Prevention of temporary emergency medical center closure through isolation zone and screening triage in COVID-19 outbreak

Background: In Korea, temporary emergency medical center (EMC) closures are used to prevent nosocomial transmission of COVID-19, but they can harm the local emergency medical system. This study aimed to evaluate the occurrence of temporary EMC closures and the adequacy of isolation zone and screening triage during the COVID-19 outbreak.Methods: This retrospective study was conducted in Daegu, Korea from 18 February 2020 to 30 April 2020, in patients who caused temporary EMC closures. The distribution of EMC closures according to time and isolation zone installation, screening triage by four criteria (epidemiologic link, fever, respiratory symptoms, unknown pneumonia), reasons for RT-PCR SARS-CoV-2 tests, and causes of EMC closures was analysed. Results: There were a total of 26 temporary EMCs closures including eight multi-center closures. Temporary EMCs closures occurred frequently in the early stages of outbreak. Temporary EMC closure was made without RT-PCR SARS-CoV-2 confirmation. Before and after isolation zone installation, there were 24 and two temporary EMC closures, respectively. Respiratory symptoms were the most common basis for identification at screening triage centers, and fevers were the symptoms most commonly recognized by clinicians. Most (88.5%) patients causing closures met one or more of the four criteria at EMC admission. The most common cause of temporary EMC closures was patient complaint of prominent symptoms suggestive of another disease regardless of presence of screening criteria (18 cases, 69.2%).Conclusions: Isolation zone installation and strictly applying the four criteria individually in screening triage is useful in reducing temporary EMC closure.