Preparedness of Emergency Medical Services (EMS) for Coronavirus (COVID-19)
Ambulance crews are very likely to encounter Corona Virus. The following article describes a series of measures to be taken regarding the meeting of these cases.
Emergency Medical Services (EMS) play a vital role in responding to requests for assistance, triaging patients, and providing emergency medical treatment and transport for ill persons. Especially ambulance crews are very likely to encounter Corona Virus (COVID-19), which started in China on December 31, 2019 and spread all over the world. The following are a series of measures to be taken regarding the meeting of these cases, the precautions to be taken at the scene and during the ambulance transport and the delivery of the case to the hospital and the ambulance disinfection:
112 / Ambulance Call Centers
- Calls to the center should be questioned by health personnel trained on this subject in accordance with the Person Under Investigation (PUI) case definition published by WHO and CDC and related algorithms should be used.
Is the patient presented with:
Fever and / or new onset of cough or difficulty breathing,
In the last 14 days;
a. In close contact with the confirmed COVID-19 case;
b. Located in the relevant health facility in a country where hospital-related COVID-19 cases are reported;
c. People in epidemic areas (People’s Republic of China, Singapore, Iran, Thailand, Japan, Hong Kong, South Korea, Italy)
d.Regardless of their place of residence or travel history, healthcare professionals working in units treated with COVID-19 infection patients
- Ambulance crews assigned to calls evaluated according to the PUI definition should be informed about the case and be warned to wear Personal Protective Equipment (PPE) before arriving at the scene.
- If the ambulance team requests security team support to the scene, coordination with the relevant units should be ensured.
- The ambulance crew should be supported on which hospitals to be transferred according to the condition of the case.
- The hospital where the case will be transferred by the ambulance crew should be informed in advance.
- This information should also be reported to the Local Health Authorities.
- Ambulance crews that will exit PUI or approved diagnosed patients reported by the center must be properly protected and wear appropriate personal protective equipment (PPE) using Routine Practices and Additional Precautions (Droplet, Contact and Airborne).
- Personal Protective Equipment of Ambulance Crews
- A single pair of disposable patient examination gloves.
- Disposable isolation gown,
- Respiratory protection (i.e., N-95 or higher-level respirator),
- Eye protection (i.e., goggles or disposable face shield that fully covers the front and sides of the face)
- When the Possible Case is reached, the first assessment should be started at a distance of about 180 cm from the patient, if possible.
- In the last 14 days, for any asymptomatic patients with a history of travel to Epidemic areas (People’s Republic of China, Singapore, Iran, Thailand, Japan, Hong Kong, South Korea, Italy), for more information about their stay / self-isolation and activity restrictions it should be recommended to contact the local public health unit.
- A face mask should be worn by the patient (preferably by himself). If a nasal cannula is required or should be used, a face mask should be used over the cannula. If necessary, an oxygen mask should be used.
- When performing risk assessments, ambulance personnel should consider that COVID-19 contamination can occur when performing direct or indirect contact, droplet and possibly aerosol generating procedures.
- Healthcare providers should also consider all persons who come into contact with the patient upon arrival at the scene.
- The number of personnel to be in the back cabin of the ambulance should be limited during the transfer of the possible case to the hospital.
- The partition (window or door) between the patient’s cabin and the driver’s compartment should be kept closed during a possible case transfer.
- Ambulance personnel should not touch their faces while working.
- A negative pressure isolation stretcher should be preferred for the transportation of approved COVID-19 cases by ambulance.
- All protective equipment should be removed and disposed of in accordance with the medical waste regulations after the possible case has been delivered to the hospital.
- EMS personnel should inform the healthcare provider that admits that the patient has a history of exposure and signs and symptoms suggestive of COVID-19, so that appropriate infection control measures can be taken before reaching the patient.
- Follow routine procedures for transferring the patient to the recipient healthcare provider (for example direct the patient directly to the Infection Isolation Chamber in the Air)
Patient care documents
- The filling of patient care documents and forms should be done by EMS personnel after harvest transplant is completed, PPEs are removed and hand hygiene is done.
- Any written document must match verbal communication to hospital staff when transferring patient care.
- The EMS documentation should include a list of EMS staff and public safety providers involved in the response and level of patient contact (for example, no patient contact when direct patient care is provided). These documents may need to be shared with local public health authorities.
Cleaning Ambulances After Moving PUI or approved COVID-19 Cases
- After transporting the patient, leave the back covers of the transport vehicle open to allow sufficient air exchange to remove potentially infectious particles.
- Sufficient air exchange should be provided to complete the transfer of the patient to the receiving facility and to complete all documents.
- When cleaning the ambulance, EMS personnel should wear disposable clothes and gloves. If splashing or spraying is expected during cleaning, a face shield or face mask and goggles should be worn.
- Ensure that environmental cleaning and disinfection procedures are followed consistently and accurately, including ensuring adequate ventilation when using chemicals. The doors should remain open while the ambulance is being cleaned.
- Clean and disinfect the ambulance in accordance with standard operating procedures. All surfaces that may have been in contact with the patient or materials contaminated during patient care (for example stretchers, rails, control panels, floors, walls, work surfaces) must be thoroughly cleaned and disinfected using EPA registered hospital grade disinfectant.
- Clean and disinfect reusable patient care equipment according to the manufacturer’s instructions before using it on another patient.
Follow-up and / or Reporting Measures by EMS Staff After Looking at PUI or approved COVID-19 patients
EMS staff should be aware of the follow-up and / or reporting measures they should take after looking after a PUI or approved COVID-19 patient:
- State or local public health authorities should be informed about the patient, so appropriate follow-up can be followed.
- Exposed to PUI or confirmed COVID-19, EMS personnel should inform the chain of commands to ensure proper follow-up.
- Unprotected exposures (for example recommended PPEs not to be worn) should be reported to occupational health services, a supervisor, or a designated infection control officer for evaluation.
- EMS personnel should be careful for fever or respiratory symptoms (for example cough, shortness of breath, sore throat). If these symptoms develop, they should isolate themselves and inform the occupational health services and / or local public health authority for an appropriate assessment.
- World Health Organization, Novel-coronovirus-2019 https://www.who.int/emergencies/diseases/novel-coronavirus-2019
- Centers for Disease Control and Prevention,Coronavirus Disease 2019 (COVID-19), Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19 in the United States https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html
- New York State, Department of Health, Bureau of Emergency Medical Services and Trauma Systems https://www.health.ny.gov/professionals/ems/pdf/20-02.pdf
- Republic of Turkey Ministry of Health, General Directorate of Public Health, Infectious Diseases Department https://hsgm.saglik.gov.tr/tr/bulasici-hastaliklar/2019-n-cov/liste/2019-ncov-sunumlar.html