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Coronavirus Illness 2019 (COVID-19)


Suggestions for EMS Personnel

EMS Employer Obligations

The duties described on this part are for the care and transport of all sufferers, and never just for the care and transport of sufferers with suspected or confirmed SARS-CoV-2 an infection. The Ryan White HIV/AIDS Remedy Extension Act of 2009 addresses notification procedures and necessities for medical services and state public well being officers and their designated officers relating to publicity of emergency response workers (EREs), which incorporates EMS and different first responders, to doubtlessly life-threatening infectious illnesses. In March 2020, CDC/NIOSH up to date the listing of doubtless life-threatening infectious illnesses to which EREs is perhaps uncovered which are lined by the Act to incorporate the addition of COVID-19, the illness attributable to the virus SARS-CoV-2. A medical facility should reply to acceptable requests by making determinations about whether or not EREs have been uncovered to infectious illnesses included on the listing. See https://www.cdc.gov/niosh/docs/2020-119/pdfs/2020-119.pdf?id=10.26616/NIOSHPUB2020119pdf icon for extra info.

As well as, employers are required to:

  • Develop IPC insurance policies and procedures for EMS items that embody a advisable sequence for safely donning and doffing PPE.
  • Present all EMS personnel with job- or task-specific training and coaching on stopping transmission of infectious brokers, together with refresher coaching.
  • Be certain that EMS personnel are educated, educated, and have practiced the suitable use of PPE previous to caring for a affected person, together with consideration to appropriate use of PPE and stopping self-contamination and contamination of environmental surfaces in the course of the technique of eradicating such gear.
  • As a part of the Occupational Security and Well being Administration (OSHA) respiratory safety program, guarantee EMS personnel are medically cleared, educated, and match examined for respiratory safety machine use (e.g., N95 filtering facepiece respirator), or medically cleared and educated in using another respiratory safety machine (e.g., unfastened becoming powered air-purifying respirator, PAPR) at any time when respirators are required. OSHA has numerous respiratory coaching moviesexterior icon.
  • EMS items needs to be supplied enough provides (e.g., hand sanitizer, cleansing provides, EPA-registered hospital disinfectants, PPE) so EMS personnel can adhere to advisable IPC practices.
  • Be certain that EMS personnel {and professional} cleaners contracted by the EMS employer tasked to wash and disinfect transport autos and gear are educated, educated, and have practiced the method in accordance with EPA-registered label directions, gear producer’s directions, and the EMS company’s normal working procedures.

Display all EMS Personnel for Indicators or Signs of SARS-CoV-2 An infection on the Begin of Every Shift

Though screening for signs won’t establish asymptomatic or pre-symptomatic people with SARS-CoV-2 an infection, symptom screening stays an vital technique to establish those that might have COVID-19 and require immediate evaluation and response.

  • Display all EMS personnel and guests (i.e., anybody getting into the power) for signs in keeping with COVID-19 and publicity to others with SARS-CoV-2 an infection. Display EMS personnel at the beginning of every shift. Display guests previous to entry to the power (e.g., firehouse or EMS station).
    • Actively take their temperature and ensure absence of signs in keeping with COVID-19. Fever is both measured temperature ≥100.0°F or subjective fever.
    • Ask them if they’ve been suggested to self-quarantine due to publicity to somebody with SARS-CoV-2 an infection.
  • Promptly handle anybody with signs of COVID-19 or who has been suggested to self-quarantine:
    • EMS personnel ought to don a facemask if not already sporting one, return residence, and notify occupational well being companies to rearrange for additional analysis.
    • Guests needs to be restricted from getting into the power.

