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Bulletin Brief: May 19

Tue, 19 May 2020 20:52:18 GMT

*New* ACS Post-COVID-19 Readiness Checklist for Resuming Nonemergent Surgery Issued

COVID-19 Pandemic Breast Cancer Consortium Outlines Considerations for Resumption of Care

ACS Academy of Master Surgeon Educators Committee Addresses Challenges and Opportunities in Surgical Training during COVID-19

2020 ACS Quality and Safety Conference to Be Held Virtually

ACS News and Announcements

ACS Post-COVID-19 Readiness Checklist for Resuming Surgery

Fri, 15 May 2020 20:44:58 GMT

As many states have approved the resumption of elective surgery, we understand patients may have questions and specific uncertainties about the safety of undergoing elective operations in hospitals, regardless of whether COVID-19 patients are being concurrently treated in the same facility.

The patient-surgeon relationship is one that is built on transparency and trust. More than ever, patients are turning to their surgeons for advice and information that will help them feel more knowledgeable not just about their surgery, but having that surgery in a time when COVID-19 exists.

To address this, the ACS developed the American College of Surgeons Post-COVID-19 Readiness Checklist for Resuming Surgery. The intent of this checklist is to help surgeons ultimately communicate the important items patients want to know.

In the coming days, the College will provide a tool kit of materials to help you communicate with patients regarding how they can safely return for surgery they need. We will continue to support our surgical community and patients as we return to surgical care.

https://www.facs.org/covid-19/checklist

Bulletin Brief: May 12

Tue, 12 May 2020 20:49:32 GMT

his new newsletter replaces Bulletin: ACS COVID-19 Updates, which ended publication last week, and the weekly ACS NewsScope that you traditionally have received on Thursday night. It combines all the elements of both newsletters, as well as new content, in a reader friendly and responsive format. As always, your feedback is appreciated as this publication evolves. https://www.facs.org/publications/bulletin-brief/051220

5 Things to Know:

Lisa A. Newman, MD, MPH, FACS, FASCO, Second Vice-President-Elect, ACS, explains why African Americans are more severely affected by COVID-19 to TIME Reports with Katie Couric

Contact Congress today to encourage support for ACS provisions in the next COVID-19 legislation

New ACS National Professional Development Seminars can help medical students whose undergraduate education has been affected by COVID-19

Apply for open 2020 ACS Committee opportunities

ACS Surgeon Specific Registry updates: MIPS 2019 data submitted and MIPS 2020 participation available

Bulletin: ACS COVID-19 Updates—May 8

Tue, 12 May 2020 18:52:36 GMT

As the curve begins to flatten and hospitals and surgeons’ offices resume offering elective procedures, the COVID-19 Communications Committee has set its sights on new opportunities.

The Bulletin: ACS COVID-19 Updates has served the community of health care providers well during the acute phase of this pandemic. Going forward, the Bulletin: ACS COVID-19 Updates will evolve to a new e-newsletter, Bulletin Brief. This new weekly communications vehicle will continue to provide updates on important advances the American College of Surgeons (ACS) and other stakeholders are making to assist you in providing optimal care for the duration of the pandemic, but also will include the latest information on other ACS activities and news.

Bulletin Brief will replace this newsletter and the weekly ACS NewsScope that you traditionally have received on Thursday night. It will be distributed Tuesday nights and will combine all the elements of both newsletters in a reader-friendly and responsive format.

> Read more

Surgeons Launch Campaign to Prevent Steep Medicare Cuts

Fri, 08 May 2020 18:55:04 GMT

As most of you already know, surgeons are facing steep Medicare and other payment cuts in the next 24 to 30 months. Continued reimbursement cuts will result in unsustainable financial strains on surgeons’ practices, jeopardizing patients’ timely access to care. In the near term, changes in the office and outpatient evaluation and management (E/M) codes adopted by the Centers for Medicare & Medicaid Services (CMS) will reduce Medicare payments to surgeons by as much as 7 percent starting January 1, 2021. We also anticipate that CMS will propose double-digit cuts in global surgery payments sometime in the future.

Coming together to combat this threat, and to protect and defend the interests of surgeons of all specialties around the country, national surgical organizations, including the American College of Surgeons, have formed the Surgical Care Coalition. The coalition has coalesced around a comprehensive, multi-faceted campaign to educate the public and policymakers about the value of surgeons, and to prevent significant reimbursement cuts.

