8 Emergency Physician COVID-19 Readiness and Practices

Abstract

The purpose of this survey study was to assess the working environment of emergency physicians (EPs) early in the Corona Virus Disease 2019 (COVID-19) pandemic. Areas of interest included access to appropriate personal protective equipment (PPE), hospital policy, personal effects of the pandemic on EPs, and how the pandemic has changed their individual practices. An anonymous Survey Monkey survey for all practicing EPs was released on an EPs social medial group in mid-April 2020. The survey consisted of 15 questions covering demographics, hospital policies and work environment, individual physician concerns and changes in practice and habits. 220 emergency physicians responded to the survey with 209 complete submissions. 41 of 50 states, Puerto Rico, and Canada had at least one response. Almost one-third have been in practice for either 5-9 years and 10-19 years post-residency each. More than half work in a community hospital (58%) and approximately one-third work at a tertiary or regional medical center. There was a wide spread in the number of ICU beds at their facility on a scale of 0-50 in increments of 10. Although the vast majority report isolated COVID-19 areas and limited visitors, nearly 15% reported that their site did not have any current plans to create an isolated area. About half reported a hospital policy requiring N95 respirators in COVID-19 positive or suspected rooms although a quarter of those also included wearing N95 respirators in all patient rooms (N95s). Other common policies included universal masking and N95s for high risk or aerosolizing procedures only. N95s and surgical masks were the most commonly provided PPE. 86% were concerned about short term shortages or were already facing shortages. More than half reported access to a powered air-purifying respirator (PAPR). N95s were the most likely to run out (82%) followed by gowns (60%) and surgical masks (42%). Most purchased at least one item of PPE (86%). Three-quarters report not self-quarantining at home, although almost all (98%) have added steps to reduce risk of bringing contaminants home. Removing shoes and work clothes prior to entering the home (86%) and immediately showering upon arriving home (88%) were the most common practices followed by showering and/or changing at the hospital (45%). Other responses included cleaning or separating personal work items, temporarily living in a separate location, or limiting contact with others in the household. The majority were concerned about transmitting COVID-19 to low and/or high-risk friends or family members (74% and 72%, respectively). Almost one-quarter were high risk and were concerned about becoming ill. More than half were concerned about the personal financial impact of the pandemic. One month after COVID-19 was declared a pandemic by the World Health Organization and a national emergency by the United States we surveyed emergency physicians, COVID-related policy changes, supply chains, and personal effects. At that time most hospitals had enacted policies regarding PPE use, created isolated COVID areas, and limited visitors. Most EPs had concerns regarding immediate and short-term inadequate PPE supplies and have bought at least one PPE item to use at work. Very few emergency physicians reported no concerns regarding personal risks of contracting or transmitting COVID.