Assess All Sufferers for SARS-CoV-2 An infection

  • If PSAP/ECC telecommunicators advise that the affected person is suspected of getting SARS-CoV-2 an infection, based mostly on signs or shut contact with a person with SARS-CoV-2 an infection, EMS personnel ought to placed on acceptable PPE (as described in Part 2) earlier than getting into the scene. EMS personnel ought to pay attention to the indicators and signs of COVID-19.
  • If details about potential for SARS-CoV-2 an infection has not been supplied by the PSAP/ECC, EMS personnel ought to train warning when responding to any affected person. Preliminary evaluation ought to start from a distance of a minimum of 6 ft from the affected person, if attainable. If the affected person’s situation permits, the affected person could also be directed to fulfill the EMS crew at an acceptable location outdoors or in a extra ventilated space.
  • All sufferers (if tolerated), no matter COVID-19 signs, needs to be instructed to follow supply management. Affected person contact needs to be minimized to the extent attainable till a material face overlaying or facemask is on the affected person.
  • If attainable, EMS personnel ought to ask the affected person about indicators and signs of COVID-19 or if the affected person has had current shut contact with somebody with SARS-CoV-2 an infection.
  • If SARS-CoV-2 an infection is suspected, PPE as described in Part 2 needs to be used. If SARS-CoV-2 an infection just isn’t suspected, EMS personnel ought to comply with normal procedures and use acceptable PPE for evaluating and offering care to the affected person. Consideration for common PPE (as described under) needs to be given relying on the extent of group transmission.

Implement Common Supply Management Measures

Supply management refers to make use of of material face coverings or facemasks to cowl an individual’s mouth and nostril to stop the discharge of respiratory secretions when they’re speaking, sneezing, or coughing. Due to the potential for asymptomatic and pre-symptomatic transmission, supply management measures are advisable for everybody, even when they don’t have signs of COVID-19.

  • Sufferers and members of the family needs to be sporting their very own material face overlaying (if tolerated) previous to the arrival of EMS personnel and all through the period of the encounter, together with throughout transport. If they don’t have a face overlaying, they need to be provided a facemask or material face overlaying, as provides enable.
    • Facemasks and material face coverings shouldn’t be positioned on younger youngsters beneath age 2, anybody who has bother respiration, or anybody who’s unconscious, incapacitated or in any other case unable to take away the masks with out help.
    • If a nasal cannula is used, a facemask ought to (ideally) be worn over the cannula. Alternatively, an oxygen masks can be utilized if clinically indicated. If the affected person requires intubation, see under for added precautions for aerosol-generating procedures.
  • EMS personnel ought to put on a facemask always whereas they’re in service, together with in breakrooms or different areas the place they may encounter co-workers.
    • When out there, facemasks are most well-liked over material face coverings for EMS personnel as facemasks supply each supply management and safety for the wearer towards publicity to splashes and sprays of infectious materials from others.
      • Fabric face coverings ought to NOT be worn as an alternative of a respirator or facemask if greater than supply management is required.
    • To scale back the variety of instances EMS personnel should contact their face and potential threat for self-contamination, EMS personnel ought to take into account persevering with to put on the identical respirator or facemask (prolonged use) all through their complete work shift, as an alternative of intermittently switching again to their material face overlaying.
      • Respirators with an exhalation valve are usually not advisable for supply management, as they permit unfiltered exhaled breath to flee.
    • EMS personnel ought to take away their respirator or facemask, carry out hand hygiene, and placed on their material face overlaying when leaving on the finish of their shift.
  • Educate EMS personnel in regards to the significance of performing hand hygiene instantly earlier than and after any contact with their respirator or facemask.

Encourage Bodily Distancing

Healthcare supply requires shut bodily contact between sufferers and EMS personnel. Nevertheless, when attainable, bodily distancing (sustaining a minimum of 6 ft between individuals) is a vital technique to stop SARS-CoV-2 transmission.

  • Throughout transport, restrict the variety of EMS personnel within the affected person compartment to important personnel.
  • Restrict others using within the ambulance whereas the affected person is transported to the healthcare facility to solely these important for the affected person’s bodily or emotional well-being or care (e.g., care accomplice, mum or dad, and so forth.)
    • They need to put on a material face overlaying if attainable, and, ideally, be screened for signs of COVID-19 or shut contact with a person with COVID-19 prior to move together with taking their temperature earlier than getting into the ambulance.
    • These with signs or a historical past of shut contact within the prior 14 days shouldn’t be permitted within the ambulance.

