A Global Survey of Emergency Department Responses to the COVID-19 Pandemic

Prashant Mahajan, MD, MPH, MBA; Chong Shu-Ling, MD, MBBS, MRCPCH, MCI, MPH; Camilo Gutierrez, MD; Emily White, MS; Benjamin A.Y. Cher, MS; Elizabeth Freiheit, PhD; Apoorva Belle, MA, MHA; EMERGE NETWORK; Johanna Kaartinen, MD, PhD; Vijaya Arun Kumar, MD, MPH; Paul M. Middleton, MD; Chip Jin Ng, MD; Daniel Osei-Kwame, MBChB; Dominik Roth, MD, PhD; Tej Prakash Sinja, MBBS, MS; Sagar Galwankar, BBS, DNB, MPH; Michele Nypaver, MD; Nathan Kuppermann, MD, MPH; Ulf EKelund, MD, PhD


Western J Emerg Med. 2021;22(5):1037-1044. 

In This Article

Abstract and Introduction


Introduction: Emergency departments (ED) globally are addressing the coronavirus disease 2019 (COVID-19) pandemic with varying degrees of success. We leveraged the 17-country, Emergency Medicine Education & Research by Global Experts (EMERGE) network and non-EMERGE ED contacts to understand ED emergency preparedness and practices globally when combating the COVID-19 pandemic.

Methods: We electronically surveyed EMERGE and non-EMERGE EDs from April 3–June 1, 2020 on ED capacity, pandemic preparedness plans, triage methods, staffing, supplies, and communication practices. The survey was available in English, Mandarin Chinese, and Spanish to optimize participation. We analyzed survey responses using descriptive statistics.

Results: 74/129 (57%) EDs from 28 countries in all six World Health Organization global regions responded. Most EDs were in Asia (49%), followed by North America (28%), and Europe (14%). Nearly all EDs (97%) developed and implemented protocols for screening, testing, and treating patients with suspected COVID-19 infections. Sixty percent responded that provider staffing/back-up plans were ineffective. Many sites (47/74, 64%) reported staff missing work due to possible illness with the highest provider proportion of COVID-19 exposures and infections among nurses.

Conclusion: Despite having disaster plans in place, ED pandemic preparedness and response continue to be a challenge. Global emergency research networks are vital for generating and disseminating large-scale event data, which is particularly important during a pandemic.


Emergency departments (ED) globally are on the front lines in addressing the COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most EDs have disaster preparedness plans in place for health system responses to large-scale disasters, including infectious disease outbreaks. However, infectious disease pandemics pose a unique challenge due to their infrequency and the extended period over which they may occur.

The incomplete and evolving knowledge of a novel pathogen limits early preparations for resource needs during a pandemic and predisposes individuals and communities to poor health outcomes. Critical evaluation of the global response to the 2009 H1N1 influenza pandemic identified substantial variability and poorly conceived or even absent preparedness plans in many emergency care systems.[1] This missed opportunity to implement successful disaster response plans prior to the following major infectious outbreak highlights the need to study global ED responses and healthcare system preparedness on a continuous basis.[2,3] With the ongoing COVID-19 pandemic, knowledge regarding presentation, prognosis, and response to therapies continues to evolve. It is imperative for data, lessons learned, and successful approaches used by EDs with a high pandemic burden to be made rapidly and reliably available to those in earlier stages.

Emergency medicine networks are valuable for collection of data supporting research, administrative, and educational goals and can potentially be leveraged to collate and disseminate experiences from disasters.[4] Emergency Medicine Education & Research by Global Experts (EMERGE) is a newly developed network of 26 EDs across 17 countries and six continents whose goal is to improve the care of acutely ill and injured patients by garnering the collective experiences of its member EDs.[5,6]

In this study we sought to leverage the EMERGE network and establish collaborations with non-EMERGE EDs to determine global ED preparedness for COVID-19 and, specifically, to identify successful processes and protocols that may be adopted and/or adapted by other EDs to improve patient outcomes.