Survey: ‘Significant gaps’ in NZ’s emergency departments’ Covid-19 preparedness

Practices crucial to restricting Covid-19 transmission are going untested and even ignored in New Zealand emergency departments, according to a recent study.

However, the Australasian College for Emergency Medicine president says this is simply a byproduct of the overwhelming demand emergency departments are experiencing.

The study, recently released online ahead of peer review and led by Northland District Health Board’s Dr Michael Howard, detailed “significant gaps” in emergency departments (ED) Covid-19 preparedness, highlighted by senior medical officials across all New Zealand DHBs.

From 137 respondents, the key findings were:

• More than 12 per cent reported no access to negative pressure rooms
• 86 per cent disagreed that their ED workstations allowed adequate room for physical distancing
• Initial PPE training, simulations and segregating patients were widespread but appear to be waning with persistent low Covid-19 prevalence
• About one-third of EDs did not use spotters while removing PPE
• N95 mask fit testing was not being done in 11 per cent of cases

The survey indicated ED upgrades had not been done equitably, given the 12.4 per cent of EDs without access to a negative pressure room were mostly in smaller hospitals.

Survey respondents believed “wearing inadequate PPE for patients not suspected of Covid-19 infection” was their most likely source of virus exposure. Lack of adequate staffing levels during the pandemic was also cited as the highest concern for two-thirds of respondents.

Asked to recall last year’s level four lockdown, approximately 72 per cent of respondents at the time were sometimes to always concerned about ED preparedness, personal risk of infection (62 per cent), and of infecting family (55 per cent).

While acknowledging the work done to minimise community outbreaks, the survey concluded important policies were not being followed.

“Certainly, the low prevalence of [Covid-19] has allowed the practice and controls crucial in this pandemic elsewhere to go untested and sometimes even ignored without consequence in NZ,” it read.

Australasian College for Emergency Medicine president Dr John Bonning agreed that New Zealand’s low virus profile had created gaps in ED Covid-19 protocol.

However, he was confident this was not intentional negligence, but more a symptom of the incredible demand EDs were operating in currently.

“I don’t think it’s reckless complacency and laziness,” he said.

“If we slow processes down and wait for a swab for anybody before we admit them to a ward and do a whole bunch of things that may be required, that would just make us unmanageably slow and inefficient.”

Given the small possibility of New Zealand being overrun by Covid-19, as seen in India currently, Bonning speculated attending to current demand levels was being prioritised over certain virus protocols.

Bonning said the survey indicated the need to relieve pressures on EDs while ensuring Covid-19 protocols could be implemented if required.

The Ministry of Health was approached for comment.

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