For EMS personnel, the potential for publicity to SARS-CoV-2 just isn’t restricted to direct affected person care interactions. Transmission can even happen by way of unprotected exposures to asymptomatic or pre-symptomatic co-workers in breakrooms, co-workers or guests in different widespread areas, or different exposures in the neighborhood. Examples of how bodily distancing will be carried out for EMS personnel embody:

  • Reminding EMS personnel that the potential for publicity to SARS-CoV-2 just isn’t restricted to direct affected person care interactions.
  • Emphasizing the significance of supply management and bodily distancing when engaged in non-patient care actions.
  • Designating areas for EMS personnel to take breaks, eat, and drink that enable them to stay a minimum of 6 ft aside from one another, particularly after they should be unmasked.

Implement Common Use of Private Protecting Gear

  • EMS personnel working in areas with reasonable to substantial group transmission usually tend to encounter asymptomatic or pre-symptomatic sufferers with SARS-CoV-2 an infection. If SARS-CoV-2 an infection just isn’t suspected in a affected person (based mostly on symptom and publicity historical past), EMS personnel ought to comply with Commonplace Precautions (and Transmission-Primarily based Precautions if required based mostly on the suspected prognosis). They need to additionally:
    • Put on eye safety along with their facemask to make sure the eyes, nostril, and mouth are all shielded from splashes and sprays of infectious materials from others.
    • Put on an N95 or equal or higher-level respirator, as an alternative of a facemask, for:
    • Respirators with exhalation valves are usually not advisable for supply management.
  • For EMS personnel working in areas with minimal to no group transmission, the common eye safety and respirator suggestions described for areas with reasonable to substantial group transmission are optionally available. Nevertheless, EMS personnel ought to proceed to stick to Commonplace and Transmission-Primarily based Precautions, together with use of eye safety and/or an N95 or equal or higher-level respirator based mostly on anticipated exposures and suspected or confirmed diagnoses. Common use of a facemask for supply management is advisable for EMS personnel.

Create a Course of to Deal with to SARS-CoV-2 Exposures Amongst EMS Personnel and Others

EMS ought to have a course of for notifying the well being division about suspected or confirmed instances of SARS-CoV-2 an infection, and will set up a plan, in session with native public well being authorities, for the way exposures in EMS personnel shall be investigated and managed and the way contact tracing shall be carried out. The plan ought to deal with the next:

  • Who’s liable for figuring out contacts (e.g., EMS personnel, sufferers, members of the family) and notifying doubtlessly uncovered people?
  • How will such notifications happen?
  • What actions and follow-up are advisable for many who have been uncovered?

Contact tracing needs to be carried out in a approach that protects the confidentiality of affected people and is in keeping with relevant legal guidelines and rules. EMS personnel and sufferers who have been transported to a healthcare facility needs to be prioritized for notification. These teams, if contaminated, have the potential to show many people at greater threat for extreme illness, or within the scenario of admitted sufferers, are at greater threat for extreme sickness themselves.

Details about threat evaluation and work restrictions for healthcare personnel (HCP) together with EMS personnel uncovered to SARS-CoV-2 is on the market within the Interim U.S. Steering for Danger Evaluation and Work Restrictions for Healthcare Personnel with Potential Publicity to Coronavirus Illness 2019 (COVID-19).

Details about when HCP together with EMS personnel with suspected or confirmed SARS-CoV-2 an infection might return to work is on the market within the Interim Steering on Standards for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19.

The EMS system should be ready for potential staffing shortages and have plans and processes in place to mitigate these, together with offering sources to help EMS personnel with anxiousness and stress. Methods to mitigate staffing shortages can be found.

