Triage Station Research Articles

Maintaining essential health services during COVID-19 in Ghana: a qualitative study

IntroductionEvidence suggests that non-pharmaceutical interventions such as lockdown policies, restriction of movement and physical distancing to control the novel COVID-19 contributed to the decline in utilisation of essential health services....

Triage practices for emergency care delivery: a qualitative study among febrile patients and healthcare workers in a tertiary care hospital in Nepal

BackgroundImproving screening and triage practices is essential for early severity assessments at the first point of contact and ensuring timely attention by healthcare workers (HCWs). The main objective of this study was to explore the triage process among febrile patients and HCWs in the emergency department (ED) of a tertiary care hospital in a resource-constrained setting.MethodsThis qualitative study was conducted from March to May 2023 at the ED of Tribhuvan University Teaching Hospital (TUTH), Nepal. The study included in-depth interviews with febrile patients (n = 15) and HCWs (n = 15). Additionally, direct observation notes (n = 20) were collected to document the triage process and patients’ experiences in the ED. Data underwent thematic analysis using the Interpretative Phenomenological Analysis (IPA) approach.ResultsThe ED of TUTH offered comprehensive triage services with clear delineation for the severity of febrile patients in line with the World Health Organization (WHO) guidelines. Nonetheless, challenges and constraints were identified. In the ED, evenings were generally the busiest period, and the triage process was not thorough during night shifts. Perception of triage was limited among patients and variable among HCWs. Digitalizing recordings of patient information including payment was deemed necessary for effective management of patients’ waiting times at the triage station. High patient throughput added pressure on HCWs and had a potential influence on the delivery of services. Availability of medical equipment and space were also identified as challenges, with patients sometimes compelled to share beds. There were constraints related to waste disposal, hygiene, cleanliness, and the availability and maintenance of washrooms. Febrile patients experienced delays in receiving timely consultations and laboratory investigation reports, which affected their rapid diagnosis and discharge; nonetheless, patients were satisfied with the overall healthcare services received in the ED.ConclusionsImproving current triage management requires resource organization, including optimizing the waiting time of patients through a digitalized system. Urgent priorities involve upgrading visitor facilities, patient consultations, laboratory investigations, hygiene, and sanitation. HCWs’ recommendations to resource the ED with more equipment, space, and beds and a dedicated triage officer to ensure 24-hour service, together with training and incentives, warrant further attention.

Development and implementation of a triage station at one of the largest hospitals during the peak of the third wave of COVID-19 in Vietnam

Development and implementation of a triage station at one of the largest hospitals during the peak of the third wave of COVID-19 in Vietnam

Prospective study of pain and patient outcomes in the emergency department: a tale of two pain assessment methods

BackgroundAccurate pain assessment is essential in the emergency department (ED) triage process. Overestimation of pain intensity, however, can lead to unnecessary overtriage. The study aimed to investigate the influence of pain on patient outcomes and how pain intensity modulates the triage’s predictive capabilities on these outcomes.MethodsA prospective observational cohort study was conducted at a tertiary care hospital, enrolling adult patients in the triage station. The entire triage process was captured on video. Two pain assessment methods were employed: (1) Self-reported pain score in the Taiwan Triage and Acuity Scale, referred to as the system-based method; (2) Five physicians independently assigned triage levels and assessed pain scores from video footage, termed the physician-based method. The primary outcome was hospitalization, and secondary outcomes included ED length of stay (EDLOS) and ED charges.ResultsOf the 656 patients evaluated, the median self-reported pain score was 4 (interquartile range, 0–7), while the median physician-rated pain score was 1.5 (interquartile range, 0–3). Increased self-reported pain severity was not associated with prolonged EDLOS and increased ED charges, but a positive association was identified with physician-rated pain scores. Using the system-based method, the predictive efficacy of triage scales was lower in the pain groups than in the pain-free group (area under the receiver operating curve, [AUROC]: 0.615 vs. 0.637). However, with the physician-based method, triage scales were more effective in predicting hospitalization among patients with pain than those without (AUROC: 0.650 vs. 0.636).ConclusionsSelf-reported pain seemed to diminish the predictive accuracy of triage for hospitalization. In contrast, physician-rated pain scores were positively associated with longer EDLOS, increased ED charges, and enhanced triage predictive capability for hospitalization. Pain, therefore, appears to modulate the relationship between triage and patient outcomes, highlighting the need for careful pain evaluation in the ED.