While we have engaged experts in a variety of areas to assist us with this effort, we also need your help.

In the coming weeks and months, we will ask you to take action in support of this campaign. Whether it is by responding to surveys, writing your elected officials, or penning an OpEd, your active participation in this campaign is imperative and crucial to its success.

These past months have been an incredibly trying time for every single American. Our country’s health care professionals who continue to fight on the front line of the COVID-19 pandemic have had to shoulder an even greater share of the burden. Given the current situation and the role surgeons are playing in it, now is not the time to place further strains on the health care system with steep and unsustainable reimbursement cuts.

We will regularly update you on the coalition’s progress, but in the meantime, please let me know if you have any questions.

All the best,

Valerie W. Rusch MD, FACS
President, American College of Surgeons

Beth H. Sutton, MD, FACS
Chair, Board of Regents, American College of Surgeons

L. Scott Levin, MD, FACS
Vice-Chair, Board of Regents, American College of Surgeons

David B. Hoyt, MD, FACS
Executive Director, American College of Surgeons

Gary L. Timmerman, MD, FACS
Chair, Health Policy and Advocacy Group, American College of Surgeons

Bulletin: ACS COVID-19 Update—May 5

Tue, 05 May 2020 22:30:00 GMT

As hospitals and surgeons across the nation resume elective operations, they face yet another challenge: patients who are avoiding hospitals and other health care centers until they are certain the COVID-19 pandemic has ended. An AJC (Atlanta Journal Constitution) article notes that it is not only patients who can now undergo operations that were postponed during the peak of the pandemic who are avoiding health care facilities, but also patients who are experiencing symptoms of impending cardiac arrest, stroke, and other conditions that typically would warrant a trip to the emergency department.

As this article notes, the problem extends to all parts of the country, with patients delaying treatment only to wind up with a much more severe medical condition that requires more costly care or, worse yet, that ends in premature mortality.

It is our responsibility as health care professionals to assure patients that our institutions and offices are clean and safe places where the strictest standards of care are followed. The American College of Surgeons (ACS) urges its members to explain the evidence-based protocols that they have put in place to ensure the delivery of optimal care.

https://www.facs.org/covid-19/newsletter/050520

Bulletin: ACS COVID-19 Update—May 1

Sat, 02 May 2020 01:00:00 GMT

The intent of this newsletter is to provide readers with a summary of the American College of Surgeons’ (ACS) activities related to the novel coronavirus (COVID-19). We summarize clinical guidance and issues, updates on promising therapies, recommendations and information on the availability of personal protective equipment (PPE), links to peer-reviewed literature, resources to help surgeons maintain their well-being, and details about educational events.

Bulletin: ACS COVID-19 Update—April 28

Wed, 29 Apr 2020 01:00:00 GMT

The novel coronavirus (COVID-19) has taken a toll on patients, their families, and on the health care professionals who are battling this pandemic on the frontlines. We anticipate that members of the American College of Surgeons (ACS) will find this newsletter useful in addressing the financial issues they are experiencing and that it will point them toward the resources they need to get through this difficult time financially and emotionally.

https://www.facs.org/covid-19/newsletter/042820

Bulletin: ACS COVID-19 Updates—April 24

Fri, 24 Apr 2020 21:41:40 GMT

Various parts of the U.S. are preparing to incrementally offer surgical services that have been deferred until their state and local governments, as well as public health officials, were certain medical centers had the capacity and resources to care for patients with COVID-19 and those who have not been infected. To help surgeons and hospitals through the transition, the April 17 issue of this newsletter provided guidance on ramping up elective surgical care. This issue highlights efforts to help surgeons deal with the impact that COVID-19 has had on their financial stability and to explore new treatment options.

https://www.facs.org/covid-19/newsletter/042420

New ACS COVID-19 Registry: Registration Now Open

Fri, 24 Apr 2020 19:41:09 GMT

The American College of Surgeons (ACS) COVID-19 Registry is now available to all hospitals interested in collecting important clinical patient data for a disease about which little is known. Hospitals are now joining.

The registry gathers data on surgical and nonsurgical COVID-19 positive patients.

