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Covid-19: emergency departments lack proper isolation facilities, senior medic warns

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m953 (Published 09 March 2020) Cite this as: BMJ 2020;368:m953

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  1. Gareth Iacobucci
  1. The BMJ

The vast majority of NHS emergency departments in England do not have adequate isolation facilities for containing the spread of infectious diseases such as covid-19, one of the country’s most senior emergency doctors has told The BMJ.

Chris Moulton, consultant in emergency medicine at the Royal Bolton Hospital and former vice president of the Royal College of Emergency Medicine, said he had visited and observed around 80 emergency departments in his current role as joint emergency medicine lead for the NHS’s Getting it Right First Time (GIRFT) programme.1

He said, “I don’t think I’ve seen a department that has a proper isolation cubicle with an anteroom where you can get changed, wash your hands, and then go into the main cubicle. We’ve been very lax on this.”

He said that while some emergency departments had enough space to isolate people, only around half of those he had observed were properly designed.

“Some big emergency departments have got lots of ability to isolate people, they can be put in single cubicles behind closed doors. But in some departments, the ability to isolate people is very limited. Some departments have no cubicles with glass doors, many just have curtains.

“There will be much more risk of spread to other patients and to staff,” he warned.

Moulton said the lack of preparedness highlighted the general lack of capacity in NHS trusts. He said, “In a system which is underfunded, trusts with huge deficits don’t want to spend more money than they have to. And there isn’t much they can do about capacity. We haven’t got enough fire engines—one day there’s going to be a fire that we won’t be able to send an engine to.”

Moulton warned it was probably too late to rectify the lack of isolation facilities to affect the spread of covid-19, but he said that the GIRFT programme would make national recommendations for the future that every emergency department has proper isolation cubicles.

“We were already planning to put this in the GIRFT report before the coronavirus came along because of our past experience with Ebola,” he said.

More broadly, Moulton said that the lack of staffing and bed capacity in emergency departments would push trusts to the limit when covid-19 escalates. “It’s not an easy situation to deal with, to create more capacity in a system that’s already working at full capacity,” he said.

He added that trusts in deprived areas seeing a high volume of patients with complex needs may be hardest hit by covid-19 and may require assistance from other hospitals.

“I think neighbouring hospitals will have to step up and help them, either by supplying staff, by taking ambulances, or by taking the patients.”

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