"Africans, we know how to adapt indeed": Adaptations to family planning and reproductive health services in humanitarian settings in Nigeria during the COVID-19 pandemic.

On March 30, 2020, the Government of Nigeria implemented its first COVID-19 related lockdown. We worked with two humanitarian projects in Nigeria, the Integrated Humanitarian Assistance to Northeast Nigeria (IHANN II) in Borno State and the United Nations High Commissioner for Refugees South-South Health and Nutrition Intervention (UNHCR-SS-HNIR) for Cameroon Refugees and vulnerable populations in Cross River State, to document the programmatic adaptations to Family Planning/Reproductive Health (FP/RH) services in response to COVID-19 and identify successes and challenges of those adaptations. A mixed methods approach including quantitative analysis of data from routine programmatic activities, qualitative data from in-depth interviews (IDIs) with project staff and process documentation of programmatic activities and modifications was used to 1) identify modifications in FP/RH services due to COVID-19, 2) understand staff perception of their utility and impact, and 3) gauge trends in key FP/RH in-service delivery indicators to assess changes prior to and after the March 2020 lockdown. Monitoring data shows notable declines in service utilization after lockdowns in antenatal care, postnatal care, and outreach campaigns, followed by a return to pre-lockdown levels by July 2020. Results show projects introduced numerous COVID-19 precaution strategies including: community sensitization; triage stations and modification of service flow in facilities; and appointment scheduling for essential services. Findings from IDIs speak to a well-coordinated and implemented COVID-19 response with project staff noting improvements in their time management and interpersonal communication skills. Lessons learned included the need to better sensitize and educate communities, maintain FP commodities and increase support provided to health workers. Deliberate adaptations in IHANN II and UNHCR-SS-HNIR projects turned challenges to opportunities, ensuring continuity of services to the most vulnerable populations.

Первичная медицинская сортировка пациентов с COVID-19 на догоспитальном этапе

The COVID-19 pandemic affected every sector of society, radically altering the work of health systems throughout the world. In the situation of the mass influx of patients seeking medical care that was hard to control, the issue of the widespread adoption of the medical sorting (triage) principles became urgent within weeks. The review provides analysis of 49 publications dealing with various aspects of arranging pre-hospital triage. The dynamic changes in approaches to triage, its objectives and technologies, as well as in the contribution of various X-ray imaging methods depending on the evolving experience of working with the novel infection, are of great interest. The search for literature in Russian and English published before March 10, 2022 was performed in a number of databases (Embase, Medline/PubMed, Researchgate, medrxiv.org, RISC). The search was performed using the following keywords: COVID-19, coronavirus, коронавирус, SARS-COV-2, 2019nCOV, lung ultrasound, computed tomography, computerized tomography, компьютерная томография, СT, triage, сортировка. The strategy of establishing pre-hospital triage centers or stations in case of pandemic makes it possible to reduce both the burden on the emergency departments and the occupancy rate for inpatient services. Quick access to various imaging methods (X-ray imaging, lung ultrasound or computed tomography) greatly facilitates taking clinical decisions, and could be considered beneficial in the current extraordinary situation.

COVID-19 suspicion and diagnosis in pregnancy: A big conundrum!

This article aims to discuss all the challenges faced in the diagnosis of coronavirus disease 2019 (COVID-19) in pregnancy, isolation of suspected and positive patients, their management, and the strategies to prevent the transmission of infection among the healthy population and medical fraternity. The diagnosis of COVID in pregnancy is influenced by many factors, including normal physiological changes in pregnancy, comorbid conditions associated with pregnancy, and the presence of asymptomatic infection in patients. Suspicion of COVID-19 in pregnant females is of utmost importance at a primary health center for risk mitigation of exposure to medical personnel. A retrospective study was carried out in the labour room in a tertiary care center in India. Two groups were made, suspected COVID and confirmed COVID in pregnant patients. The case records were analysed. Out of a total of 5164 admissions, 95 patients were admitted as suspected (1.8%), but only two patients were COVID-positive amongst them. 84% of COVID-positive patients were asymptomatic. Fever was the most common symptom in both groups (P-value: 0.15). Preeclampsia and anaemia were the most common comorbidities in both groups, not statistically significant. There were 32% of intensive acre unit (ICU) admissions in suspected COVID patients, and 77% of them were having respiratory distress. COVID-19 presents as an asymptomatic infection in most pregnant patients. Physiological changes to the cardiorespiratory and immune systems along with associated comorbidities in pregnancy, increase a woman's susceptibility and delay diagnosis. Consideration of patients as suspected COVID at triage stations on the basis of only contact or travel history poses a great burden on the health care system. Although triage is an essential tool to identify symptomatic COVID patients, universal testing strategies should continue simultaneously. Streamlining medical care professionals into self-sufficient teams ensures adequate clinical coverage amongst the suspected COVID, confirmed COVID, and routine labour room admissions.

