Table 3.
Positions, Titles, and New Job Actions in HEICS Operations Section During the SARS Outbreak
| Position (Title) | New Job Actions |
|---|---|
| Operations chief (Chair of infection control committee) | Organized education and training on infection control measures and SARS-related medical care for section |
| Supervised implementation of infection control measures | |
| Medical care director (Chief of internal medicine department) | Organized physician education on SARS-related medical care |
| Chaired daily SARS case conference | |
| Supervised conversion of 50-bed pulmonary medicine ward to SARS isolation subunit and SARS critical care unit and adjacent 50-bed psychiatry ward to Employee isolation subunit | |
| Supervised implementation of infection control policy in patient care areas—hand-washing after every patient contact, restricted use of aerosol-producing interventions, etc. | |
| Assigned physicians to SARS-related units to match service loads | |
| Treatment areas supervisor (Chief of emergency medicine department) | Supervised infection control measures and SARS-related medical care in EMS |
| Suspended ED observation functions | |
| Triage unit leader (Head nurse of emergency medicine department) | Supervised fever screening of all persons entering ED entrance |
| Supervised identification of afebrile persons via colored stickers on outer clothing | |
| Supervised provision of respiratory personal protective equipment (PPE) to all afebrile persons entering ED – surgical masks for visitors, N95 or surgical masks for others depending on risk/preference | |
| Supervised diversion of febrile persons to SARS assessment unit | |
| Supervised provision of N95 masks to febrile persons | |
| Immediate treatment unit leader (Designated emergency physician) | Closed ED to EMS when adequate infection control threatened by patient volume |
| SARS assessment unit leader (Head of non-trauma division of emergency department) | Supervised screening of persons with fever for possible SARS |
| Supervised full evaluation of patients with possible SARS for suspected or probable SARS | |
| Supervised medical care of patients undergoing evaluation for suspected or probable SARS | |
| Supervised resuscitation of critically ill or injured patients with fever or possible SARS | |
| Supervised use of powered air purifying respirator with hood for personnel performing endotracheal intubation or airway suctioning | |
| Supervised isolation of persons with fever until possible SARS ruled out | |
| Supervised isolation of patients with suspected or probable SARS outside hospital until bed available in SARS isolation unit | |
| Supervised use of N95 masks by patients | |
| Supervised restriction of transport of non-essential equipment and materials out of area | |
| Supervised decontamination of essential equipment and materials leaving area with 5% bleach | |
| Inpatient areas supervisor (Chief of general medicine) | Coordinated patient disposition to SARS isolation subunit |
| Supervised relocation of patients in pulmonary ward to other inpatient wards at onset of SARS outbreak | |
| Supervised transfer of one patient with pulmonary tuberculosis (TB) requiring negative pressure isolation (NPI) bed to local TB hospital at onset of SARS outbreak | |
| SARS isolation unit leader (Pulmonary medicine attending and infectious disease attending physicians alternating every other day) | Supervised use of powered air purifying respirator with hood for personnel performing endotracheal intubation or airway suctioning |
| Supervised medical care in SARS isolation subunit | |
| Supervised isolation of patients with suspected or probable SARS in SARS isolation subunit | |
| Supervised isolation of febrile personnel in Employee isolation subunit | |
| Supervised use of N95 masks by patients and isolated employees | |
| Supervised decontamination of all personnel leaving unit via shower (with soap and water) and clothing change (hospital scrubs) | |
| Surgical services unit leader (Chief of surgery department)* | Cancelled elective surgery after Surgical Intensive Care Unit (SICU) closed |
| Maternal-child unit leader (Chief of pediatrics department)* | Assigned pediatricians to SARS assessment unit to help evaluate children with fever |
| Supervised planning and preparedness for pediatric SARS isolation unit if needed | |
| Critical care unit leader (Chief of critical care medicine department)* | Supervised conversion of SICU to SARS critical care unit |
| Supervised relocation of SICU patients to burn unit | |
| Supervised conversion of burn unit to new SICU | |
| Supervised planning for SARS-related medical care in two negative pressure isolation-Medical Intensive Care Unit (NPI-MICU) beds if needed | |
