Nepal Orthopaedic Association (NOA) guideline For Doctors on COVID 19 pandemic. Nepal Orthopaedic Association (NOA) guideline for the management of orthopaedic conditions and trauma during and after COVID 19 pandemic

COVID 19 presents unprecedented pressure and challenges to all mankind, generating a large number of patients in a short period of time, testing limits of our medical practice. Management of trauma patients in the extraordinary circumstances may not be the ideal one but one tailored to the need of the hour, balancing safety, resources, and optimal treatment. Social distancing and lockdown might reduce some injuries, but we should also support the health service system of the country by decreasing the operative load and resource consumption. The workforce will be redeployed to alternate roles. Maintaining normal orthopedic emergency services will be increasingly difficult as the workforce and resources deplete. Triaging to deliver maximal benefit to patients and optimally protect and preserve the human and other resources should be our main aim. Our plans must be dynamic and reactive to the unfolding situation. The surgeon should stay vigilant, have a high level of clinical suspicion, take more precautions to avoid COVID 19, be more flexible, be collaborative, and show leadership in the coming hard times.

NOA aims to provide a guideline to support surgeons to make the decision on day to day basis during and after COVID 19 pandemic. This guideline is not immutable and will be modified as the situation evolves; evidence develops and results in feedback. Also, national and local guidelines may dictate the priorities.

Objectives

Maintain emergency surgical capabilities by rotation of staff and maintaining a healthy reserve
Protection and preserve the surgical workforce. Minimize risk to staff and patient by
Nonsurgical management whenever possible
PPE used correctly
Rest and recuperation must be provided
Avoid long term overwork and fatigue
Psychological support to all team members
Real-time training on infection control measures as needed
Fulfill any other roles as required by the national and local authority
Resource optimization
1. Theatre resources
  1. Regular appraisal of available resources
  2. Daily strategic meeting with theatre coordinator and anesthetics and relevant surgical specialty

Know relevant clinical details, ICU bed status, absentees, redeployed staffs

Agree upon resource allocation and patient prioritization

Equipment and resources relocation for other needs for COVID 19

Documentation

Management decisions should be recorded in medical record and notes should be made about the patient being assessed and treated during during COVID 19 pandemic.