The ACS COVID-19 Registry is a quality improvement program and has been officially granted non-human subject research status, which does not require institutional review board oversight. > Learn More

Bulletin: ACS COVID-19 Update—April 10

Fri, 10 Apr 2020 21:13:37 GMT

April 10th Bulletin

The Centers for Medicare & Medicaid Services (CMS) announced that hospitals, physicians, and other health care providers would be receiving $30 billion in grants directly from CMS. The American College of Surgeons (ACS) has been actively advocating for these grants. In short, it appears that each physician who participated in the Medicare program in 2019 will receive approximately 6.1 percent of their 2019 Medicare revenue. These are payments, not loans, to health care providers, and will not need to be repaid. The specific announcement including the formula of how much each individual will receive, how the payments will be made and other details regarding the program can be found

here.

Efforts to provide resources and practical suggestions for surgeons to consider as they strive to combat the financial pressures resulting from the COVID-19 pandemic, the Practice Protection Committee met this week by videoconference and has developed an updated resource document found in this issue. Fellows will find information and links to application information for three federal programs that provide financial resources, a list of questions to consider for discussion with their professional tax advisor, a document to assist surgeons who provide telehealth services, and perhaps most importantly, a section on practical suggestions and options to consider using in these unprecedented times.

In addition, this issue of Bulletin: COVID-19 Updates responds to some of the critical challenges facing members of the ACS. Questions continue regarding clinical and ethical decisions. Among the most wrenching are decisions regarding end-of-life and resuscitation maneuvers such as cardiopulmonary resuscitation (CPR). Throughout this epidemic, patients and their families must trust that CPR will be administered fairly and without restraint to all patients who need it. The Alden March Bioethics Institute of Albany Medical College, NY, has developed a framework to guide CPR decision making, which is highlighted in this issue. We also provide guidance on providing ventilator care to patients with acute respiratory distress syndrome.

We review new therapies for COVID-19 patients in this issue, including the use of convalescent plasma, which has been used successfully in the past to treat patients suffering from Ebola, polio, and mumps, and severe acute respiratory syndrome. More specifically, a consortium of more than 50 hospitals and universities has created the National COVID-19 Convalescent Plasma Project to pool efforts to investigate the use and efficacy of convalescent plasma from COVID-19 patients who recovered from the disease.

Telemedicine is increasingly used to protect the health and safety of both health care professionals and their patients, to share knowledge across borders, and to ensure access to care for individuals in rural and other under-resourced areas. The Coronavirus Aid, Relief, and Economic Security (CARES) Act, enacted March 27, appropriated $200 million to the Federal Communications Commission (FCC) for an emergency program to provide funding so health care providers can purchase services and devices necessary to provide telehealth care. Additionally, the FCC separately allocated $100 million to create a Connected Care Pilot Program, which will provide monies to cover 85 percent of the costs of broadband connectivity. These efforts are summarized in this issue of the newsletter.

The ACS is concerned that African Americans are disproportionately affected by COVID-19 and are dying from the virus at higher rates than whites. This issue includes an analysis of the problem.

The public service announcements asking people to stay home to stop the spread of COVID-19 continue. Today, former Los Angeles Chargers placekicker Rolf Benirschke partnered with ACS to ask people to help their communities by practicing social distancing.

It has been said that great challenges bring great opportunities. The COVID-19 pandemic has proven to be perhaps the greatest challenge many ACS members have experienced. This newsletter continues to serve as a valuable resource for members who are on the frontlines and points them toward opportunities to create a better future for their patients. Be sure to stay tuned for the next edition, when we start to ramp up hospital capacity in the coming weeks.

ACS Statement on Discrimination

Fri, 03 Apr 2020 17:16:25 GMT

The American College of Surgeons (ACS) is aware of reports of racial and ethnic discrimination during the COVID-19 pandemic. Since this outbreak started, Asian members of both our own surgical community and the public at large continue to experience bias. We strongly condemn these actions.

COVID-19 does not discriminate. It affects all people, regardless of gender, race, ethnicity, age, sexual orientation, or geographic location. Discrimination of any kind is antithetical to the mission of any health care professional. We were drawn to this profession to serve all patients.

The ACS supports all health care personnel who provide essential services in our communities at this time and maintains that they should be able to continue to do so without the specter of hatred and violence resulting from xenophobia, racism, and bigotry. We also encourage you to discuss any discriminatory acts you witness at any time to your institution’s leadership and to the ACS.