2. Beneficial IPC practices when caring for a affected person with suspected or confirmed SARS-CoV-2 an infection

Private Protecting Gear (PPE)

EMS personnel who will immediately take care of a affected person with suspected or confirmed SARS-CoV-2 an infection or who shall be within the compartment with the affected person ought to adhere to Commonplace Precautions and use a NIOSH-approved N95 or equal or higher-level respirator (or facemask if a respirator just isn’t out there), robe, gloves, and eye safety.

When out there, respirators (as an alternative of facemasks) are most well-liked; they need to be prioritized for conditions the place respiratory safety is most vital, together with the care of sufferers with pathogens requiring Airborne Precautions (e.g., tuberculosis, measles, varicella). Extra details about an infection management practices and Transmission-Primarily based Precautions is on the market within the An infection Management Steering for Healthcare Professionals about Coronavirus (COVID-19).

  • Hand Hygiene
    • EMS personnel ought to carry out hand hygiene earlier than and in any case affected person contact, contact with doubtlessly infectious materials, and earlier than placing on and after eradicating PPE, together with gloves. Hand hygiene after eradicating PPE is especially vital to take away any pathogens which may have been transferred to reveal palms in the course of the elimination course of.
    • EMS personnel ought to carry out hand hygiene through the use of alcohol-based hand sanitizer (ABHS) with 60-95% alcohol or washing palms with cleaning soap and water for a minimum of 20 seconds. If palms are visibly dirty, use cleaning soap and water earlier than returning to ABHS.
    • EMS personnel ought to make sure that hand hygiene provides are available to all personnel on the transport automobile.
  • Private Protecting Gear Coaching
    EMS ought to choose acceptable PPE and supply it to EMS personnel in accordance with OSHA PPE requirements (29 CFR 1910 Subpart I)exterior icon. EMS personnel should obtain coaching on and show an understanding of:
    • when to make use of PPE
    • what PPE is critical
    • easy methods to correctly don, use, and doff PPE in a fashion to stop self-contamination
    • easy methods to correctly eliminate or disinfect and keep PPE
    • the constraints of PPE.

Any reusable PPE should be correctly cleaned, decontaminated, and maintained after and between makes use of. Services ought to have insurance policies and procedures describing a advisable sequence for safely donning and doffing PPE.

The PPE advisable when caring for a affected person with suspected or confirmed SARS-CoV-2 an infection contains the next:

