Search

ACEP Stands Behind Emergency Physicians

Sandra M. Schneider, MD, FACEP

ACEP first notified its members of the potential spread of Covid-19 into the US on January 20th, the day the first US citizen was diagnosed with Covid (he had traveled to Wuhan during their outbreak). The first community-acquired disease in the US occurred in Washington State on 2/26. It quickly became apparent that the disease was in the US and was spreading. On 3/16 ACEP organized a briefing for Congress with emergency physicians on the front line in Washington State. For a while it appeared that the disease would stay somewhat confined to the Seattle region. However a sample from a patient in NYC on March 1st was positive for Covid, and the disease started to spread in that city. March 13th the President declared a national emergency as the disease.

Throughout March, the CDC recommended no PPE was needed unless the patient was suspected of having Covid, and suggested a surgical mask would be adequate for those encounters unless intubating. However on March 20th ACEP went against the CDC recommendations and issued this statement:

Our emergency care team is the front line in this crisis at a time when identifying those who may have COVID-19 is very challenging. Given the guidance from the CDC that droplet precautions recommend use of a face mask or surgical mask, ACEP believes that healthcare personnel in the emergency department (ED) and emergency medical services  (EMS) should consider wearing a face mask or surgical mask during their entire shift if they are providing patient care, unless the mask becomes soiled and needs replacement.

In order to preserve PPE, until the current shortages are reduced, healthcare personnel in the ED and EMS should consider wearing the same mask for the entire shift. We also understand that close contact during procedures or processes (including a physical examination) that generate potentially infectious aerosols requires a higher level of PPE that includes an N95 respirator.
This was sent to over 32,000 members in an email, with a 51% open rate.

ACEP received criticism from a number of institutions suggesting that this would drain the supply of masks. In addition there were physicians who were disciplined for wearing masks as they would ‘scare away’ patients. So on March 25th, ACEP issued this statement:

Global penetrance of COVID-19 has placed significant stress on the ability to produce and supply appropriate PPE to health care workers. Additionally, the risk pool of known and unknown disease in our communities has greatly challenged our ability to reliably determine patients who are at low risk. For these reasons, ACEP has and will continue to support the use of surgical masks with proper eyewear and other protective equipment for all physicians and other individuals caring for patients, regardless of patient complaint. Processes and procedures that create higher risk, such as close contact and aerosolizing procedures, require full PPE, including N95s. 

Because the inadequate PPE supply increases the risk to our physicians, they have taken to buying their own PPE or utilizing donations from other industries. ACEP urges hospitals and other health care facilities to allow physicians to use their donated or self-purchased PPE.
This was sent to 32,000 members with an open rate of 47%.

It is important to note that at that time the CDC still contended that no barrier was needed when caring for non-covid patients, despite the fact that testing was not widely available. 

ACEP also released 6 press releases regarding PPE starting 2/27:

April 7, 2020 Now is Not the Time to Reduce Support for Health Care Heroes

April 3, 2020 ACEP Urges Americans To Wear Cloth Masks in Public, Save Medical Masks for Health Professionals

March 30, 2020 ACEP Strongly Supports Emergency Physicians who Advocate for Safer Working Conditions amidst Pandemic

March 30, 2020 Leading Health Care Groups Issue Urgent Call for Federal Action to Address Medical Equipment Shortages

March 5, 2020 ACEP Releases Emergency Department Guidance to Manage COVID-19 Outbreaks

March 4, 2020 Emergency Physicians Recommend Policy Changes to Effectively Combat U.S. COVID-19 Outbreak

February 27, 2020 Emergency Physicians and Emergency Nurses Need More Resources to Fight Coronavirus

Many of these called for more PPE and opening of the national stockpile (which did happen).

ACEP also collected stories of physicians being reprimanded for wearing PPE or bringing it from home. Those stories were shared with the CDC, the American Hospital Association and the Joint Commission (TJC). TJC issued its own statement regarding the right of physicians to wear their own PPE. ACEP has also reached out to individuals who have been reprimanded and offered resources to those individuals.

ACEP has also been very active on Covid issues not related to PPE, including amazing advocacy at a national and state level (including liability relief) https://www.acep.org/globalassets/new-pdfs/advocacy/acep-policy-priorities-covid19-03.04.202.pdf ,extensive resources for physicians including the new Field Guide (www.acep.org/covid19fieldguide), partnerships with industry which now offer their thanks in the form of discounts for our members (hotel, food delivery, pet products). Coming soon will be extensive wellness resources to help maintain our members through this crisis. All of these and many more can be found at www.acep.org/covid -19. 

We have been in weekly communication with the CDC, currently working with them on return to work issues and their most recent recommendation of masking the public. Our representatives have been part of collaborations to create the new guidelines for BLS and ACLS during Covid, and the soon to be released guidelines for ST elevation in patients with Covid. In addition our representatives are working on the NIH and 6 other specialty organizations to develop the first national treatment guidelines which should be available the week of 4/20.