SurgeonsVoice: COVID-19 Impact On Surgery

Wed, 01 Apr 2020 23:48:22 GMT

As the COVID-19 pandemic continues, it is more important than ever to share stories about surgical challenges and triumphs. The ACS is interested in learning more about how COVID-19 is impacting your ability to practice and provide quality surgical care as this will help to ensure that the College is well-equipped to continue to advocate on your behalf both in Washington, DC, and across the country.

Please take a moment to share how COVID-19 is impacting you, both personally and professionally. This could include practice impediments; access to, or ability to provide, care; additional administrative burdens; equipment shortages; personal shortcomings (health, finances, etc.), or other concerns.

Thank you for taking the time to share your story. As activity continues to unfold, all Fellows and residents are encouraged to review ACS resources related to COVID-19.

ACS Statement on PPE Shortages during the COVID-19 Pandemic

Wed, 01 Apr 2020 23:46:03 GMT

The American College of Surgeons (ACS) recognizes that many health care facilities are facing shortages of personal protective equipment (PPE), including face masks, gowns, and respirators. The ACS believes it is essential that surgeons, nurses, anesthesiologists, and other health care personnel be able to speak freely, without fear of retribution, as they seek to find a solution to accessing PPE. We advise surgeons to speak with their institutional leadership on these matters and to be able to direct any concerns to the ACS, with the goal of protecting themselves and their colleagues.

The Joint Commission has released a statement supporting the use of standard face masks and respirators provided from home when health care facilities cannot provide access to PPE that is commensurate with the risk to which health care personnel are exposed during the COVID-19 pandemic. Where masks or respirators are recommended, the ACS maintains that surgeons should have access to and latitude to wear these masks at their sole discretion. The Centers for Disease Control and Prevention (CDC) also has released a document that offers a series of strategies or options to optimize supplies of disposable N95 filtering facepiece respirators.

The ACS strongly supports the ability of surgeons to use their own masks or PPE, but this option does not obviate the hospital’s responsibility to provide adequate PPE to all their health care workers. In these extraordinary times, the ACS encourages institutions to adapt and be flexible so that health care personnel continue to feel safe; The Joint Commission guidelines are a reasonable starting point.

Guide for Protecting Yourself in the OR and Ensuring Your Family’s Well-Being

Sat, 28 Mar 2020 00:48:43 GMT

Increasing information is becoming available regarding protection of health care professionals, including the operation room (OR) team. The American College of Surgeons (ACS) has developed a guide that brings together the latest information, data, and recommendations for personnel in the OR, as well as how to minimize risk of COVID infection afterwards. Of note is a video developed by a physician at Weill-Cornell Medical Center with practical information for frontline healthcare workers. The following topics are covered:

Use of personal protective equipment in the OR, including donning/doffing of the PPE
Intubation risks
Specific operative risk issues
After operation: leaving the OR and leaving the facility

Updated Emergency General Surgery Guidelines Released

Sat, 28 Mar 2020 00:47:16 GMT

The American College of Surgeons has posted updated COVID-19 Guidelines for Triage of Emergency General Surgery Patients.

The goal of the guidelines is to provide timely surgical care to patients presenting with urgent and emergent surgical conditions while optimizing patient care resources (such as hospital and intensive care unit beds, personal protective equipment, ventilators) and preserving the health of caregivers.

Third Issue Posted - Bulletin: ACS COVID-19 Newsletter

Sat, 28 Mar 2020 00:40:16 GMT

Our goal is to keep you informed on how to address this ever-evolving pandemic using the best available information. The Regents and staff look forward to receiving your feedback. Subscribe to the newsletter

Guiding Principles for Ethical Considerations

Wed, 25 Mar 2020 02:46:36 GMT

Given the many ethical issues that have arisen in the response to and the management of COVID-19 patients, the American College of Surgeons (ACS) Committee on Ethics has prepared some guiding principles to help our Fellows and their institutions in their decision-making process. These guidelines provide a framework for discussion and do not supersede or supplant thoughtful recommendations coming from institutional bioethics committees. Rather, they should be viewed as an adjunct where such committees exist, and as a resource where they do not. In this initial installment, we examine ethical issues caused by the triaging challenges, moral distress, and financial burden created by this global pandemic.

https://www.facs.org/covid-19/newsletter/032420/ethics

Personal Protective Equipment (PPE) in the Operating Room - Recommendations

Wed, 25 Mar 2020 02:40:57 GMT

An important point for surgeons is the use of PPEs in the operating room. Because there seems to be a variable understanding of the recommendations, we have provided some basic recommendations. The CDC has the following information and recommendations for PPE use for COVID-19 patients, or persons under investigation (PUI).

