Management of adult cardiac arrest in the COVID-19 era: consensus statement from the Australasian College for Emergency Medicine.

INTRODUCTION: The global pandemic of coronavirus disease 2019 (COVID-19) has caused significant worldwide disruption. Although Australia and New Zealand have not been affected as much as some other countries, resuscitation may still pose a risk to health care workers and necessitates a change to our traditional approach. This consensus statement for adult cardiac arrest in the setting of COVID-19 has been produced by the Australasian College for Emergency Medicine (ACEM) and aligns with national and international recommendations. MAIN RECOMMENDATIONS: In a setting of low community transmission, most cardiac arrests are not due to COVID-19. Early defibrillation saves lives and is not considered an aerosol generating procedure. Compression-only cardiopulmonary resuscitation is thought to be a low risk procedure and can be safely initiated with the patient's mouth and nose covered. All other resuscitative procedures are considered aerosol generating and require the use of airborne personal protective equipment (PPE). It is important to balance the appropriateness of resuscitation against the risk of infection. Methods to reduce nosocomial transmission of COVID-19 include a physical barrier such as a towel or mask over the patient's mouth and nose, appropriate use of PPE, minimising the staff involved in resuscitation, and use of mechanical chest compression devices when available. If COVID-19 significantly affects hospital resource availability, the ethics of resource allocation must be considered. CHANGES IN MANAGEMENT: The changes outlined in this document require a significant adaptation for many doctors, nurses and paramedics. It is critically important that all health care workers have regular PPE and advanced life support training, are able to access in situ simulation sessions, and receive extensive debriefing after actual resuscitations. This will ensure safe, timely and effective management of the patients with cardiac arrest in the COVID-19 era.

Demand for Emergency Services Trends in New South Wales Years 2010-2014 (DESTINY): Age and Clinical Factors Associated with Ambulance Transportation to Emergency Departments.

OBJECTIVES: The study aimed to analyze ambulance transportations to Emergency Departments (EDs) in New South Wales (NSW) and to identify temporal changes in demographics, acuity, and clinical diagnoses. METHODS: This was a retrospective analysis of a population based registry of ED presentations in New South Wales. The NSW Emergency Department data collection (EDCC) collects patient level data on presentations to designated EDs across NSW. Patients that presented to EDs by ambulance between January 2010 and December 2014 were included. Patients dead on arrival, transferred from another hospital, or planned ED presentations were excluded. RESULTS: A total of 10.8 million ED attendances were identified of which 2.6 million (23%) were transported to ED by ambulance. The crude rate of ambulance transportations to EDs across all ages increased by 3.0% per annum over the five years with the highest rate observed in those 85 years and over (620.5 presentations per 1,000 population). There was an increase in the proportion of category 1 and 2 (life-threatening or potentially life-threatening) cases from 18.1% to 24.0%. CONCLUSION: Demand for ambulance services appears to be driven by older patients presenting with higher acuity problems. Alternative models of acute care for elderly patients need to be planned and implemented to address these changes.

Emergency clinician performed ultrasound: availability, uses and credentialing in Australian emergency departments.

OBJECTIVE: To determine the current availability, uses and credentialing processes of emergency clinician performed ultrasound (EDUS) in Australian ED. METHODS: Cross-sectional survey of Australian ED that are accredited for advanced training. RESULTS: Ninety-four per cent of respondents (67/71, 95% confidence interval [CI] 86-98%) reported availability of EDUS. Availability was similar in both major referral and non-major referral ED. The most common uses for EDUS were focused abdominal sonography for trauma in 93% (62/67, 95% CI 83-97%), vascular access procedures in 90% (60/67, 95% CI 80-95%) and abdominal aortic aneurysm assessment in 88% of respondents (59/67, 95% CI 78-94%). Of the 67 departments with EDUS availability, 60% (40/67, 95% CI 48-71%) had a credentialing process. Of the major referral group 80% (20/25, 95% CI 61-91%) had a credentialing process compared with 52% (20/42, 95% CI 33-62%) in the non-major referral group. CONCLUSION: Emergency department ultrasound is widely available in Australia. Only 60% of surveyed ED had a credentialing process in place for EDUS. This may be of concern given the current Australasian College for Emergency Medicine policy regarding EDUS.