PCEM POSITION STATEMENT

ON COVID-19 COMMUNITY QUARANTINE GUIDELINES

FOR HEALTHCARE PROVIDERS

Medical professionalism demands the responsibility to treat those in need even during surges and
epidemics. Physicians have the ethical obligation to provide urgent medical care every day and
most especially during emergencies and disasters despite threats to own safety, health and life.

The Philippine College of Emergency (PCEM) currently has 19 recognized training institutions
with close to 300 active emergency physicians working in the frontlines of both government and
private hospitals in the Philippines battling the COVID-19 on top of the daily demands of ED
consults. PCEM, as a specialty society, recognizes that our role is not only to address the critical
problems of patients who come to the ED but also to serve as vital link in public health, public
safety and the health care system. The health sector’s response to the COVID-19 emergency must
now be one that is collaborative and coordinative at the local level with guidance from national
authorities. Emergency medicine as the safety net and last frontier of public health can take a lead
role in this important task.

PCEM would like to commit the following:

1. The pre-hospital and emergency department workforce shall continue to work with the
public health authorities and with the other medical specialties to promote interventions
that will ensure better health outcomes while managing dual responsibilities to individual
patients and communities when community quarantine is in effect.
2. The pre-hospital and emergency department workforce shall continue to abide by the
isolation and quarantine guidelines recommended by the public health authorities and the
medical specialties
3. The pre-hospital and emergency department workforce shall take precautionary measures
to ensure personal safety and health through health promotion (pre-duty); practice of
desired health behavior as wearing of appropriate personal protective equipment to
minimize the risk of transmitting infectious diseases from physician-to-patient or
physician-to-physician (while on tour of duty); and to immediately seek medical evaluation
and treatment and follow isolation/quarantine protocols to mitigate complications of
exposure in case of breach in barriers if they suspect themselves to be infected (post-duty)
4. The pre-hospital and emergency department workforce shall ensure that care/interventions
for the COVID-19 patients are evidence-based, non-discriminatory and according to
ethical considerations
5. The highest possible level of confidentiality shall be protected without disregard to
obligatory reporting for cases of public health concern
6. Access to emergency care shall be ensured with provision for appropriate triaging of cases
and with anticipation for surge of cases
Recognizing that, healthcare workforce is a finite reserve and there is a need to balance protecting
this resource and meeting demands to continue caring for the patients, PCEM requests the
following during community quarantine:

7. Availability of test kits to ensure minimal delays in therapeutic and disposition plans
8. Availability of appropriate and adequate protective and preventive measures for pre-
hospital and emergency department workforce caring for the patients with emerging and
infectious diseases
9. Exemption from restriction of movement to and from work of the emergency healthcare
workforce as part of the recognized frontline services with strict adherence to protocols
and to ensure that there shall be no undue delay in the process of clearances of
identifications for passage
10. Establishment/provision of field hospitals or quarantine hubs dedicated for PUIs; step-
down health facilities for the low-risk, stable COVID-19 patients to decongest the hospitals
attending to the more critical cases
11. Adding more check-point triages to immediately assess for history of travel, exposure and
symptoms (initial screen for COVID-19) (e.g., Entry and Exit points)
12. Extension of triaging to the fields (pre-hospital) and from the community through the
Barangay Health Emergency Response Teams (BHERTs)
13. Establishment of referral network and resource optimization for patient admission for the
PUIs and confirmed cases
14. Where feasible, adjustments to policies and procedures to reduce social contact such as use
of telemedicine, teleworking arrangements, flexible and physiologic hours
15. Policies to support healthcare providers for self-quarantine/self-isolation when there is
exposure and suspicion of breach in PPEs (suspension of need for medical certificates as
document support)
16. Anticipation of shortage of health human resource due to increased absenteeism from
quarantine or illness and to plan for business continuity with reserve/back-up work force
17. Considerations for geographically isolate and disadvantaged areas to be allowed to be
visited by emergency physicians
18. Appropriate triaging of patients at the Emergency Departments following clinical
algorithms
19. Ensuring strategic police presence/outposts in hospitals with high volume
20. Hazard pay compensation for both government and private healthcare providers
21. Compensation for work-hours lost due to quarantine/illness in line with the profession
22. Decongestion of hospital wards of patients who can be safely discharged early
23. Non-closure/termination of urgent/out-patient clinics to ensure only true emergencies go
to the EDs
24. Team Approach in the management of the COVID-19 patient and to ensure accountability
25. Ensure non-refusal of frontline medical services to see non-urgent patients, these people
will divert to the emergency department if they do not have access to their primary clinics
26. Provision of psychological first aid/regular debriefings to the healthcare workforce
27. Establishment of tele-emergency services/centers through clusters and use of telephone
triage should there be questions that may be answered without visiting the EDs
(Appendix A)
Appendix A

PROPOSAL FOR TELE-EMERGENCY SERVICES AS RESPONSE

FOR COVID-19 FOR CODE RED ALERT LEVELa

As the threat for a wider spread of the COVID-19 virus intensifies, the region needs to
have an organized response to mobilize available health resources and maximize the utilization
its hospital manpower, beds and facilities to halt community transmission, direct people to the
appropriate resources and provide quality health care for the people

OBJECTIVES:
1. To manage DOH and LGU response through an incident command system with dedicated
tele-emergency services.