While in the operating room (OR), N95 respirators are recommended, particularly when operating on confirmed or suspected COVID-19 patients; however, the American College of Surgeons recognizes that many health care facilities have limited access to N95s at this time. Recent recommendations have been developed by the ASA and others for projected shortages of N95 masks. These include: implementing leadership controls to minimize who needs respiratory protection, use of alternatives to N95 masks, practices allowing extended use and or limited reuse of N95 masks, prioritization of N95 masks for health care personnel at highest risk of COVID-19 and consider use of masks approved by the National Institute of Occupational Safety and Health typically used in manufacturing and construction. For individuals at highest risk of exposure at institutions that are unable to provide N95 masks to all members of the OR team, we recommend that all surgeons and other personnel who are not wearing N95s evacuate the OR during intubation, extubation, and other procedures that may generate aerosolized small particles. The Centers for Disease Control and Prevention and the American Society of Anesthesiologists have recommendations to help prioritize.

Ensuring a proper fit of the N95 mask is paramount, so FIT TESTING is needed. The CDC also has delineated some key factors for using the N95 mask effectively, as well as checking for an appropriate mask “seal”.

Finally, shortages of masks increasingly are being reported, so strategies for optimizing facemasks/PPEs from the CDC are provided in this link.

Proper Donning and Doffing of PPE to Treat COVID-19 Patients

A similar donning and doffing technique can be used as the Centers for Disease Control and Prevention (CDC) recommended for physicians on the front lines during the Ebola crisis. Informational materials are available that demonstrate the procedures described in CDC guidance for putting on and removing PPE.

PPE for Office Visits

The same recommendations made for hospital care should be applied to outpatient office visits. The safety of patients and health care professionals is best served by allowing patients to stay home whenever possible to avoid bringing together large numbers of people. Although much of the focus has been on surgery and procedure areas, outpatient office areas experience a much higher volume of traffic with more providers in a smaller area without routine PPE during patient interactions. In addition to trying to discourage social interaction in these settings, additional preservation of PPE is a priority, which is undermined by continuing to see patients without urgent problems in outpatient offices. Thus, whenever possible outpatient evaluation should be by permissible remote connectivity. Patients who the provider deems in need of urgent personal evaluation may still be offered in-person office visits.

Elective Case Triage Guidelines for Surgical Care

Wed, 25 Mar 2020 02:33:10 GMT

The ACS has collected guidelines from various specialties, facilities, and thought leaders to help inform the decision making occurring at the local level.

The guidelines include

Some overarching principles for all cases include the following:

Be aware that while some of the following triaging guidelines include a “Level 1” (e.g., lowest level of COVID-19 acuity) in the recommendations, one must be aware that the rates of COVID-19 are predicted to skyrocket in the next few weeks, and the overarching recommendation is to prepare for markedly increased rates when triaging elective cases at present.
Patients should receive appropriate and timely surgical care, including operative management, based on sound surgical judgment and availability of resources.
Consider nonoperative management whenever it is clinically appropriate for the patient.
Consider waiting on results of COVID-19 testing in patients who may be infected.
Avoid emergency surgical procedures at night when possible due to limited team staffing.
Aerosol generating procedures (AGPs) increase risk to the health care worker but may not be avoidable. For patients who are or may be infected, AGPs should only be performed while wearing full PPE including an N95 mask or powered, air-purifying respirator (PAPR) that has been designed for the OR. Examples of known and possible AGPs include:
1. Intubation, extubation, bag masking, bronchoscopy, chest tubes
2. Electrocautery of blood, gastrointestinal tissue, any body fluids
3. Laparoscopy/endoscopy
There are insufficient data to recommend for/against an open versus laparoscopy approach; however, the surgical team should choose an approach that minimizes OR time and maximizes safety for both patients and healthcare staff. Refer to to Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines for these patients.