Designing Affordance-Based Procedures Using Heuristic Cognitive Work Analysis: Application to Triage in an Emergency Department

This study describes the concept of affordance-based procedure and its implementation in a triage station in a hospital emergency department. Rather than seeking to increase operators’ adherence to procedures, an affordance-based procedure (1) aims to induce task steps using affordances that also (2) support degrees of freedom for action. The design of this procedure was guided by the application of an extended version of cognitive work analysis, named “heuristic cognitive work analysis.” This design process produced a new procedural document: a reception card. Ten months after its implementation, a qualitative evaluation with 10 triage nurses shows that the reception card is viewed as supporting coordination between the different nurses’ tasks and providing an external memory to cope with frequent interruptions during high patient inflow, even though the document is used for convenience and with unexpected and partial uses of its items. The document assessed also afforded emerging benefits, that is, acceleration of ambulance release, higher level of confidentiality, assistance for staff hand-overs. Finally, novice triage nurses are particularly sensitive to the benefits brought by this affordance-based procedure.

Management and implementation strategies of pre-screening triage in children during coronavirus disease 2019 pandemic in Guangzhou, China.

BACKGROUNDEmerging infectious diseases are a constant threat to the public’s health and health care systems around the world. Coronavirus disease 2019 (COVID-2019), which was defined by the World Health Organization as pandemic, has rapidly emerged as a global health threat. Outbreak evolution and prevention of international implications require substantial flexibility of frontline health care facilities in their response.AIMTo explore the effect of the implementation and management strategy of pre-screening triage in children during COVID-19.METHODSThe standardized triage screening procedures included a standardized triage screening questionnaire, setup of pre-screening triage station, multi-point temperature monitoring, extensive screenings, and two-way protection. In order to ensure the implementation of the pre-screening triage, the prevention and control management strategies included training, emergency exercise, and staff protection. Statistical analysis was performed on the data from all the children hospitalized from January 20, 2020 to March 20, 2020 at solstice during the pandemic period. Data were obtained from questionnaires and electronic medical record systems. RESULTSA total of 17561 children, including 2652 who met the criteria for screening, 192 suspected cases, and two confirmed cases without omission, were screened from January 20, 2020 to March 20, 2020 at solstice during the pandemic period. There was zero transmission of the infection to any medical staff. CONCLUSIONThe effective strategies for pre-screening triage have an essential role in the prevention and control of hospital infection.

Clinical presentation of COVID-19 - a model derived by a machine learning algorithm.

COVID-19 pandemic has flooded all triage stations, making it difficult to carefully select those most likely infected. Data on total patients tested, infected, and hospitalized is fragmentary making it difficult to easily select those most likely to be infected. The Israeli Ministry of Health made public its registry of immediate clinical data and the respective status of infected/not infected for all viral DNA tests performed up to Apr. 18th, 2020 including almost 120,000 tests. We used a machine-learning algorithm to find out which immediate clinical elements mattered the most in identifying the true status of the tested persons including age or gender matter, to enable future better allocation of surveillance policy for those belonging to high-risk groups. In addition to the analyses applied on the first batch of the available data (Apr. 11th), we further tested the algorithm on the independent second batch (Apr. 12th to 18th). Fever, cough and headache were the most diagnostic, differing in degree of importance in different subgroups. Higher percentage of men were found positive (9.3 vs. 7.3%), but gender did not matter for the clinical presentation. The prediction power of the model was high, with accuracy of 0.84 and area under the curve 0.92. We provide a hand-held short checklist with verbal description of importance for the leading symptoms, which should expedite the triage and enable proper selection of people for further follow-up.

COVID-19: Additional Precautions against Aerosols for the Slit Lamp User.