  • Respirator or Facemask (Fabric face coverings are NOT PPE and shouldn’t be worn for the care of sufferers with suspected or confirmed SARS-CoV-2 an infection or different conditions the place use of a respirator or facemask is advisable.)
    • Placed on an N95 respirator (or equal or higher-level respirator) or facemask (if a respirator just isn’t out there) earlier than performing affected person care, if not already sporting one as a part of prolonged use methods to optimize PPE provide. Different respirators embody different disposable filtering facepiece respirators, powered air purifying respirators (PAPRs), or elastomeric respirators.
    • N95 respirators or respirators that provide an equal or greater degree of safety needs to be used as an alternative of a facemask when performing or current for an aerosol producing process. See appendix for respirator definition and extra details about respiratory safety.
    • Disposable respirators and facemasks needs to be eliminated and discarded after exiting the affected person’s care space until implementing prolonged use or reuse. Carry out hand hygiene after eradicating the respirator or facemask.
      • If reusable respirators (e.g., PAPRs or elastomeric respirators) are used, they need to even be eliminated after exiting the affected person’s care space. They should be cleaned and disinfected in accordance with producer’s reprocessing directions previous to re-use.
    • When the availability chain is restored, EMS personnel utilizing facemasks as an alternative of respirators ought to return to make use of of respirators for sufferers with suspected or confirmed SARS-CoV-2 an infection.
  • Eye Safety
    • Placed on eye safety (i.e., goggles or a face protect that covers the entrance and sides of the face) earlier than performing affected person care, if not already sporting as a part of prolonged use methods to optimize PPE provide.
      • Protecting eyewear (e.g., security glasses, trauma glasses) with gaps between glasses and the face doubtless don’t defend eyes from all splashes and sprays.
      • Private eyeglasses and phone lenses are NOT thought-about enough eye safety.
    • Be certain that eye safety is appropriate with the respirator so there’s not interference with correct positioning of the attention safety or with the match or seal of the respirator.
    • Take away eye safety after performing affected person care, until implementing prolonged use.
    • Reusable eye safety (e.g., goggles) should be cleaned and disinfected in accordance with producer’s reprocessing directions previous to re-use. Disposable eye safety needs to be discarded after use until following protocols for prolonged use or reuse.
  • Gloves
    • Placed on clear, non-sterile gloves earlier than performing affected person care.
      • Change gloves in the event that they grow to be torn or closely contaminated.
    • Take away and discard gloves after offering affected person care, and instantly carry out hand hygiene.
  • Robes
    • Placed on a clear isolation robe earlier than performing affected person care. Change the robe if it turns into dirty. Take away and discard the robe in a devoted container for waste or linen after offering affected person care. Disposable robes needs to be discarded after use. Fabric robes needs to be laundered after every use.
    • If coveralls are used as an alternative choice to robes, placed on a clear coverall earlier than performing affected person care. A brand new coverall is required for every affected person. Change the coverall if it turns into dirty. Take away and discard the coverall in a devoted container for waste after offering affected person care. Disposable coveralls shouldn’t be reused.

EMS techniques ought to work with their well being division, healthcare coalitionexterior icon, or emergency administration company to deal with shortages of PPE.

Aerosol-Producing Procedures

  • If attainable, seek the advice of with medical management earlier than performing aerosol-generating procedures for particular steerage. EMS personnel ought to train warning if an aerosol-generating process (AGP) is critical
    • An N95 or equal or higher-level respirator corresponding to disposable filtering facepiece respirators, PAPR, or elastomeric respirator as an alternative of a facemask, needs to be used along with the opposite PPE described above, by EMS personnel current for or performing aerosol-generating procedures.
    • Bag valve masks (BVMs), and different ventilatory gear, needs to be outfitted with HEPA filtration to filter expired air.
    • EMS techniques ought to seek the advice of their ventilator gear producer to substantiate acceptable filtration functionality and the impact of filtration on positive-pressure air flow.
    • If attainable, the rear doorways of the transport automobile needs to be opened and the HVAC system needs to be activated throughout AGPs. This needs to be performed away from pedestrian site visitors.
    • If attainable, discontinue AGPs previous to getting into the vacation spot facility or talk with receiving personnel that AGPs are being carried out.

EMS Transport of a Affected person with Suspected or Confirmed SARS-CoV-2 An infection to a Healthcare Facility (together with interfacility transport)

If a affected person with suspected or confirmed SARS-CoV-2 an infection requires transport to a healthcare facility for additional analysis and administration (topic to EMS medical path), the next actions ought to happen throughout transport:

