To accommodate the growing number of Covid-19 patients in Metro Manila, VRP Medical Center will be opening the extension of its Emergency Room (ER) this week. This new extension will double VRP’s ER capacity and will be dedicated to Covid-19 cases.
Dr. Dan Luchangco, an ER consultant at VRP, related that it was in the middle of the pandemic when he and the other ER doctors were having a difficult time segregating people at the ER. They even reached a point where Covid-19 patents had to wait in the ER for several days just to get a bed in the patient floors.
“Sadly, it had come to the point where we had to turn away some patients because we simply had nowhere to put them. They did not have anywhere to lie down and so we had to stop accepting,” Dr. Luchangco said. “We also had to maintain the capacity to treat the true emergencies that come in so we try to reserve beds for that as well.”
To remedy the situation, the management acted decisively and converted the vacant long and narrow lot located beside the hospital into another ER facility. The existing ER has 16 beds and the ER Extension will have an additional 12 beds, a green zone and a nurse’s station.
The entrance to the ER Extension is located just across the entrance of the existing ER facility. Upon entry to the ER Extension, the first room across it is the resuscitation area which will accommodate patients who are dead on arrival or need to be revived. Next to the resuscitation area are four critical beds which are “equipped with mechanical ventilators, and all the critical care equipment that the patient needs. All rooms have cubicles with walls in between.”
“So this whole area, the ER Extension, will be considered what we call a hot zone so we know that we have Covid patients,” Dr. Luchangco said. “So you can imagine it is long and narrow, so two rows. There is a corridor down the middle and two rows of beds.”
As for the ventilation of the area, the air “will go through the hallway, out to the beds, through the exhausts on the outer side and then out.” The ventilation is designed to protect not only the patients from the staff as well. The ER Extension will also have its own mobile X-Ray machine so that the patients will no longer have to be brought outside of the ER facility.
One interesting feature of the Extended ER is the green zone. Dr. Luchangco related that this is the area where the health-care workers and doctors will enter and exit the new ER facility. As the staff enter the green zone, they will be in the common area where they will change into their scrubs. Prior to entering the hot zone, they will have to put on their PPEs at the donning and doffing area.
“Donning means putting on your PPE and doffing is to remove and these are very important steps to controlling infection obviously because you have to put on your PPE carefully and also, even more important, is the doffing which is to remove your contaminated PPE,” he said.
“So there should be a dedicated area for this and it should be done very carefully in a step by step manner so that you do not end up infecting yourself as you are removing protection. After removing the PPE, the staff immediately takes a shower just to be sure they are clean prior to changing into their clothes,” he added.
Dr. Luchangco pointed out that the inclusion of the green zone in the ER Extension was a welcome move since “we don’t know when this will end and this can be used later on for other infection pandemics.” There is also a treatment room where doctors can do procedures like suturing and casting for broken bones.
There is usually a call room which has beds where the doctors and staff can rest. Since they have to wear PPEs and it is not really safe to lie down, lounge chairs have been provided at the nurse’s station where “the staff will be able to rest while maintaining their PPE.”
“The ER Extension has been many months in the making but once the management decided to convert the vacant lot, a team was put together to plan for the ER Extension,” Dr. Luchangco said. “It went through the Department of Health permits and other government permits so this was constructed very fast to meet the needs of Covid-19 patients.”