2. To minimize unnecessary exposure for health care workers at the same time provide answers
to queries of patients pertaining to COVID -19 detection, treatment and management

3.. To triage patients to appropriate health facilities and health resources through tele-emergency
services guided by protocols that are based on international guidelines and applicable to local
setting

4. To direct pre-hospital response teams to address pockets of community transmission with

guidance of EMS medical director

STRATEGIES:

1. COMMUNICATION CENTER: Set-up the tele-emergency hub with linkages with medical
dispatch through the local government disaster office or emergency medical services system
which will function as a) call center b) pre-hospital triage c) dispatch center d) monitoring center
for response and e) managing inter-facility referral and transport

2. TRANSPORT TEAMS: Mobile ambulances and fast reaction teams in two-wheeled vehicles
including baranggay ambulances may be utilized to patrol areas and ready to be dispatched to
respond to a health emergency or transport patients to appropriate health facility

3. IDENTIFICATION OF CAPABILITIES OF HEALTH FACILITIES/MOBILIZATION OF

RESPONSE TEAMS at the LGU level
a. testing centers – with available negative pressure tents available to screen possible COVID
cases
b. admission facilities for observation of PUIs with minimal risk of severe disease
c. admission facilities for severe disease or severe acute respiratory infection
d. quarantine hubs – facilities for PUMs were they can be kept under observation of 14 days
d. quality teams – to monitor the health of health care workers and manage manpower for shared
resources

4. DEVELOPMENT OF RESPONSE PROTOCOLS to be used at the call center/dispatch center

Example:
i. Determine Symptoms:
- Does the patient have fever?
- Does the patient have any respiratory symptoms – i.e cough, shortness of breath/ difficulty of
breathing, colds, throat itchiness or pain

ii. Determine Exposure Risk

- Has the patient been in close contact, providing direct care (without PPE), staying in the
same closed environment or travelling with close proximity with someone who has tested
positive for COVID-19
- Has history of recent travel for the past 14 days prior to onset of symptoms in countries
identified by WHO (China, South Korea, Japan, Australia, Hong Kong, Taiwan, Middle
East etc.

iii. Determine Severity of Illness

- Is the patient awake? Breathing normally?
- Is the patient ambulatory?
- Is the patient highly febrile?

LEVEL 1
WITH NO ARI
SYMPTOMS (+) OBSERVE AT HOME
EXPOSURE

LEVEL 2
WITH MILD ARI
OBSERVE AT HOME AND
SYMPTOMS (-)
GIVE MEDICAL ADVISE
EXPOSURE

LEVEL 3
WITH MODERATE ARI
DIRECT TO TESTING
SYMPTOMS (+)
CENTER
EXPOSURE -- PUI

LEVEL 4
WITH SEVERE ILLNESS
DIRECT TO FACILITY
(+) EXPOSURE OR
WITH ADMISSION AND
PUI/PUM WITH WITH
CRITICAL UNIT
INCREASING SEVERITY

5. MONITORING AND MODIFICATION OF RESPONSE – Continuous assessment and re-

assessment of service.
a
This sample proposal has initially been conceptualized and submitted as a response plan for the Davao Region (XII)
through the Southern Philippines Medical Center, which has telemedicine services and through its memorandum of
agreement with Davao Central 911, the EMS system created by then Davao City Mayor and now President Rodrigo
Roa Duterte. At the moment, the proposal is due for proof of concept and dry run.
Signed this 14th of March, 2020 at Manila, Philippines by the PCEM Board of Directors.

DAVE C. GAMBOA, M.D., FPCEM

MARTIN EUGENE ANTHONY S. LUNA, M.D., FPCEM

NANNEDE C MERCADO, M.D, FPCEM

JOHN PAUL E. NER, M.D., FPCEM

RICHARD HENRY S. SANTOS, M.D., FPCEM

BERNADETT P. VELASCO, M.D., FPCEM

PATRICK JOSEPH G. TIGLAO

Secretary General

PAULINE F. CONVOCAR, MD, FPCEM

President