To the Editor: We read with great interest the article by Lam et al,1 which describes the special precautions in ophthalmic practice required due to COVID-19. However, precautions related to aerosol transmission may need to be emphasized due to evolving understanding of transmission of the disease. Early in the COVID-19 pandemic, droplet and contact transmission were postulated to be the main modes of transmission. Droplets were defined as being “large” and measuring 20 to 100 μm. Upon expulsion, these droplets rapidly drop to land within 1 m of the infected individual. Transmission may also occur by direct contact with an infected individual or a surface that the person has touched. Recently, the World Health Organization (WHO) has relooked into the modes of transmission for COVID-19.2 Aerosols are generally defined as respiratory particles <10 μm. Generation of aerosols has been normally associated with coughing or sneezing but notably, may be produced even by normal breathing and speech. In fact, SARS-CoV-2 RNAs have been detected in air samples near infected patients despite them not coughing during sample taking.3 Pertinently, aerosols can remain suspended in the air and viral particles have been found in greater concentrations closer to the infected person.4 These aerosols may be carried by air currents to distances above 10 m, which may greatly increase its transmissibility. Furthermore, aerosols are thought to be able to penetrate the lower respiratory tract including the alveoli. Since SARS-CoV-2 in aerosols can be viable for up to 3 hours,5 these may pose an increased risk to those in proximity to infected individuals through breathing and normal speech. THREAT TO THE SLIT LAMP USER Ophthalmologists have been identified as an at-risk specialty for contracting respiratory disease due to the proximity at the slit lamp and higher likelihood of potential exposure to patients’ conjunctival and respiratory secretions.1 In view of the evolving knowledge of aerosol transmission in the chain of spread of COVID-19, we wish to bring attention to current personal protective equipment (PPE) recommendations which may not adequately protect the ophthalmologist. EXISTING PPE RECOMMENDATIONS AND PITFALLS Various ophthalmological societies have provided guidelines on the use of PPE. The Royal College of Ophthalmologists and the American Academy of Ophthalmology (AAO) recommend ophthalmologists to wear surgical masks and eye protection when examining patients. In addition, the AAO has also recommended the use of commercially available slit lamp breath shields to protect against droplets from coughs and sneezes. In view of the mounting evidence of aerosol transmission particularly in indoor environments, there is an increased risk of COVID-19 infection to the ophthalmologists due to inadequate PPE. This is considerably so as presymptomatic transmission may be as high as 50% to 60%.6 IMPLICATIONS TO THE SLIT LAMP USER Administrative procedures such as the setting up of triage stations at hospital entrances which include symptom-based questionnaires and temperature screening have been recommended as part of infection control measures.7 This should be complemented with universal masking for those who wish to seek ophthalmic care as COVID-19 patients may not exhibit any symptoms. Surgical masks have been shown to reduce coronavirus RNA in aerosols and droplets from exhaled air samples8 and could be used to reduce transmission risk. This has already been adopted in the current AAO guidelines. Universal patient mask-wearing at the slit lamp seems particularly prudent. To mitigate against aerosol transmission at the slit lamp, ophthalmologists must adhere to the wearing of a protective mask and eye protection. Despite some evidence of surgical masks and respirators providing similar levels of protection,9 respirators have been shown to have stronger association with reduced infection rates compared to surgical masks.10 Where local resources permit and prevailing rates of community transmission are high, the use of respirators should be preferred to surgical masks. CONCLUSIONS In the presence of evolving evidence of aerosol and presymptomatic transmission in COVID-19, it is timely to reevaluate existing PPE recommendations to ophthalmologists. Slit lamp shields may reduce contamination and exposure to large droplets but aerosols will circumvent these to reach the ophthalmologist. Universal masking within eye clinics should be considered to reduce presymptomatic transmission. PPE recommendations for ophthalmologists could also be reviewed to include the use of a respirator during routine slit lamp examination. In the context of frequent close contact with many patients over the course of a day and in communities with high prevalence of COVID-19 cases, this makes good sense. However, the ideal protective measures will depend on the availability of resources locally. An alternative is the use of surgical masks for both ophthalmologists and patients.

‘The incident triage area’: a response to the COVID-19 pandemic in the Bristol Royal Infirmary

With the onset of the COVID-19 pandemic, hospitals nationwide have been presented with a number of potential challenges, including possible increased volume of patient attendances, acuity of illness and potential...

The Response of Medical Doctors and Hospital Administration to Infection Prevention and Control in the Health Care of Suspected/Confirmed COVID-19 Patients.

