• 21 Supady A, Curtis JR, Abrams D. et al. Allocating scarce intensive care resources during the COVID-19 pandemic: practical challenges to theoretical frameworks. Lancet Respir Med 2021; DOI: 10.1016/S2213-2600(20)30580-4.
• 22 Nguyen LH, Drew DA, Graham MS. et al. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. The Lancet Public Health 2020; 5: e475-e483
• 23 Cabarkapa S, Nadjidai SE, Murgier J. et al. The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: A rapid systematic review. Brain Behav Immun Health 2020; 8: 100144
• 24 Aiken LH, Clarke SP, Sloane DM. et al. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002; 288: 1987-1993
• 25 Lilly CM, Cody S, Zhao H. et al. Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes. JAMA 2011; 305: 2175-2183
• 26 Vindegaard N, Benros ME. COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain Behav Immun 2020; 89: 531-542
• 27 Wasserman D, Iosue M, Wuestefeld A. et al. Adaptation of evidence-based suicide prevention strategies during and after the COVID-19 pandemic. World Psychiatry 2020; 19: 294-306
• 28 Cantu L, Thomas L. Baseline well-being, perceptions of critical incidents, and openness to debriefing in community hospital emergency department clinical staff before COVID-19, a cross-sectional study. BMC Emerg Med 2020; 20: 82-88
• 29 Jovanović A, Klimek P, Renn O. et al. Assessing resilience of healthcare infrastructure exposed to COVID-19: emerging risks, resilience indicators, interdependencies and international standards. Environ Syst Decis 2020; 40: 1-35