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I'm Robert Benjamin Saldana,
board-certified emergency
medicine for about 20 years now.
In emergency medicine,
this is what we do,
disaster management.
It's in our bones to
be prepared for this.
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The concern that we as providers
in the emergency department
have is that we have of late
seen that patients are avoiding
or delaying their care
with concern that they
may expose themselves to COVID.
Patients seem to be
delaying their emergencies
and presenting not only
with maybe an acute stroke,
but complications from
those acute events
that they waited with at home.
So this is one of those typical
patients in the community that
have symptoms of heart disease
but have been delaying care
to the ER.
She's got leg swelling, chest
pain, and some shortness
of breath on exertion, which is
kind of classic cardiac symptom
for heart attack
or congestive heart
failure, all those things
that could with delayed care
become life threatening
if they aren't already.
And she's been delaying
coming to the ER.
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You're now looking
at our entrance
into the main
emergency department.
Ambulance will enter here.
Patients will also just walk in.
They'll first meet
a greeter here
which will take a look
at their vital signs,
get them registered so we can
put them into the triage area.
Family will be
screened at the door.
Moving forward, we've
decided to limit visitors.
Limiting visitors
allows us to avoid
the unintended consequence
of infecting others.
Families and patients
have been amenable
and understand that that's
a current requirement
along with the
social distancing.
After the patient is
registered to the ER,
they'll come in contact
with a nurse who's
going to do some evaluation.
This area of the ER,
we've set it apart
so we can have a HIPAA-compliant
conversation with the patient,
take some vital signs,
and start with what
we call an acuity to
decide where in the ER
this patient needs to be placed.
Depending on what we call
the acuity, the severity
of a patient, after
they're triaged,
they will either be in the
hallway waiting depending
on the volume or come
directly to one of the rooms
where a provider will come.
As you can see, we're
respecting social distancing
with how we have people placed.
This also allows us
to have conversations
with patients as
they're waiting,
reassess, give them follow up.
This is a hallway that
enters from the main lobby
and the valet area.
As you can see the
signs, there'll
be some questions,
a temperature taken,
and then this is where we split.
After the screening
process, if a patient
is suspected of
COVID, then they'll
come into a bifurcated or
a separate area in the ER
where there's a dedicated
staff, that staff in respirators
with appropriate PPE.
In every room, we
have air scrubbers.
A little noisy, but allows
for a negative pressure
room for respiratory isolation.
And so it's a lot
safer for patients
to be evaluated there for
themselves and the staff
than in what we call the
cold zones of the ER, which
are patients that
we're seeing that don't
have suspicion for COVID.
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I would just caution
people that if they
have symptoms of heart
attack, stroke, early fever,
and have comorbids, they
definitely should not
wait on their emergencies.
We're open.
We've always been
open, and we're ready.
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