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Standard Operating Procedure (SOP): COVID-19 Dispatch and Referral Unit (DRU) For COVID-19 Response in Cox’s Bazar, Bangladesh

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BACKGROUND

The COVID-19 outbreak is rapidly evolving in Cox’s Bazar District and there is an increasing need to ensure referral to treatment and isolation facilities for patients and contacts both in the Rohingya camps and in the host community. The increase in the COVID-19 case load requires not only an increase in capacity but also a centralized control system for dispatch of ambulances and transport of patients and contacts. For this reason, under the leadership of Health Sector and in collaborations with other partners IOM is actively coordinating and managing a Dispatch and Referral Unit (DRU) in support of the health sector ‘s Surge Case Management Working Group. This surge referral mechanism can be activated during health, and outbreaks (such as (COVID-19, and monsoon/cyclone related emergencies,) not to interrupt routine medical emergency referrals. It is an inter-agency supported mechanism under health sector requiring support of the sector partners to contribute vehicles into the centrally managed common pool.

DRU Objectives

• Timely dispatch and arrival of ambulances to patients in need of isolation and treatment • Prioritization of patients and appropriate transfers to suitable facilities based on patient need and aligned with changing response strategy
• Early containment of disease by timely referral of contacts to isolation/quarantine facilities
• Ensure no health facility is prematurely or unnecessarily overwhelmed
• Consistent operating procedures used for all responding agencies and staff
• Protection and continuity of ambulance services for non-COVID-19 activities

DRU Scope of Support

DRU WILL:

• Act as overall communication hub for receiving, responding to and documenting COVID-19 referral support requests, in line with defined care pathways and based on defined prioritization • Coordinate 24/7 transport and referral of COVID-19 suspected/confirmed cases (including symptomatic contacts) in Rohingya camps
o From a referring health facility to an ITC or SARI ITC
o From an ITC to a SARI ITC
o From a quarantine facility to an ITC or SARI ITC
• Coordinate transport and referral of COVID-19 confirmed cases (identified through sentinel testing) in Rohingya camps from the community to an ITC or SARI ITC
• Coordinate transport and referral of asymptomatic contacts of confirmed Covid-19 cases (Rohingya) from the community to a quarantine facility (daytime hours only)
• Backstop support to UNHCR and IOM in their respective AOR in transporting “new arrivals and travelers” to transit center for quarantine depending on priorities of patient transfer, phase of the outbreak and availability of additional vehicle in the pool
• Referral of suspected cases among NGOs workers based near or within the Rohingya Refugee Camps to Isolation Unit for testing in line with ISCG referral pathway
• Support for referral of host community Covid-19 cases to Government health facilities in Cox’s Bazar district
• Provide ambulance support (only) for transfer of critical case to Sadar Hospital in case the health facility or SARI ITC ambulance in their internal pool
• Provide vehicle support for transfer of dead bodies, when the cause of death is related to COVID19, from SARI ITC to community (not for internal community transfer)

DRU CANNOT:

• Transport any laboratory specimens
• Provide generalized support to transport dead bodies other than death due to COVID-19 (in case of death in transit; receiving facility will take responsibility for dead body management according to protocol)
• Trace patients’ and contacts’ current location to inform families
• Coordinate transport of any other emergency referrals (for routine referral support contact IOM referral hotline number)