BackgroundThe outbreak of novel coronavirus infection emerged in and spread from China to other countries. Health care workers are at significant risk of infection from this virus in medical settings. We aimed to explore and evaluate the response of medical doctors and hospital administration to infection prevention and control of suspected or confirmed COVID-19 patients.MethodsThis cross-sectional study included 108 doctors who had exposure to suspected/confirmed COVID-19 patients in public hospitals.ResultsThe doctors were aged 24 to 53 years, working in general hospitals (72.2%), primary health centers (23.1%), and a special coronavirus hospital (4.6%). One third (33.3%) reported that their hospitals had established a clinical triage station at the entrance to the facility. Suspected COVID-19 cases were immediately placed in an area separate from other patients (63.9%). The doctors ensured that patients covered their nose and mouth with a tissue to cough or sneeze (53.7%), and they performed hand hygiene after patient contact (98.1%). A medical team designated to care exclusively for suspected or confirmed COVID-19 cases was reported by 50.9%. The screening equipment was shared among patients (56.5%). The doctors avoided moving and transporting patients out of their room or designated area (83.3%). Many hospitals (76.9%) limited the number of medical staff and visitors who come in contact with suspected or confirmed patients. Most hospitals (72.2%) did not have a surveillance process for acute respiratory infections. Only 51.9% reported that staff collecting specimens used appropriate personal protective equipment.ConclusionsThe doctors reported that we adhere to infection prevention in providing health care, in contrast with hospital administration.

“The same but different” Triaging in primary healthcare settings: A focused ethnography study

<h2>ABSTRACT</h2><h3>Aims</h3> To explore the experiences of nurses working in triage stations of primary health care centres. <h3>Background</h3> Primary healthcare system evolves according to the demographical and epidemiological transitions within the nation. The escalating demand on healthcare due to the aging population have seen a rising need from patients with onset of an acute condition or the deterioration of chronic conditions. This has led to a stress in the primary healthcare system where more patients were referred to the tertiary hospitals for the management of more complex conditions. <h3>Design</h3> A focused ethnographic study was conducted in five primary healthcare centres in Singapore. Twenty-two registered nurses were selected through purposive sampling where data was collected through field notes, covert observations and semi-structured interviews from August 2017 to November 2017. Source, time, space and person triangulation generated emerging themes. <h3>Results</h3> Thematic analysis revealed a central exhaustive description of ‘the same but different', was supported by three themes including: valuing previous nursing experience; (2) acknowledging patients' and relatives' concerns, and (3) affirming of nurses' triage decisions with primary health care doctors. <h3>Conclusions</h3> This study provides a pioneering exploration of the experiences of nurses working in a triage area within primary healthcare centres. Data generated herein afford a deeper understanding of the decision and communication involving primary healthcare triage nurses and the importance of interprofessional communication between doctors and nurses in order for them to gain understanding on their decision making process.

ISUOG Consensus Statement on organization of routine and specialist obstetric ultrasound services in context of COVID‐19

ISUOG Consensus Statement on organization of routine and specialist obstetric ultrasound services in context of COVID‐19

Ultrasound-Guided Interventions During the COVID-19 Pandemic—A New Challenge

Ultrasound-Guided Interventions During the COVID-19 Pandemic—A New Challenge

Strategies for qualified triage stations and fever clinics during the outbreak of COVID-2019 in the county hospitals of Western Chongqing

The outbreak of SARS-CoV-2 infection in China is highly transmissible by airborne droplets and close contact with infected secretions. Essential control of this disease relies on the prompt identification, appropriate risk evaluation, isolation of possible cases and prevention measures for the spread of the virus. The hospital is a high-risk area for nosocomial transmission with inappropriate room setup for triaging and diagnosing febrile patients. Chongqing municipality is adjacent to Hubei (the most affected province), with 576 confirmed cases and 22,700 people with close contact history of the disease in Chongqing.

Proposed measures to be taken by ophthalmologists during the coronavirus disease 2019 pandemic: Experience from Chang Gung Memorial Hospital, Linkou, Taiwan.

PURPOSE:Although Taiwan was one of the first countries to develop coronavirus disease 2019 (COVID-19), with effective antiepidemic measures, Taiwan has effectively controlled the spread of the disease. The purpose of this article is to provide useful safety strategies for ophthalmologists in daily practice during the COVID-19 pandemic.MATERIALS AND METHODS:Infection control strategies in the hospital and Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, are discussed.RESULTS:Ophthalmologists are at high risk of contracting COVID-19 infection, as they have close contact with patients during ocular examinations, and are also facing high patient volume in outpatient clinics as well as emergency consultations. Furthermore, ocular symptoms, such as conjunctivitis, may be the presenting signs of COVID-19 infection. We provide our strategies, which include hospital's gate control with triage station, patient volume control, proper personal protective equipment, and consultation with telemedicine technology, to decrease the risk of cross-infection between medical staffs and patients.CONCLUSION:To achieve the goal of preventing viral spread and maximizing patient and medical staffs' safety, besides providing proper protective equipment, it is also crucial for staffs and patients to strictly follow antiepidemic measures. We hope that our experience can help ophthalmologists and health-care workers to have a safer working environment when facing COVID-19 pandemic.

