Want to know more about patient management in triage centers? The Karnataka state government recently released fresh guidelines for the management of COVID-19 positive patients in triage areas. A triage area is defined as a hospital, health center or any such suitable facility in a home, ward or village.
Patients are to be managed here by qualified medical professionals including MBBS AYUSH/ PG residents and interns. Based on the protocols, patients who have tested positive for the COVID-19 virus shall be advised for home isolation or shifted to CCC, DCHC or DCH facilities.
Patient Management In Triage Centers – Assessment Of Patients
Medical professionals will assess patients based on the symptoms presented, vital signs, presence of existing co-morbidities and any ongoing medications or treatments. They will be categorized under 6 heads.
- A: Asymptomatic patients with SpO2 >94% with room air
- B: Patients with mild symptoms and SpO2 >94% with room air
- C: Patients with existing comorbidities and SpO2 >94% with room air
- D and E: Patients showing signs of pneumonia and SpO2 <94% with room air
- F: Patients with signs of sepsis/ septic shock/ MODS and SpO2 <94% with room air
Doctors may take the following decisions based on the above assessment.
- Patients in Group A, B and C will be sent for home isolation or to a CCC
- Patients in group D will be admitted in Wards
- Patients in group E will be admitted in HDU
- Patients in group F will be admitted in the ICU
Patient Management In Triage Centers- Treatment Protocol
Any patient with signs of breathlessness and an oxygen saturation< 94% can be started on oxygen according to need irrespective of the RTPCR status. The following may also be given:
- Inj. Low molecular weight Heparin 40 mcg S/C stat
- Inj. Methyl Prednisolone 40mg IV state/ Inj. Dexamethasone 6mg IV stat
If required COVID Awake Repositioning Proning (CARP) protocol should be initiated.
Blood sampling for the COVID-19 panel, ECG and GRBS can be conducted in the triage area and Chest X-rays and HRCT Thorax can be planned once the patient stabilizes.
Zoning of Hospitals and Treatment Centers
Wards in Hospitals and Treatment Centers are to be categorized as per the following guidelines.
- Zone A: Ward/ floor for patients not requiring oxygen
- Zone B1: Ward/ floor for patients requiring 1-5 liters of oxygen per minute
- Zone B2: Ward/ floor for patients requiring 5-10 liters of oxygen per minute
- Zone C: Ward/ floor for patients requiring 10-15 liters of oxygen per minute
- Zone D: Ward/ floor for patients requiring more than 15 liters of oxygen per minute
Patient Management In Triage Centers – Requirements For Triage Areas
The government has also listed criteria that all triage areas must comply with:
- A single point of entry manned by security personnel
- Adequate area to receive patients arriving in ambulances. This area must be manned by at least 1 nursing staff and 1 group D worker.
- Patients must be accommodated on trolleys until they can be shifted to the designated area.
- Triage areas should have a minimum of 5-10 doctors and interns from specialties other than general medicine, pulmonary medicine and anesthesia.
- A proper waiting area should be demarcated for patients waiting to be triaged
- The center should have sufficient wheelchairs and trolleys.