ACEP COVID-19 Field Guide
Table of Contents
- ACEP COVID-19 Field Guide
- Publisher’s Notice
- Introduction
- Preparing for Work
- Returning from Work
- COVID-19 Aerosol and Surface Stability
- Self-Isolation
- Guidance for Health Care Personnel Regarding Exposure
- Safety Practices for Health Care Workers Who May Have Had Exposure to a Person With Suspected or Confirmed COVID-19
- Return to Work Criteria With Confirmed or Suspected COVID-19
- ACEP Statements on PPE
- Appropriate PPE
- Aerosolization
- Facility Changes
- Ultrasound Cleaning
- Personnel Safety
- Cardiac Arrest Resuscitation in the COVID-19 Era
- Air Method Guidelines for the Care of Patients With Suspected or Confirmed COVID-19
- Health Care Professional Preparedness Checklist For Transport and Arrival of Patients With Confirmed or Possible COVID-19
- How COVID-19 Moves Within a Hospital
- Infection Prevention and Control Recommendations for Patient Arrival and Triage
- Medical Screening Examinations
- Telehealth and Tele-Triage
- Quick Guide to a Basic Tele-Triage Program
- Risk Stratification and Triage in Urgent Care
- Vaccinations
- Signs and Symptoms
- Laboratory Abnormalities
- Chest X-Ray and CT
- Ultrasound
- Testing
- Severity and Progression of Disease
- Populations at Risk
- Evaluation Pathway for Patients with Possible COVID-19
- Management of Patients With COVID-19
- Critical Issues in the Management of Adult Patients Presenting With Community-Acquired Pneumonia
- Alternative Treatments
- Acute Cardiomyopathy or Heart Failure
- Acute Myocardial Infarction
- Cardiac Arrest
- Discharge: Expected Recovery
- Discharge to Home Palliative Care
- ICU Care in the Emergency Department
- Ventilators
- Health Care Workers
- Law Enforcement
- Racial and Ethnic Minority Groups
- Elderly Patients
- Immunocompromised Patients
- Pregnant Patients and Pregnancy
- Pediatric Patients
- Homeless Patients
- Dialysis Patients
- Psychiatric Patients
- Behavioral Health Patients
- Patients With Substance Use Disorders
- Immigrants
- Incarcerated Population
- Financial Resources
- Billing and Coding for COVID Care
- EMTALA
- State Waiver of Liability
- Other Federal Updates and Guidance
- ACEP Offers, Wellness, and Counseling Services
- Burnout, Self-Care, and COVID-19 Exposure for First Responders
- Critical Incident Stress Information
- Managing Patient and Family Distress Associated with COVID-19 in the Prehospital Care Setting
- ACEP Policy on Visitation and Custody
- Impact on Research
- Change to Education Policies
- Licensure and Credentialing
Return to Work Criteria With Confirmed or Suspected COVID-19
Home Safety
Guidance from the CDC on return to work criteria for HCP with confirmed or suspected COVID-19
Use one of the following strategies to determine when health care personnel (HCP) may return to work in health care settings (Figure 2.1).
Symptom-based strategy for determining when HCP can return to work:
- HCP with mild to moderate illness who are not severely immunocompromised:
- At least 10 days have passed since symptoms first appeared; and
- At least 24 hours have passed since last fever, without the use of fever-reducing medications; and
- Symptoms (eg, cough, shortness of breath) have improved.
- Note: HCP who are not severely immunocompromised and were asymptomatic throughout their infection may return to work when at least 10 days have passed since the date of their first positive viral diagnostic test.
- HCP with severe to critical illness or who are severely immunocompromised:
- At least 10 days and up to 20 days have passed since symptoms first appeared; and
- At least 24 hours have passed since last fever, without the use of fever-reducing medications; and
- Symptoms (eg, cough, shortness of breath) have improved.
- Note: HCP who are severely immunocompromised but who were asymptomatic throughout their infection may return to work when at least 20 days have passed since the date of their first positive viral diagnostic test.
The CDC is no longer recommending a test-based strategy to determine when to allow HCP to return to work. Additional information can be found on the CDC’s Guidance on Return to Work Criteria for Healthcare Workers.
Figure 2.1 When can I return to work? Credit: Michael Macias, MD.
After returning to work, HCP should:
- Wear a face mask for source control at all times while in the health care facility until all symptoms are completely resolved or at baseline. A face mask instead of a cloth face covering should be used by these HCP for source control during this time period while in the facility. After this time period, these HCP should revert to their facility policy regarding universal source control during the pandemic.
- A face mask for source control does not replace the need to wear an N95 or higher-level respirator (or other recommended PPE) when indicated, including when caring for patients with suspected or confirmed COVID-19.
- Of note, N95 or other respirators with an exhaust valve might not provide source control.
- Self-monitor for symptoms, and seek re-evaluation from occupational health if respiratory symptoms recur or worsen.
For further information, review the CDC’s "Criteria for Return to Work for Healthcare Personnel With Confirmed or Suspected COVID-19 (Interim Guidance)."
Figure 2.2 Recommendations for monitoring and work restrictions based on risk category. Credit: Michael Macias, MD.
