Emergency Care During the Coronavirus Pandemic

Jeremiah Schuur, MD, and Anthony Napoli, MD

Since the start of the COVID-19 pandemic we have seen an approximate 30 to 40 percent decrease in emergency department (ED) visits across the Lifespan health system.

There are many things that factor into the decreased ED utilization. Those include:

  • social distancing and shelter-in-place guidelines by the Governor
  • less frequent travel out of the home reduces exposure to risk factors that often contribute to ED utilization, such as traffic accidents, workplace accidents, injuries from recreational activities
  • fewer coronavirus cases as well as non-COVID infectious exposures
  • efforts on the part of the hospital system, primary care providers, and specialists, through things like telehealth

But we are concerned that some patients with emergency conditions such as heart attacks are not coming to the hospital out of fear of COVID.

A national trend

Since the start of the coronavirus pandemic, ED utilization is similarly down throughout the country with the infrequent exception of some areas such as New York City, which have experienced brief surges because of an overwhelming number of COVID patients.  

While there are fewer lower acuity visits that we otherwise term “focused emergencies,” such as fractures and lacerations, the acuity of illness (how sick patients are when they arrive) of patients who do present to the ED has increased.

When to seek care at an ED

Recommendations for seeking care in the emergency department are not significantly different during a pandemic as compared to normal operations, with the exception of recognizing signs/symptoms related to COVID-19.  Emergency departments are the resource for time-sensitive acute care conditions.  

During this pandemic, what is most concerning is a delay in getting care for acute conditions that are time dependent. Those include chest pain and other symptoms of heart attacks; strokes or stroke symptoms such as slurred speech or one-sided weakness; surgical emergencies such as appendicitis; and traumatic accidents.

In the last several decades we have made substantial strides in offering emergency care to time-sensitive conditions like heart attacks, strokes, trauma, and sepsis.  In some of these cases, actual minutes count. We don’t want patients to hold off coming to the ED when it is necessary. We are equipped to care for both COVID-19 patients and non-COVID-19 patients and do so for both safely.

Telehealth

In some instances, telehealth may be an option for many symptoms. Contact your primary care provider for more information or you can learn more about Lifespan’s telehealth services here.

Signs you need immediate help

It is important that you know the signs and symptoms that signal the need for immediate medical attention. We recommend the American College of Emergency Physicians document “Know When To Go” which lists the following:

For adults:

Adults experiencing any of the following should seek immediate medical attention. Call 9-1-1 or go to the emergency department for:

  • difficulty breathing, shortness of breath
  • chest or upper abdominal pain or pressure lasting two minutes or more
  • fainting, sudden dizziness, weakness
  • changes in vision
  • choking
  • head or spine injury
  • injury due to a serious motor vehicle accident, burns or smoke inhalation, near drowning, deep or large wound or other serious injuries
  • ingestion of a poisonous substance
  • difficulty speaking
  • confusion or changes in mental status, unusual behavior, difficulty waking
  • any sudden or severe pain
  • uncontrolled bleeding
  • severe or persistent vomiting or diarrhea
  • coughing or vomiting blood
  • suicidal or homicidal feelings
  • unusual abdominal pain
For children:

A child experiencing any of the following should receive immediate medical attention. Call 9-1-1 or go to the emergency department for:

  • severe headache or vomiting, especially following a head injury
  • uncontrolled bleeding
  • inability to stand up or unsteady walking
  • unconsciousness
  • abnormal or difficult breathing
  • skin or lips appear blue, purple or gray
  • feeding or eating difficulties
  • increasing or severe, persistent pain
  • fever accompanied by change in behavior (especially with a severe, sudden headache accompanied by mental changes, neck/back stiffness)
  • any significant change from normal behavior, including confusion or delirium, decreased responsiveness or alertness, excessive sleepiness, irritability, seizure, strange or withdrawn behavior, or lethargy
For coronavirus-specific symptoms:

To determine if you require immediate medical attention, the RI Department of Health website offers an online tool to check your symptoms along with more information on coronavirus here.

We are always here for you

The Lifespan emergency medicine departments at Rhode Island, The Miriam, Newport and Hasbro Children's hospitals have all taken many steps to ensure all patients can be cared for in a safe environment and receive the timely, high quality care they need and deserve. We have a carefully prepared workflow to keep our patients with COVID-19 in separate areas from those who do not have the virus. We work in close coordination with the departments of infection prevention and infectious disease, hospital administrators, and the Rhode Island Department of Health. We also welcome additional best practices consultations from our colleagues around the country as we all battle this pandemic.  

We want to reassure our community that even during this pandemic, we are well equipped to provide safe, high quality care for all of our patients.

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