Quick Take: UWashEMS enters COVID-19 ‘second phase’
University of Washington EM physicians update on COVID-19 atypical presentation, airway management and N95 cleaning
In the latest University of Washington Fellowship Grand Rounds online presentation, UWashEMS fellows and emergency medicine physicians David Murphy and Betty Yang gave an overview of current Seattle data, CDC guidelines and mask cleaning. This was followed by Michael Sayre, MD, an emergency medicine physician at Harborview Medical Center and Seattle Fire Department medical director discussing what the future holds and Dr. Andrew Latimer, an emergency medicine physician at Harborview Medical Center and associate medical director of Airlift Northwest addressing common COVID-19 questions.
The group discussed their current EMS protocols, mask reuse and PPE considerations.
Top quotes from the UWashEMS Grand Rounds
Here are a few quotes from the physicians about COVID-19 management.
“Donning and doffing is still an important part of this. The CDC recommends hand hygiene before and after to ensure you don’t contaminate.”
— Dr. Betty Yang
“We definitely want to maintain our high level of care, including for those who potentially have COVID-19.”
— Dr. Andrew Latimer
“We all feel like we’ve been sprinting for the past six weeks to get a handle on this and now we’re moving into the second phase.”
— Dr. Thomas Rea
Top takeaways from the UWashEMS Grand Rounds
Here are the top 5 takeaways from this session from UWashEMS on COVID-19.
1. PPE, PPE, PPE
Based on preliminary data, Seattle has found that less than 1% of first responders tested positive for COVID-19 after interacting with possible COVID-19 patients. With the proper PPE, first responders are adequately protected when interacting with these patients. Keep wearing your PPE!
2. Cleaning N95 masks
Currently the CDC recommends three methods for cleaning masks for reuse: UV light, moist heat and vaporized hydrogen peroxide. In Seattle, the team is currently working on possible UV light boxes in the stations as this has been shown to have >99.9% anti-microbial efficacy.
The CDC also suggests keeping used masks in paper bags for 5 days and then reusing them. Studies on related viruses have shown that this is about the amount of time the virus can survive on mask material. Ideally, you would have a mask and bag for each day of the week, but it depends on your PPE supply.
It is important to note that bleach wipes and alcohol-based solutions for mask cleaning have been shown to be detrimental to mask function.
3. Airway management as usual with proper PPE
Treat hypoxic patients who are potentially COVID-19 positive the same as you normally would, just ensure that you are wearing proper PPE. If you need to perform a potentially aerosolizing procedure (intubation, BVM, nebulizer treatment, NRB, etc.), providers and others in the vicinity should be wearing an N95 mask. Whenever possible, try to perform airway management in a well-ventilated area.
4. Wear PPE after recovery from COVID-19
Even if you have contracted and recovered from COVID-19, it’s important to still wear your PPE. We do not know how much immunity prior infection provides at this time and this RNA virus has the potential to mutate.
5. The COVID-19 patient isn’t always obvious
Atypical presentations are becoming more and more common. For example, a patient with no history of chronic heart failure may present with what seems to be a heart failure exacerbation but is actually COVID-19. It’s important to use your critical thinking when treating patients and to keep COVID-19 on the differential until you can rule it out.
Additional resources on COVID-19 management
Learn more about COVID-19 prehospital management, precautions with these resources:
- CDC EMS Recommendations
- King County and Seattle Medic One Resources for EMS
- Quick Take: Encounter does not equal exposure if adequate PPE is worn
- Quick Take: Airway management lessons learned for COVID-19 patients
- Airway management adjustments in the era of COVID-19
- MCHD emergency protocol to eliminate nebulized albuterol
- Stretching your service’s supply of N95 respirators