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Emergency departments and the COVID-19 pandemic: making the most of limited resources
  1. Rob Mitchell1,2,3,
  2. Colin Banks3,4
  3. On behalf of authoring working party
  1. 1 Emergency and Trauma Centre, Alfred Hospital, Melbourne, Victoria, Australia
  2. 2 School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  3. 3 Global Emergency Care Committee, Australasian College for Emergency Medicine, West Melbourne, Victoria, Australia
  4. 4 Emergency Department, Townsville Hospital and Health Service, Townsville, Queensland, Australia
  1. Correspondence to Dr Rob Mitchell, Emergency and Trauma Centre, Alfred Hospital, Melbourne VIC 3004, Australia; ro.mitchell{at}

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Dear Editor,

The coronavirus disease 2019 (COVID-19) pandemic will stretch hospital resources all over the world. EDs in high-income countries are not immune, but those in low-income and middle-income countries (LMICs) are likely to be impacted more significantly. Emerging data speak to overwhelming demands for care and widespread disruption of hospital functioning.1

In order to support colleagues in resource-limited settings, the Australasian College from Emergency Medicine (ACEM) has developed a free guide for emergency care (EC) clinicians in LMICs preparing for a surge of patients with COVID-19.2 Content was developed by a working party of ACEM’s Global Emergency Care Committee and included EC clinicians from Timor Leste, Vanuatu, Papua New Guinea and Solomon Islands. The guide provides consensus-based advice on optimising resource utilisation during the pandemic and draws heavily on technical guidance from the WHO.3 It is intended to complement, not replace, local and national guidelines.

The guide is structured according to the central components of ED disaster response: systems, space, supplies and staff. A small number of boxes provide specific guidance to clinicians on triage and screening, infection prevention and control and clinical management. Figure 1 reproduces the section of the guide dedicated to ‘systems’.


Excerpt from the guide focussed on 'systems'. IPC, Infection, Prevention and Control.

EC clinicians in LMICs will be deeply impacted by COVID-19, and there is a substantial risk of burnout and moral injury. ACEM’s guide is an attempt to express solidarity with colleagues in resource-limited settings and will hopefully stimulate further collaboration among the global EC community.

The guide is available free online at: Feedback on the document is encouraged and should be directed to



  • Twitter @robdmitchell

  • Collaborators Gary Nou, Vincent Atua, Patrick Toito’ona, Gustodio Alves de Jesus, Gerard O'Reilly, Georgina Phillips, Nick Taylor, Megan Cox and Sarah Korver

  • Contributors RM led the working party that developed the guide and drafted this manuscript. CB had oversight of the initiative as Chair of the Australasian College for Emergency Medicine Global Emergency Care Committee.

  • Funding Formatting and online publication of the guide was supported by the Australasian College for Emergency Medicine.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.