COVID-19 Emergency Medical Deployment Teams (EMDT) Mobilization Guidelines-2020

  • COVID-19 Emergency Medical Deployment Teams (EMDT) Mobilization Guidelines 2020

    1. Context:
    In this month number of positive cases increased significantly and trend continues to upsurge. We have observed in an average 46 per day in the last week which was 34 in the one week prior to that. Majority of cases are reported from bordering districts where unregulated influx of migrants from India has been observed. As such migrants are coming from high burden areas the positive number of cases may increase in these areas where existing health systems capacity, particularly human resources, are available in limited numbers.
    2. Rationale:
    There could be many situations that may result inadequate staff in hospitals which includes increasing cases in the locality, staff may need leave after serving COVID-19 patients or some may need to be quarantined due to their exposure to positive patients. This guideline is prepared to provide guidance on management of mobile teams by hub or hub and satellite hospitals for sending them to hospitals where there is lack of human resources to treat and care COVID-19 cases.
    3. Team composition:
    The number of staff in this guideline has been are estimated for management of 50 suspected or confirmed COVID19 in-patients with mild symptoms. If the patients show moderate or severe symptoms, then additional team with the appropriate expertise will be mobilized or patients will be transferred to the higher level nearby COVID designated hospital. In addition, tele-consultation center for specialty consultation will be also established to facilitate consultation with specific specialists.
    Based on the availability of ICU with ventilators, the attending doctor can decide when to consult with tele-consultation center and ICU and appropriate expert will help him/her to manage the case. Each hub or hub and satellite hospitals will prepare two COVID-19 Management Mobile Teams (EMDT). In case if hub-hospital is not able to supply the human resources, then it can arrange with the help of its satellite hospitals.
    The composition of each team will be:
    1. Physician (Junior consultant or above) – 1 No.
    2. Doctor (MD resident or above) – 1 No.
    3. Nurses or health assistants – 6 Nos.
    4. Attendant* – 3 Nos.
    The team will have the most senior doctor as the team leader and in case of any issue/problem team lead will resolve them. Each team will work for 12 hours shift for 7 days. After which another team can replace the team. If the staffs are not quarantined, then the attendant may not be required. Based on the case burden and severity of
    the cases additional teams can be deployed.
    The hubs should prepare the list of staffs of the team and sent to MOHP and these teams will be mobilized by HEOC on request of hospital, local or provincial governments.
    * The attendants will join the last three lessons with.
    4. Scope of the work:
    The team will work at the assigned hospital and following would be the major tasks to be performed:
    • Introductory meeting with the Administrator or Chief of the hospital and introduce the team and explore the hospital arrangements.
    • Provide treatment and necessary other care to patients.
    • Train existing staff of the hospital in various aspects of COVID-19 care.
    • Maintain and support hospital administration to keep proper patient records and leave it in the hospital for future use.
    • Maintain proper records of major work done at hospital e.g. what was done, how much and with what resources, and leave a copy of the records for the hospital for future reference.
    • Work with the local authorities for equipment and support on accommodation, food and transportation as required.
    • Regularly connect with HEOC and give report in alternate days.
    • In case of any administrative issue or further guidance is required from federal ministry consult HEOC focal point as per the need.
    • If there is any consultation required, reach available experts within the hospital or outside, particularly designated hospitals or COVID19 tele-medicine centers.
    • The team lead will meet and work with the administration/Chief of the hospital regularly and amicably.
    5. Essential criteria to be member of EMDT:
    o Should be able to travel,
    o Less than 45 years of age,
    o Should not have these co-morbidities:
    ▪ Diabetes
    ▪ Hypertension
    ▪ Taking any immuno-suppressive drugs
    o Should have undergone CMT online training.
    6. Training arrangement for EMDT:
    The training for EMDT should be of two days covering following topics:
    • National COVID-19 strategy and management planning
    • National COVID-19 disaster management policy
    • Management of respiratory disease
    • Management of other COVID-19 symptoms
    • Management of mild and sever cases of COVID-19
    • Management of Ventilator support for COVID-19

    • Management of COVID-19 management, including dead body management*
    • Infection control (PPE management)*
    • Transfer of COVID-19 patients*

    Note: * attendants will join selected sessions.

    7. Key considerations:
    The team should consider following key points while working at designated hospital:
    • Treat the patients to the best of your abilities and with respect, dignity and empathy.
    • Work with available resources.
    • Work with the other staffs of the hospital with politeness and respect.
    • Respect the equipment, basic amenities and other hospital facilities.
    • Respect the local culture and follow it as far as possible.
    8. Role and responsibilities:
    Doctors’ role:
    • Work to the best of their ability keeping in mind of their and their team’s safety.
    • Give standard of care with best of their knowledge, and if there is any need of consultation, should not hesitate to call HEOC or tele- consultation center.
    • The main aim is to give the best of treatment with available resources.
    Nurses’ role:
    • Work with diligence and empathy to help the patient get cured.
    • Use proper safety techniques for protection of oneself and the patient.
    • Teach patient and others to follow good hygiene.
    Attendants’ role:
    • Only go with the team if called, usually if the staffs of the hospital are quarantined including the attendants.
    • Work diligently and keep the wards and area clean
    • Use proper safety technique to protect oneself and others, including the environment.
    Ministry of Health and Population’s role:
    • Provide life insurance of the EMDT members.
    • Provide cost to train and orient medical teams
    • Provide TA/DA according to the government policy.
    • Provide COVID19 hazard allowances if applicable.
    • Support 24/7 for any issues from HEOC.
    • Monitor the teams and provide guidance.
    • Request reports at the end before returning to their hospital

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