ACS Bulletin: COVID-19 Surgery Information and Resources

Sat, 21 Mar 2020 14:29:14 GMT

Because many of you are experiencing the effects of the novel coronavirus and have questions about how to handle the anticipated onslaught of cases, the American College of Surgeons (ACS) has developed a twice-weekly newsletter from the Bulletin to keep you informed and updated on best practices. The information in the newsletter was conceived and compiled by members of the ACS Board of Regents and Officers and is published under the aegis of our Division of Integrated Communications. During this time, we will be pausing My ACS NewsScope and ACS NewsScope. We will resume publication of these newsletters when the demand for information regarding COVID-19 slows. In the meantime, we anticipate you will find this newsletter useful in providing optimal care to your patients.

In this first issue of COVID-19 Updates, we provide answers to frequently asked questions regarding management of COVID patients, links to journal articles addressing the topic, and federal and regulatory updates, and other updates on the issue.

Our goal is to keep you informed on how to address this ever-evolving pandemic using the best available information. The Regents and staff look forward to receiving your feedback.

Check our website and social media channels for frequent updates.

Subscribe to the Bulletin: COVID-19 Newsletter

Creating Space for Well-Being Alongside COVID-19 Outbreak

Fri, 20 Mar 2020 14:30:05 GMT

The American College of Surgeons (ACS) is committed to the health and well-being of surgeons and the health care community. During the Coronavirus Disease (2019) COVID-19 pandemic, it is important to create space to care for oneself amidst the increased demands of caring for patients, providing additional support to hospital systems and staff, managing workload, and navigating the impact COVID-19 has on individuals, families, communities, hospitals, and our world.

ACS encourages you to take advantage of the curated resources and tools focused on well-being below.

Tips

Check with your hospital or practice to see if an Employee Assistance Program (EAP) is available for any additional support. EAPs typically include assessments, counseling, and referrals for additional services to employees with personal and/or work-related concerns, such as stress, financial issues, legal issues, family problems, office conflicts, and alcohol and substance abuse.
Use support systems in place, such as reaching out to mentors, peers, colleagues, significant others, family, and friends.
Remind yourself of the signs and symptoms of stress, fatigue, and burnout:
- Exhaustion
- Depersonalization
- Lack of efficacy

Resources and Tools

ACS Surgeon Well-Being Index—ACS offers this as a free resource to Fellows, Associate Fellows, and resident surgeons in the United States and Canada. Source: ACS
Seven things you can do today to help improve your mental health amidst COVID-19. Source: University of Alabama at Birmingham, School of Medicine, Department of Surgery
Sustaining the Well-Being of Healthcare Personnel during Coronavirus and Other Infection Disease Outbreaks. Source: Center for Study of Traumatic Stress
Emergency Responders: Tips for taking care of yourself. Source: CDC
Develop a buddy system: Share in safety and well-being of peers. Source: CDC

Recommendations for Health Care Administrators

The Well-Being Index Team offers ideas for health care administrators to consider implementing to reduce stress. Applying some or all of them will substantially increase the overall well-being of your staff.

Offer living accommodations for ICU/ER physicians who live with a vulnerable family member, so they do not have to go home (e.g., on-campus, hotel).
Provide meal credit (e.g., Uber eats, delivery) for those working extra shifts or unanticipated overtime.
Make dictation and transcription services available to all in the ICU/hospital/ER.
Redeploy health care workers with known health conditions that place them at elevated risk for complications should they contract COVID-19 to other settings.
Require workers to take breaks to recharge and encourage adequate time off between shifts.
Halt all required online modules and non-essential tasks.
Provide taxi and ridesharing fare reimbursement to all employees directly engaged in COVID-19 efforts.

Source: The Well-Being Index

If you need more guidance or information, please reach out to Kathleen McCann or Jenny Mohan.

Maintaining Trauma Center Access and Care during the COVID-19 Pandemic: Guidance Document for Trauma Medical Directors

Thu, 19 Mar 2020 01:35:23 GMT

Regionalized trauma systems have been developed to ensure access to care for injured patients who require time-sensitive life-saving interventions and advanced critical care to support recovery. The current worldwide COVID-19 pandemic threatens to overwhelm the healthcare system and thus impact the ability to care for critically injured patients and other surgical emergencies. The intent of this document is to advise trauma medical directors and trauma program managers on factors to consider as the public health and health care sectors prepare for an anticipated surge of critically ill patients related to COVID-19 infection.

