CDC updates EMS, 911 guidance for COVID-19

By Sarah Sinning

Last month, the Centers for Disease Control released their “Interim Guidance for Emergency Medical Services and 911 Public Safety Answering Points for COVID-19 in the United States.”

In addition to calling for “close coordination and effective communications” between all emergency response stakeholders – 911 call centers, the EMS system, healthcare facilities and the public health system – the guidelines also strongly encouraged “the involvement of an EMS medical director” for “appropriate medical oversight” of a rapidly evolving situation.

What follows is an overview of these guidelines, complete with the most up-to-date revisions.

RECOMMENDATIONS FOR 911 PSAPS

• Create modified caller queries as appropriate, using the guidance of an EMS medical director as well as local, state and federal health authorities.
• Dispatchers should question callers to determine risk of infection.
• All patients meeting the appropriate criteria should be transported as a person under investigation.
• Information on a possible PUI should be communicated to EMS clinicians before arrival on scene.
• PSAPs responding to ill travelers at international ports of entry should be in contact with the appropriate CDC quarantine station for guidance.

RECOMMENDATIONS FOR MEDICAL FIRST RESPONDERS

• If dispatchers advise that COVID-19 infection is suspected, EMS clinicians should put on full list of appropriate PPE (see below).
• Regardless of PSAP directive, clinicians should exercise precautions when responding to patients with any signs of upper respiratory infection, including performing initial assessments from a distance of at least six feet.
• Contact should continue to be minimized until a facemask is in place on the patient. If a nasal cannula is in place, a facemask should be worn over it. An oxygen mask can also be used if clinically indicated.
• Only essential personnel should ride in the patient compartment during transport.

RECOMMENDED PERSONAL PROTECTIVE EQUIPMENT

• N-95 or higher-level respirator or facemask (if a respirator is not available). The CDC has also issued guidance for proper N-95 respirator use, including how to ensure a proper fit.
• Eye protection that fully covers the front and sides of the face. Personal eyeglasses and contact lenses are NOT considered adequate.
• A single pair of disposable patient examination gloves, which should be changed if they become torn or heavily soiled.
• Isolation gown (unless there is a shortage, in which case gowns should be reserved for aerosol-generating procedures)
• Anyone directly involved in patient care, including drivers who move patients onto stretchers, should wear appropriate PPE. Remove PPE once contact has ceased (i.e. before getting into isolated driver’s compartment)
• Remaining EMS clinicians should remove and discard PPE once patient is released to facility

RECOMMENDED PPE: AEROSOL-GENERATING PROCEDURES

• An N-95 or higher-level respirator, instead of a facemask, should be worn in addition to the other PPE described above.
• BVMs, and other ventilatory equipment, should be equipped with HEPA filtration to filter expired air.
• Rear doors of transport vehicle should be opened (if possible) and HVAC system should be activated during procedure.

EMS TRANSPORT OF PUI

• Clinicians should notify receiving healthcare facility of patient status, including signs and symptoms of COVID-19 infection.
• Keep patient separated from other people as much as possible; no one other than medical personnel should ride with the patient, including family members.
• Isolate driver from patient compartment; if vehicle without isolated driver compartment must be used, open outside air vents in driver area and turn on rear exhaust fans to highest setting.

DOCUMENTATION OF PATIENT CARE

• All documentation should be completed after clinicians have completed transport, removed PPE and thoroughly washed hands.
• Documentation should include listing of all clinicians and public safety professionals involved as well as the level of contact with patient.

CLEANING TRANSPORT VEHICLES

• After transport, leave rear doors of vehicle open to facilitate removal of infectious particles; the time it takes to complete transfer and necessary documentation is sufficient.
• Wear disposable gown and gloves when cleaning vehicle, including a face shield or mask if splashes or sprays are anticipated.
• Doors should remain open when cleaning chemicals are in use to provide proper ventilation.
• Routine cleaning and disinfection procedures are appropriate.
• Products with EPA-approved emerging viral pathogen claims are recommended. Access list here.
• Follow standard procedures for disposing of PPE used while cleaning.

FOLLOW-UP

• State and local health officials should be notified so appropriate monitoring of the patient can occur.
• EMS agencies should develop policies for assessing and managing exposure risk, and should do so in coordination with public health authorities.
• Any unprotected exposure by clinician should be reported up the chain of command.
• Clinicians should be alert for the development of fever or other respiratory symptoms, again notifying the proper authorities and self-isolating if necessary.

To review the interim guidance in full, visit CDC.gov.