Coronavirus — Resuscitation Planning — Clinical Pathway: Emergency

Resuscitation Planning:
Guidance for Resuscitation Considerations to Review Each Shift

Resuscitation bay should be default location.
- Only related patients who live in the same household can be simultaneously cared for in Bay B.
If resuscitation room is down for cleaning or currently being used, 2nd second location is Behavioral Health space

Guidance for Resuscitation Planning During the Start of Each Shift

Team 1 Attending and Charge Nurse will huddle after rounds to determine Resuscitation Team

FLOCS and RNs should be pulled from any team (including triage)
Primary team should be designated as team to respond to ALL events during that shift
Back-up team should be identified in the event of two simultaneous resuscitation events
Ensure all members of designated resuscitation teams have been fit-tested for n95 use
- If member has passed fit-testing should carry appropriate n95 on person throughout shift
- If member has not had fit-testing should prioritize fit-testing at beginning of shift if available
  - See Charge Nurse for calendar of fit-testing
- If member has not passed fit-testing, team should plan for member to don PAPR
- PAPR remains the preferred method for team member who are not part of the primary bedside care team

Minimal Team will report to the Resuscitation initially:

Resuscitation Team

In-Room Responders: 2 Attendings (likely Team 1 & Rover 1), 1 FLOC, 2 Bedside RNs, 1 Medication RN and 1 RT [For Trauma Alert: Trauma Chief]
- If known patient arrival and any of the in-room response team are unlikely to be needed (eg. Medication RN, second attending) those staff members should report to Command Center instead to be on standby for room response
Room Monitor/Crowd Control (outside of room): Charge Nurse
Command Center Responders: PCA, Documentor, Ordering FLOC, RT, Pharmacy, Radiology Tech, SW, CLS, Nurse Lead
- If two simultaneous resuscitations, additional staff for second resuscitation should report to room 4
Room 5 Responder: PPE Monitor, all in-room responders should report to room 5 initially for donning
- Caveat: If sudden, unexpected, life-threatening event, initial MD / RN will respond in room to care for patient immediately, remaining staff will report to room 5 for donning prior to entering resuscitation area

Additional Staff/Consultants

Resuscitation team can and should call in any additional staff needed.
Resuscitation Command Center Nurse Lead should monitor for need for staff or supplies in room
- Eg. If compressions are required, prep Tech in PPE and ask in-room team if they need tech to respond
- Eg. If intubation is required, prep second RT in PPE and ask in-room team if they need second RT to respond
All consultants should first report to the Resuscitation Command Center to determine if physical presence is required
- Telesupport from consultants should be prioritized whenever possible
If two simultaneous resuscitations, 2nd Documenter must respond in-room to the second resuscitation along with 2nd In-Room Team (cannot stream both resuscitations effectively simultaneously)
- Second team will need to take iPad into room as primary means of communication with room 4 team
- Room 4 team to include PCA who will start BLine from room 4, ordering FLOC and 2nd Command Center Lead Nurse

PPE Recommendations

All Trauma Alerts and Medical Resuscitations will be considered suspected COVID-19 patients initially:
- N95/PAPR + Face Shield + Gown + Double Glove (Double gloves only required for those doing procedures)
For patients with no concern for COVID-19 AND no risk for aerosolizing procedures, may decrease PPE:
- Standard Mask + Face Shield + Gown + Gloves
PPE can be upgraded or downgraded at any time as clinical scenario warrants

PPE Donning & Doffing Procedure
Donning	In-Room Responders: Room 5 If sudden, unexpected event, 1 nurse and 1 physician will respond to bay directly to begin care while rest of team responds to room 5
Doffing	Room 6 or prior to leaving final destination (PTSU/OR)

Resuscitation Operations

Resuscitation Command Center – ED Family Room

Team Responsibilities

PCAs: Initiate B-Line for appropriate room to live stream care (Bay A, Bay B or SC-Bot1)
Documentor: Utilize EPIC Trauma or Code Narrator (may use paper flowsheets if technical. difficulties). Communicate with in-room team to enhance documentation and inform team of relevant updates.
Ordering FLOC: Open EPIC and order required labs, radiology, antibiotics and infusions. Communicated with in-room team to add information for resuscitation and liaise with consultants.

Consultants: Arriving consultants should be directed to Resuscitation Command Center and report to FLOC to communicate with team

Resuscitation Communication
Closed loop communication should be utilized at all times
BLine	BLine will LiveStream the resuscitation event into the Command Center Video will include views of patient/room and view of monitor If cardiac monitor view is not working, instruct bedside nurse to place iPad in front of monitor to allow Documentor to review and record vital signs Audio from BLine will be offset from that in headsets, iPads and cell phones. Consider turning headset audio down as needed and utilize video volume for shared mental model within Resuscitation Command Center. Adjust volumes as needed for extraneous noise.
Headsets	2 headsets located in Room 5 donning area – for In-Room Physician Lead and Bedside Nurse 2 headsets located in Command Center – for Command Center FLOC and Documenting Nurse Suggest initial settings: Talk OFF for Command Center FLOC and Documenting Nurse (turn out to communicate in to room as needed) Talk always ON for In-Room Physician Lead and Bedside Nurse Physician Lead may choose to turn volume down to allow for uninterrupted thought during active resuscitation – will need to be reminded by Bedside Nurse to turn volume up if Command Center requesting communication
iPads	Located in Resuscitation areas, deploy additional as needed In Command Center consider use of headphones in iPad to ease audio communication Resuscitation Bay: Bioresponse 27/28 BH Area: Bioresponse 25/26
Cell Phone	When utilizing cell phone for communication, Bluetooth headphones useful to streamline communication Attending, ordering FLOC consider exchanging cell phone numbers during rounds to facilitate communication
Two-way Radios	Held by RN Documentor to communicate into room as needed. Radios are in room 5 on chargers and must be brought into Resuscitation Room and Command Center if needed.

©2020 by Children's Hospital of Philadelphia, all rights reserved.
Use of this site is subject to the Terms of Use.

The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.