This document is not meant to be all inclusive for the planning and preparation required by hospitals and health care systems, but to raise awareness of the importance of preserving capacity to respond to traumatic injuries that routinely occur in our communities.

> Read more on maintaining access

COVID-19: Guidance for Triage of Non-Emergent Surgical Procedures

Wed, 18 Mar 2020 01:27:23 GMT

In response to the rapidly evolving challenges faced by hospitals related to the Coronavirus Disease 2019 (COVID-19) outbreak, and broad calls to curtail “elective” surgical procedures, the American College of Surgeons (ACS) provides the following guidance on the management of non-emergent operations.

It is not possible to define the medical urgency of a case solely on whether a case is on an elective surgery schedule. While some cases can be postponed indefinitely, the vast majority of the cases performed are associated with progressive disease (such has cancer, vascular disease and organ failure) that will continue to progress at variable, disease-specific rates. As these conditions persist, and in many cases, advance in the absence of surgical intervention, it is important to recognize that the decision to cancel or perform a surgical procedure must be made in the context of numerous considerations, both medical and logistical. Indeed, given the uncertainty regarding the impact of COVID-19 over the next many months, delaying some cases risks having them reappear as more severe emergencies at a time when they will be less easily handled. Following careful review of the situation, we recommend the following

New COVID-19 Community for ACS Members

Tue, 17 Mar 2020 01:28:46 GMT

Many of you have asked us questions about the Coronavirus Disease 2019 (COVID-19) outbreak, its impact, and what this rapidly evolving situation means for surgeons, their patients, and the health care infrastructure overall.

To address this need, we are establishing a new surgeon community dedicated to COVID-19. This new community will provide a forum for professional exchange of scientific information and guideline recommendations, as well as a place to share official statements and highlight the coordination of efforts around the pandemic. It will be up and running soon, and we will share a link with you when it is ready.

In the interim, we ask that you post any discussions regarding COVID-19 to the General Surgery community, which any ACS Fellow can join. This will be the primary site for COVID-19 information and discussion until the new community is available. COVID-19 content from the General Surgery community will be migrated to the new community when it is ready.

We remain committed to providing information and new resources that will help you in this dynamic environment. We will continue to communicate with you as we have more information.

David B. Hoyt, MD, FACS
ACS Executive Director

COVID-19: Recommendations for Management of Elective Surgical Procedures

Sat, 14 Mar 2020 01:27:50 GMT

Guided by the trajectory of cases in Italy and other countries, it is very likely that the U.S. health care infrastructure and resources, particularly as it relates to care of the most critically ill patients, are likely to be strained over the coming weeks. Social distancing, crowd avoidance, and other techniques do help to flatten the curve of the dissemination of Coronavirus Disease 2019 (COVID-19), but beyond that, it is appropriate to be forward thinking regarding those patients who will, nevertheless, become infected.The American College of Surgeons (ACS) has additional comments on this issue. Following a careful review of the current situation, we recommend the following

Fake Website about COVID-19—Be Cautious

Fri, 13 Mar 2020 01:29:16 GMT

We recently became aware of a malicious website impersonating a credible one dedicated to providing information on the global incidence of Coronavirus Disease 2019 (COVID-19).

The site being spoofed is the live map for COVID-19 Global Cases from Johns Hopkins University. Note: This is a link to the credible website.

Visiting this fake website [corona-virus-map[dot]com] will expose a user to the dangerous AZORult trojan, which steals information, including confidential and sensitive data. This malware has been noted to be found in fake email attachments and posted in online ads, although there are other venues by which you might come across it.

Unfortunately, this dangerous website may not be the only COVID-19 hoax circulating on the Internet. In recent weeks, there's been a rise in number of website domains registered related to COVID-19, and it is unclear whether they are all legitimate domains or if some are being deployed by cyber criminals. Read more here.

We encourage you to exercise caution when searching online, responding to emails, or opening attachments. Check carefully when opening emails from unknown senders or outside groups even if they appear to be reputable.

Here are some suggested guidelines on how to protect yourself from these types of online and email impersonators.

With all best regards,

David B. Hoyt, MD, FACS
Executive Director, American College of Surgeons

Brian Harper
Director of Information Technology, American College of Surgeons