HomeMy WebLinkAboutmemo-with-general-guidance-for-ems-providers-during-the-covid-19-emergency-5-21-20
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ALAMEDA COUNTY HEALTH CARE SERVICES
AGENCY Colleen Chawla, HCSA Director
Emergency Medical Services District
1000 San Leandro Blvd, Suite 200
San Leandro, CA 94577
Lauri McFadden, EMS Director
Karl Sporer, MD, Medical Director
Main: (510) 618-2050
Fax: (510) 618-2099
MEMORANDUM
Date: May 21, 2020
To: Alameda County Fire Departments
Falck Alameda County
Alameda County Permitted Ambulance Transport Providers
Re: General guidance for EMS providers during the COVID-19 emergency
From: Dr. Karl Sporer, Alameda County EMS Medical Director
This memo supersedes the March 17,2020 Memorandum. The evolution of this pandemic
requires us to make some modification to current emergency practices. This memo does
not replace the guidance on recommended actions to minimize exposure, including
recommended PPE.
Our Emergency Departments have not been overwhelmed and have adequate PPE,
reasonable testing capacity, and processes in place to manage potential COVID patients
safely. At this juncture, the ED may be one of many reasonable places for the evaluation
of COVID symptoms. There is also concern that many patients with other medical issues
have been reluctant to be transported to hospital. We would like to encourage our
paramedics and EMT’s to assure our patients that our hospitals are safe.
Dispatch
Dispatch Centers who utilize EMD will continue to ask screening questions
related to COVID-19.
Dispatch Centers who do not utilize EMD are strongly encouraged to implement
screening questions if they have not already done so. Questions should inquire
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about travel history, fever and respiratory symptoms (shortness of breath and/or
cough).
Dispatchers will relay pertinent information (such as positive response to
screening questions, droplet precautions indicated, etc) to field personnel.
Field Responders must realize that the information obtained by the Dispatch Center is limited to the
information that the reporting party provides. The majority of the time this information is accurate
and actionable however there may be occasions where all pertinent information is not disclosed by
the reporting party even when asked. The care principles detailed below should be considered for all
patients as appropriate.
General EMS Principles for Patients with Respiratory
Symptoms
EMS personnel should exercise appropriate precautions when responding to any
patient with signs or symptoms of respiratory infection.
o If possible, one Paramedic or EMT should enter the scene wearing PPE.
An initial assessment should occur from a distance of at least six (6) feet
from the patient
o Place a surgical mask, if available, on the patient to contain droplets
o If additional personnel are required, involve the fewest EMS personnel
needed in order to minimize possible exposures
o EMS personnel who will directly care for a patient, or who will be in the
compartment with the patient, should follow standard, contact and airborne
precautions. Recommended PPE includes:
A single pair of disposable patient examination gloves
Disposable isolation gown.
Respiratory protection (surgical facemasks are an acceptable
alternative when N-95 or higher-level respirators are unavailable)
Eye protection
Respiratory aerosol-generating procedures should be minimized as
much as clinically possible. This includes nebulized medication,
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CPAP, Bag Valve Mask, and advanced airways. If an advanced
airway is required, it is suggested that the IGel be used preferentially
over an endotracheal tube.
If a respiratory aerosol-generating procedure cannot be avoided,
EMS personnel treating the patient must use P-100 preferably or an
N95 filtering face piece respirators (FFRs) (commonly known as N95
respirators). The available supply of N95 FFRs and P-100s, if
limited, should be prioritized for these procedures.
During transport, restrict the number of providers in the patient
compartment to only essential personnel to minimize possible
exposures.
Family members and other contacts of patients with possible COVID-
19 should NOT ride in the transport vehicle, if possible. If riding in
the transport vehicle, they should wear a facemask.
Notify the receiving hospital of the situation and provide an
appropriate patient care report as soon as possible. Some EDs may
require that the patient stay in the unit until a bed/room assignment
and a route has been determined.
Before removing PPE, the transporting unit and exposed equipment
must be decontaminated.
After the transporting unit and exposed equipment are
decontaminated, only then should you properly doff all PPE and
dispose properly.
Assess and Refer
This policy was implemented in the Spring of 2018. We hope to revisit this policy and
expand its use during this emergency.
The Assess and Refer process will identify patients whose condition does not
require transport by 911 emergency ambulance. This will enhance availability of
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911 ambulances for critical patients and may decrease the patient loads at our
emergency departments.
All 911 calls for EMS will receive an appropriate response, timely assessment, and
appropriate patient care (which may include an Assess and Refer referral).
The following principles will be used by the paramedic in their decision making.
o How concerned are you with the patient’s current medical issue?
o How likely is the patient to successfully navigate the provided referral?
The requirement of successful navigation will make it less likely that Assess and
Refer will be used for homeless patients or those with active mental health
issues.
After a thorough and documented assessment, Paramedics trained to use the
Assess and Refer policy/procedure will have the following patient disposition
options available to them:
o Transport of the patient to an Emergency Department
o Refusal of Care
o Referral of the patient to another method of care not requiring emergent
ambulance transport (Assess and Refer)
o Declination of transport by paramedic if they meet criteria of low acuity
Documentation of Assess and Refer patients should include the following
o Vital signs and physical exam.
o Referral plan in the narrative
o Completion of the Alameda County EMS Assess and Refer Form
It is expected that all Assess and Refer patients will be reviewed by the appropriate
clinical coordinator.
During this emergency, the patient request for transport may be declined by a
paramedic if they meet criteria of low acuity. Note: COVID-19 patients may have
higher levels of acuity despite relatively minimal apparent distress.
Health Care Professional Isolation after possible COVID-19
Exposure
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Declaration from the Governor’s Office 3/16/20
o “To address the increased demand for healthcare workers and first
responders, state Departments shall authorize first responders, care
providers, and workers who are asymptomatic and taking precautions to
prevent the transmission of COVID-19, to continue working during the
period of this emergency.”
Those healthcare workers and first responders who may have been exposed
while at work or at home will continue to work as long as they remain without
symptoms.
Some organizations may require their staff to wear a surgical mask when
interacting with the public.
Some organizations may check personnel for fevers daily before and after
shifts.
Healthcare workers and first responders who have self-isolated after becoming
symptomatic with a possible case of COVID-19 should exclude themselves from
returning to work until:
o At least 3 days (72 hours) have passed since recovery defined as
resolution of fever without the use of fever-reducing medications and
improvement in respiratory symptoms (e.g., cough, shortness of breath);
and,
o At least 10 days have passed since symptoms first appeared
After returning to work, they should:
o Wear a facemask at all times while working until all symptoms are
completely resolved or until 14 days after illness onset, whichever is
longer