CDC updates EMS, 911 guidance for COVID-19

The CDC has updated their PPE and EPA-registered disinfectant recommendations for all first responders who anticipate close contact with possible COVID-19 cases


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.

The Centers for Disease Control and Prevention is shown Sunday, March 15, 2020, in Atlanta.
The Centers for Disease Control and Prevention is shown Sunday, March 15, 2020, in Atlanta. (AP Photo/John Bazemore)

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.

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