| SARS critical care unit leader (chief of internal medicine department) | Supervised use of powered air purifying respirator with hood for personnel performing endotracheal intubation or airway suctioning |
| Supervised medical care in both SARS critical care areas (12th floor and SICU) | |
| Supervised isolation of critically ill patients with suspected or probable SARS | |
| Supervised use of N95 masks by patients | |
| Supervised decontamination of all personnel leaving unit via shower (soap and water) and clothing change (hospital scrubs) | |
| Supervised installation of in-line HEPA filters in ventilator circuits | |
| Supervised planning for medical care in four NPI-MICU beds if needed | |
| General nursing care unit leader (Deputy director of nursing department) | Supervised nursing care in SARS isolation and critical care units |
| Supervised fever screening of personal attendants twice per 8-h shift | |
| Outpatient services unit leader (Chief of family medicine department) | Supervised fever screening of all persons entering outpatient entrance from 7:30 a.m.–9:30 p.m. daily |
| Supervised identification of afebrile persons via colored stickers on outer clothing | |
| Supervised provision of respiratory PPE to all afebrile persons entering hospital—surgical masks for visitors, N95 or surgical masks for others depending on risk/preference | |
| Supervised diversion of febrile persons to SARS assessment unit | |
| Supervised provision of N95 masks to febrile persons | |
| Supervised mailing of prescription refills to outpatient clinic patients | |
| Morgue unit leader (General manager) | Supervised decontamination, storage, and transport of SARS-related decedents for cremation |
| Supervised isolation of SARS-related decedents in two layers of body bags | |
| Supervised transport of SARS-related decedents using designated transport routes | |
| Established transport route from hospital to cremation site | |
| Laboratory unit leader (Chief of clinical pathology department) | Supervised isolation of SARS-related specimens in two plastic bags during transport and handling |
| Supervised identification of SARS-related specimens via colored stickers on containers | |
| Supervised transport of SARS-related specimens, including use of designated transport routes | |
| Organized transport of SARS-related specimens for reverse transcriptase polymerase chain reaction (RT-PCR) testing to TCDC in Taipei before May 1 | |
| Supervised laboratory upgrade to biosafety level 3 | |
| Supervised RT-PCR testing of SARS-related specimens from NCKUH and other hospitals in region after May 1 | |
| Radiology unit leader (Chief of radiology department) | Supervised deployment of portable x-ray machines and radiology technicians to SARS assessment, isolation and critical care units |
| Pharmacy unit leader (Chief of pharmacy department) | Supervised acquisition and distribution of ribavirin to SARS isolation and critical care units |
| Human services director (Chief of personnel department) | Assigned administrative employees to fever screening subunit |
| Supervised distribution of information regarding infection control policy to all personnel | |
| Supervised distribution of advisories to all personnel regarding possible isolation in Employee isolation subunit or home isolation | |
| Staff support unit leader (Chief of labor safety and health department) | Supervised production of intranet database for recording body temperatures of personnel |
| Supervised separation of personnel meal and rest areas from patient care areas | |
| Psychological support unit leader (Chief of psychiatry department) | Supervised counseling for patients and employees isolated in SARS isolation and critical care units |
| Supervised critical incident stress debriefing (CISD) for personnel working in SARS isolation and critical care units | |
| All units | Supervised monitoring of personnel twice per shift |
| Supervised education of personnel regarding infection control policy and measures | |
| Supervised use of N95 masks and universal precautions by personnel or patients in high risk areas—Fever screening subunit, Triage unit, Immediate treatment unit, Laboratory unit, Morgue unit, SARS-related units | |
| Supervised use of N95 or surgical masks by personnel or patients in low-risk areas | |
| Supervised restriction of transport of non-essential equipment or materials out of SARS-related units | |
| Supervised decontamination of essential equipment or materials leaving SARS-related units with 5% bleach |
*
Did not participate in survey, data obtained from Medical care director and Inpatient areas supervisor.