Decreased emergency department overcrowding by discharge lounge: A computer simulation study

Background:In the past decade, factors such as population growth, increased environmental incidents, and substance abuse have caused patient-overcrowding in emergency departments (EDs). Our main objective was to assess the effects of a discharge lounge on decreasing the patient waiting time and ED overcrowding by computer simulation.Methods:In this cross-sectional retrospective study, the statistical population consisted of 39264 persons referred to the ED of Al-Zahra Hospital. The sample size was calculated as 1275 through systematic random sampling at 99% confidence. To increase research accuracy, the number of patients was increased to 2515. Data were collected by standardized checklists and hospital information systems.Results:Mean waiting time for level 2 patients who left the ED against medical advice after completing the treatment was declined from 56 min to 44 min and before completing the treatment process from 80 min to 50 min. Average waiting time for level 3 patients for personal satisfaction after completing the treatment process decreased from 15 min to 13 min and before the completion of the treatment process from 67 min to 41 min; the number of discharged patients awaiting discharge was decreased at level 2 from 3 to 2 and at level 3 from 2 to 1. The number of patients waiting for admission at triage stations reduced from 44 to 39%, and the average number of patients discharged from emergency room was increased from 7 to 12.Conclusions:ED overcrowding is the hallmark of a mismatch between the availability of health care resources and patient demand for emergency care. Among major factors contributing to these situations are hindrances in patient flow and occupation of ED beds by nonurgent patients. The establishment of a discharge unit in the ED could be a practical solution to ED overcrowding.

The potential risk of sick building syndrome of the emergency department areas in a medical center in Taiwan

Background: Indoor air pollution is a constant problem in the current society, especially in the emergency department (ED). Dirty and polluted air in hospitals will reduce work efficiency of healthcare staff and could ultimately cause diseases and illness; some serious acute respiratory diseases are liable to become epidemics in the hospital. A solution to organize the medical working environment and prevent the underlying threat of nosocomial infection is becoming an increasingly important issue; therefore, a research project is designed to study the air quality in the ED of a medical center in Taiwan. Methods: Air quality measuring instruments were used three times a day for a non-continuous monitoring in the ED of the Taipei Mackay Memorial Hospital, including temperature, oxygen, carbon dioxide, ozone, total volatile organic compounds, suspended particulates (PM10) with a particle size of 10 microns or less, and formaldehyde. The emergency areas were classified into four types according to whether medical procedures were performed or not, is there confined space or not. The data collected from different ER zones were analyzed and compared. Results: The results showed that the oxygen concentration was higher than that of the general environment (20.9%) in all areas of the ED, while carbon dioxide concentration (CO 2 ) is also higher. The oxygen concentration of most places in ER exceeded 30%. The CO 2 concentration of each unit exceeds 700 ppm, especially in the internal and surgical ED, as well as the negative pressure isolation room, for which the value was close to 800 ppm (P 0.12 ppm) was detected in the nursing station the observation room and the research office. The highest concentration of ozone was also detected in the nursing station the observation room. As for the suspended particles (PM10) having a particle diameter of 10 µm or less, the level of each zone was quite low. There was a much lower concentration of volatile organic substances (VOCs) in the triage station, research office as well as corridors; while all other areas have exceeded 150 ppb. Conclusions: Our research indicates that the current emergency environment could be harmful to healthcare staff, and poor air quality in the ER is observed especially during busy hours, in older buildings, at intensive medical disposal areas and also in confined spaces. Some confined medical treatment spaces were prone to higher carbon dioxide (CO 2 ) concentrations that may cause fatigue and decrease of work efficiency. Therefore, improvement of air quality in ER and maintenance of emergency environment at the ideal air condition is significantly important. The ventilation of outdoor airflow and filtration of particles of the air conditioning systems should be thoughtfully planned as early as when designing an ER construction in order to avoid “sick building syndrome (SBS)”. That said, a healthier working environment to the ER staffs could ultimately bring more effective work and promote better medical quality.