Quick Take: Transporting Patient One – Coronavirus in the US
Snohomish County, Washington, officials describe the EMS transport of the first confirmed 2019-nCoV patient in the U.S.
OTTAWA, Ontario — The Paramedic Chiefs of Canada (PCC) hosted an informational webinar on the 2019-nCoV (Wuhan coronavirus) in conjunction with FirstWatch. The PCC began holding similar discussions during the SARS outbreak and worked with FirstWatch during the subsequent H1N1 and Ebola outbreaks. During the webinar, participants received an update on the Coronavirus and, benefited from a briefing from the team from Snohomish County, Washington, where the first North American patient (known as Patient One) was confirmed and transported by EMS.
Eric Cooper, M.D., medical program director of Snohomish County EMS; along with Scott Dorsey, assistant chief/planning from Snohomish County Fire District 7; as well as Kurt Mills, executive director of Snohomish County 911, outlined the patient notification movement, planning, interagency cooperation and the all-important debrief that occurred after the fact.
The presenters highlighted that their patient returned from Wuhan China via Seattle (SeaTac) airport on January 15. The patient became ill on January 19 and thankfully, self-reported the symptoms and was immediately tested in a clinic. On the following day, nCoV was confirmed, appropriate liaison and communication took place and transport to the receiving hospital was arranged. By 2300 hours on January 20, the transport was completed and the following day a press release was issued.
The Snohomish team identified that the key to transport planning lay in the collaboration between all partner agencies including the EMS agency designated to transport and its medical director, local public health officials, the receiving hospital and the CDC. All partners locally operated in a unified command structure to ensure cross-communication and avoidance of repetition or misunderstanding. At the outset, several questions and assumptions had to be posed. As the patient had self-reported, the discussion centered on whether the transport was actually needed, versus leave in place or even asking the patient to self-drive. If a no transport decision was determined, that would raise the question of first responder notification should there be a 911 call emanating from the address.
As this was the very first U.S. event, the level of PPE also had to be considered: was it to be Ebola versus H1N1 standards? Sound advice resulted in full PPE being donned by the crew from the station that was also tasked with hazmat response, so donning, doffing, decontamination and comfortable operation were assured. During the transport, all concerned adhered to a checklist to ensure good preparation and solid execution. The patient was transported inside an isopod and transferred from home via ambulance to the hospital's positive pressure isolation room with little trouble and maximum cooperation.
After the initial January 20 transport, Snohomish County initiated Emerging Infectious Disease Surveillance (EIDS) screening in addition to establishing an internal coordination team and contact with the medical director. The team established triggers for automated alerting of partners, including Public Health, via its FirstWatch system, and agreed-upon protocols between the communications center and potential responding units to identify the need to don appropriate PPE. Fortunately, to date, Snohomish and its EIDS screening has had one alert out of its 100-plus screening episodes.
Takeaways on Paramedic Chiefs of Canada 2019-nCoV webinar
Here are my takeaways from the webinar.
1. Engage all partners in pre-planning for 2019-nCoV
In the final analysis, the major Snohomish takeaway is that prior connections, collaboration and mutual respect with all partners, including the 911 call center, Public Health, EMS medical director, 23 fire-based and two private ambulance providers eased the burden of operating. The open and established relationship allowed for ease of communication and the ability to freely share opinions and ask questions. This, in turn, led to a good and safe outcome for all.
2. Ease coronavirus transport operations with checklists
The Snohomish County team shared the following checklists for EMS transport of a 2019-nCoV patient.
- Equipment and PPE prepared
- Conference call with Public Health officer
- Discuss PPE
- Contact numbers including the patient
- A conference call with the receiving hospital
- Planned entrance and route to iso room
- Confirmed location of patient exchange (outside/in iso room/in Isopod)
- Confirm route has unobstructed gurney access
- Contact the Patient – alert them when the transport is inbound
- Contact the Patient – alert the patient when arriving on the scene
- Contact the Patient – to come outside and stay by the door; do not approach the responders
- Secure patient into the Isopod
- Scene departure
- Hospital arrival
- Transport to room
- Transfer of care
3. Use the EIDS tool for coronavirus health screening
The International Academy of Emergency Dispatch (IAED) recommends that agencies using its Medical Priority Dispatch System (MPDS) should use its Emerging Infectious Disease Surveillance (EIDS) Tool within the Sick Person and Breathing Problem protocols. For those that are not MPDS users, IAED is offering its EIDS surveillance Tool for Coronavirus, SRI, MERS and Ebola-free of charge under a limited use agreement.
View the full webinar or download the slides here.
Learn more about coronavirus
Learn more about the implications of the 2019-nCoV for EMS with these resources from EMS1:
- Is EMS prepared for an epidemic or pandemic?
- Why EMS leaders need to discuss the Wuhan coronavirus with the public, media
- Coronavirus: A great opportunity for EMS
- Rapid Response: Wuhan coronavirus – while not a ‘doomsday scenario,’ prepare for EMS surveillance
- IAFC compiles Wuhan coronavirus resources for fire, EMS leaders
- Dispatch guidelines for Wuhan coronavirus call screening released
- Plague in the modern day: Public health outbreaks at home and away