Bhubaneswar: The Odisha government on Tuesday directed the district administrations to manage critical COVID-19 patients in the intensive care unit (ICU) or high dependency unit (HDU) of all districts initially instead of referring them to Bhubaneswar or Cuttack.
In a letter, Health and Family Welfare Department’s Additional Chief Secretary PK Mohapatra asked the District Collectors, Municipal Commissioners and Chief District Medical Officers to impart more training at grass root level and district-level hospitals, so that patient management is accurate and referral will be reduced.
“More number of dialysis beds, maternity beds, Oncology beds, trauma beds may be created for Covid patients, especially in peripheral facilities. AHPGIC can have 25 beds to take care of Chemotherapy requirement of Covid cases with cancer and SCB can have NICU to take care of Covid positive infants,” the letter stated.
All facilities should follow the notified referral policy to enable seamless coordination between the sending and receiving hospitals. The Cluster district concept must be followed. Patients insisting on being referred to Bhubaneswar or Cuttack should be counselled and dissuaded, as there is life risk in transport, the letter read.
Patients in transit should be accompanied by Emergency Medical Technician so that the patients do not develop hypoxia during transport. Unless stable, the patients should not be transported.
“Close monitoring and timely early stage treatment should be given to cases in wards so that fewer patients become serious to be put in ICU. The emphasis should be on providing non-invasive care like HFNC, may be provided in all the Covid Hospitals. Remdesivir can be considered for moderate patients, if allowed under ICMR protocol. Care should be taken for early detection of lungs infection,” it stated.
The administrations were asked to set up step-down ICUs by reserving 50% beds of the ICU beds. The patients who become stable in ICU should be shifted to the Step-down ICU.
The concept of virtual ICU may be started so that appropriate care can be given by expert advice from remote tertiary hospital level.
Diagnostic facilities such as CT scan (interpreted by Radiologist) and ultrasound of lungs should be strengthened in peripheral hospitals. Peripheral doctors can be trained in these diagnostic procedures.
Wherever possible, trained manpower can be mobilized from low-burden districts to high burden districts.
Treating teams should be provided with timely required support in terms of equipment and drugs.