Identify-Isolate-Inform: A Modified Tool for Initial Detection and Management of Middle East Respiratory Syndrome Patients in the Emergency Department

Identify-Isolate-Inform: A Modified Tool for Initial Detection and Management of Middle East Respiratory Syndrome Patients in the Emergency Department

Kristi L. Koenig

Middle East respiratory syndrome (MERS) is a novel infectious disease caused by a coronavirus(MERS-CoV) first reported in Saudi Arabia in September 2012. MERS later spread to other countriesin the Arabian Peninsula, followed by an outbreak in South Korea in 2015. At least 26 countrieshave reported MERS cases, and these numbers may increase over time. Due to internationaltravel opportunities, all countries are at risk of imported cases of MERS, even if outbreaks do notspread globally. Therefore, it is essential for emergency department (ED) personnel to be able torapidly assess MERS risk and take immediate actions if indicated. The Identify-Isolate-Inform (3I)tool, originally conceived for initial detection and management of Ebola virus disease patients in theED and later adjusted for measles, can be adapted for real-time use for any emerging infectiousdisease. This paper reports a modification of the 3I tool for use in initial detection and managementof patients under investigation for MERS. Following an assessment of epidemiologic risk factors,including travel to countries with current MERS transmission and contact with patients with confirmedMERS within 14 days, patients are risk stratified by type of exposure coupled with symptoms of feverand respiratory illness. If criteria are met, patients must be immediately placed into airborne infectionisolation (or a private room until this type of isolation is available) and the emergency practitionermust alert the hospital infection prevention and control team and the local public health department.The 3I tool will facilitate rapid categorization and triggering of appropriate time-sensitive actions forpatients presenting to the ED at risk for MERS.

2015

DOI: 10.5811/westjem.2015.7.27915

Western Journal of Emergency Medicine

eScholarship Publishing, University of California

Medicine, Medical emergencies. Critical care. Intensive care. First aid

EN