Article Text

Download PDFPDF
Delivering Community Emergency Medicine during the COVID-19 pandemic: the Physician Response Unit
  1. Rich Carden1,
  2. Bill Leaning1,2,
  3. Tony Joy1,2
  4. PRU Physician Response Unit
    1. 1 Physician Response Unit, Barts Health NHS Trust, London, UK
    2. 2 London's Air Ambulance Charity, London, UK
    1. Correspondence to Dr Tony Joy, Physician Response Unit, Barts Health NHS Trust, London E1 1FR, UK; tonyjoy{at}


    The COVID-19 pandemic has presented significant challenges to services providing emergency care, in both the community and hospital setting. The Physician Response Unit (PRU) is a Community Emergency Medicine model, working closely with community, hospital and pre-hospital services. In response to the pandemic, the PRU has been able to rapidly introduce novel pathways designed to support local emergency departments (EDs) and local emergency patients. The pathways are (1) supporting discharge from acute medical and older people’s services wards into the community; (2) supporting acute oncology services; (3) supporting EDs; (4) supporting palliative care services. Establishing these pathways have facilitated a number of vulnerable patients to access patient-focussed and holistic definitive emergency care. The pathways have also allowed EDs to safely discharge patients to the community, and also mitigate some of the problems associated with trying to maintain isolation for vulnerable patients within the ED. Community Emergency Medicine models are able to reduce ED attendances and hospital admissions, and hence risk of crowding, as well as reducing nosocomial risks for patients who can have high-quality emergency care brought to them. This model may also provide various alternative solutions in the delivery of safe emergency care in the postpandemic healthcare landscape.

    • prehospital care
    • emergency care systems

    This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

    Statistics from

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


    • Handling editor Mary Dawood

    • Twitter @richcarden, @tonyjoy81

    • Collaborators Physician Response Unit collaborators on design and implementation of pathways: Ms Husna Ahmad (London's Air Ambulance Charity (LAA), Barts Health NHS Trust (BH)), Dr Kathryn Baird (LAA, BH), Ms Mariana Campilho (LAA, BH), Dr Annie Chapman (LAA, BH), Ms Katy Hannaford (LAA, BH), Mr Dan Harding (LAA, London Ambulance Service (LAS)), Dr Rachael Harding (LAA, BH), Dr Kate Jackson (LAA, BH), Ms Nicola Lewis (BH), Dr Pip Lewis (LAA, BH), Dr Claire McCahill (LAA, BH), Dr Jon Mackenney (LAA, BH), Dr Sophie Mitchinson (LAA, BH), Dr Richard Muswell (LAA, BH), Dr Emezie Odigboh (LAA, BH), Mr Adam Ozbek (LAA, LAS), Dr Tom Palmer (LAA, BH), Dr Varsha Rao (LAA, BH), Mrs Lorraine Shoker (BH), Dr James Townsend (LAA, BH), Ms Ana Waddington (LAA, BH), Mr James Walters (LAA, LAS), Dr Anne Weaver (LAA, BH), Dr Tara Whitburn (BH), Dr David Whittington (LAA, BH), Dr Adam Woodgate (LAA, BH).

    • Contributors The Physician Response Unit team were responsible for the hard work that led to the formation and delivery of the pathways described in the article. All members of the team reviewed the manuscript. RC wrote the manuscript. TJ edited and provided senior oversight of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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