Each and every patient has to use the same, single entrance on arrival to the trauma ambulance, where they undergo a COVID-19 risk assessment which consists of a questionnaire and physical examination performed by medical professionals wearing appropriate protective equipment. Thereafter, patients are guided into separate parts of the trauma care unit based on their risk assessment results. Suspected SARS-CoV2 positive patients must undergo sampling for RT-PCR testing immediately. Until the arrival of results, they have to be isolated and treated as SARS-CoV2 positive. The contact personnel must be protected properly (special full cover clothing, FFP3 masks).
In the treatment of patients in extremis, risk assessment and diagnostic testing are delayed and SARS-CoV2 positivity is assumed automatically. To make such shortcuts possible, medical professionals have to be ready for the prompt management of potentially infected patients around-the-clock. Therefore, one trauma nurse dressed in personal protective equipment (PPE) and one trauma surgeon ready for the prompt donning of PPE are always available in our institute.
Modifications were made in several technical details of routine operative care also. In case there is a reasonable alternative, general anesthesia should be avoided. By airway generating procedures, only the required personnel in PPE are allowed to be present. Urgent, but not prompt emergency surgeries—such as pertrochanter- or femoral neck fractures—can be delayed by 24–48 h, till the result of diagnostic testing arrives. In case of a negative result and no need for airway manipulation, the operation can be performed under ordinary circumstances. Suspected or confirmed SARS-CoV2-positive patients can undergo surgery only in operating rooms that are designated for this purpose. OR personnel have to wear full PPE.
Regarding postoperative treatment, the early discharge of SARS-CoV2-negative trauma patients is a priority, even if it means that the principles of musculoskeletal rehabilitation have to be set aside temporarily. The postoperative management of people with positive or unknown status is performed by our delegated trauma surgeon residents on a designated ward of infectious diseases. Strict isolation is obligatory in case of an unknown viral status, while cohort isolation is allowed for confirmed SARS-CoV2-positive patients if the capacity level of the ward makes it necessary. Faculty from the home isolation team is always available for our resident doctors for online consultations.
Ultimately, the practical aspects of trauma care must always be adapted to the current epidemiological situation.
Our patient management protocol is demonstrated on Fig. 2.