  • EMS personnel ought to notify the receiving healthcare facility that the affected person has suspected or confirmed SARS-CoV-2 an infection in order that acceptable an infection management precautions could also be taken previous to affected person arrival.
  • Isolate the ambulance driver from the affected person compartment and hold pass-through doorways and home windows tightly shut.
  • When attainable, use autos which have remoted driver and affected person compartments that may present separate air flow to every space.
    • Earlier than getting into the remoted driver’s compartment, the motive force (in the event that they have been concerned in direct affected person care) ought to take away and eliminate PPE and carry out hand hygiene to keep away from soiling the compartment.
    • Shut the door/window between these compartments earlier than bringing the affected person on board.
    • Throughout transport, automobile air flow in each compartments needs to be on non-recirculated mode to maximise air modifications that cut back doubtlessly infectious particles within the automobile.
    • If the automobile has a rear exhaust fan, use it to attract air away from the cab, towards the patient-care space, and out the again finish of the automobile.
    • Some autos are outfitted with a supplemental recirculating air flow unit that passes air by way of HEPA filters earlier than returning it to the automobile. Such a unit can be utilized to extend the variety of air modifications per hour (ACH) (https://www.cdc.gov/niosh/hhe/reviews/pdfs/1995-0031-2601.pdfpdf icon).
  • If a automobile with out an remoted driver compartment and air flow should be used, open the surface air vents within the driver space and activate the rear exhaust air flow followers to the very best setting to create a strain gradient towards the affected person space.
    • Earlier than getting into the motive force’s compartment, the motive force (in the event that they have been concerned in direct affected person care) ought to take away their robe, gloves and eye safety and carry out hand hygiene to keep away from soiling the compartment. They need to proceed to put on their respirator (or facemask if a respirator was not out there).
  • Comply with routine procedures for a switch of the affected person to the receiving healthcare facility (e.g., wheel the affected person immediately into an examination room, wheel to devoted receiving space). At a minimal, EMS personnel ought to proceed to put on their respirator (or facemask) and eye safety whereas transferring the affected person from the ambulance into the power. Relying on the extent of direct affected person contact and care being supplied throughout switch (e.g., CPR), it could be acceptable for EMS personnel to additionally proceed sporting their robe and gloves when getting into the power. In such circumstances, switch needs to be coordinated with receiving facility and care should be taken to keep away from contaminating surfaces within the healthcare facility.

Documentation of Affected person Care

  • EMS documentation ought to embody a list of EMS personnel and public security suppliers concerned within the response and degree of contact with the affected person (for instance, no contact with affected person, supplied direct affected person care and degree of PPE worn). This documentation might have to be shared with native public well being authorities if contact tracing turns into mandatory.

Cleansing EMS Transport Autos after Transporting a Affected person with Suspected or Confirmed SARS-CoV-2 An infection

The next are common pointers for cleansing or sustaining EMS transport autos and gear after transport:

  • After transporting the affected person, go away the rear doorways of the transport automobile open to permit for adequate air modifications to take away doubtlessly infectious particles.
    • The time to finish switch of the affected person to the receiving facility and full all documentation ought to present adequate air modifications.
  • When cleansing the automobile, EMS personnel ought to put on a disposable robe and gloves, in addition to their respirator or facemask. A face protect or goggles must also be worn if splashes or sprays throughout cleansing are anticipated.
  • Be certain that environmental cleansing and disinfection procedures are adopted constantly and accurately, to incorporate the availability of enough air flow when chemical compounds are in use. Doorways ought to stay open when cleansing the automobile.
  • Routine cleansing and disinfection procedures (e.g., utilizing cleaners and water to pre-clean surfaces previous to making use of an EPA-registered, hospital-grade disinfectant to regularly touched surfaces or objects for acceptable contact instances as indicated on the product’s label) are acceptable for SARS-CoV-2 in healthcare settings, together with these patient-care areas through which aerosol-generating procedures are carried out.
    • Consult with Record Nexterior icon on the EPA web site for EPA-registered disinfectants which have certified beneath EPA’s rising viral pathogens program to be used towards SARS-CoV-2.
  • Clear and disinfect the automobile in accordance with normal working procedures. All surfaces that will have are available in contact with the affected person or supplies contaminated throughout affected person care (e.g., stretcher, rails, management panels, flooring, partitions, work surfaces) needs to be totally cleaned and disinfected utilizing an EPA-registered hospital grade disinfectant in accordance with the product label.
  • Clear and disinfect reusable patient-care gear earlier than use on one other affected person, in accordance with producer’s directions.
  • Comply with normal working procedures for the containment and disposal of used PPE and controlled medical waste.
  • Comply with normal working procedures for holding and laundering used linen. Keep away from shaking used linens.



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