EMS Responds: Coronavirus Lessons From Ground Zero

• Gloves;
• Goggles, face shield, or glasses approved for splash protection;
• Full-length gowns;
• N95 or higher-level respirators. (Note: “The CDC is now crafting language with considerations toward wearing surgical masks unless the responders are doing advanced airway procedures, such as intubations, nebulizer treatments, and suctioning,” says Bodenman. “Most hospitals in the Seattle metro area are adopting this as practice.”)

“For providers with facial hair preventing a good seal with N95 masks, please ensure that you are wearing PAPRS (full-face powered air respiratory systems) for known or suspected cases of communicable and infectious diseases with droplet precautions, such as COVID-19,” says Nick Nudell, paramedic and president of the American Paramedic Association. “Gloves, gowns, and face masks should be discarded immediately before exposing anyone else to the contaminants.”

The full CDC PPE recommendations are here.

Keep Your Distance When Possible

It is obviously not reasonable to expect EMTs to keep their distance when moving COVID-19 patients. But they can reduce their risks by minimizing contact when possible.

A case in point: “King County EMS is now working on formal procedures to send in one responder in full PPE to screen any patient, to ensure we don’t walk into a COVID patient that isn’t identified by dispatch,” says Bodenman. “Deputy Chief Ben Lane at neighboring Eastside Fire and Rescue is exploring the option of responders handing a tablet to a family member to take to the patient so they can establish the right level of PPE to wear before entering the patient’s residence.”

Transport Patients Safely

When an ambulance has to transport a COVID-19 patient to a hospital (be sure to alert the receiving site ASAP about their status), there is always a risk of infection.

To reduce the danger:

• Put a mask on the patient and ensure the pass-through between the driver and patient compartment is closed, if possible;
• Family members and friends should not ride along. If they must, they should wear face masks;
• Turn on the ventilation fan in the ambulance;
• Leave all doors open upon exiting the vehicle to ensure it has a clean air exchange as you bring the patient into the hospital.

“When possible, use vehicles that have isolated driver and patient compartments that can provide separate ventilation to each area,” says Vincent D. Robbins, past president of the National EMS Management Association. “During transport, vehicle ventilation in both compartments should be on nonrecirculated mode to maximize air changes that reduce potentially infectious particles in the vehicle. If the vehicle has a rear exhaust fan, use it to draw air away from the cab toward the patient-care area and out the back end of the vehicle.”

With any luck the ambulance will be equipped with a HEPA filter-equipped supplemental recirculating ventilation unit. But if the ambulance doesn’t have an isolated driving compartment and has to use unfiltered air during transport, “Open the outside air vents in the driver area and turn on the rear exhaust ventilation fans to the highest setting,” Robbins says. “This will create a negative pressure gradient in the patient area.”

Disinfect After Transport

Once the COVID-19 patient has been delivered, the ambulance should be disinfected as soon as possible, ideally right after transport. Do so using the following steps:

1) Wear full PPE during the cleaning/disinfection process.

2) Clean all areas consistently using EPA-registered hospital-grade disinfectants. All surfaces that may have come in contact with the patient or been contaminated during patient care—such as the stretcher, rails, control panels, floors, walls, and work surfaces—should be thoroughly cleaned and disinfected. To prevent damage during cleaning, follow the manufacturer’s instructions on cleaning and disinfecting reusable patient care equipment.

“Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2,” says Robbins. “You can find appropriate products online at the EPA’s List N: Disinfectants for Use Against SARS-CoV-2.”

In addition to normal decontamination procedures, the Kirkland Fire Department has started using electrostatic sprayers in their aid cars to add an additional layer of protection for their responders.

3) Leave the vehicle’s doors open to ensure safe ventilation of fumes.

Safety Is Job No. 1

The COVID-19 pandemic is likely the biggest challenge today’s generation of EMTs and paramedics has ever faced. This is why handling COVID-19 patients as safely as possible for everyone’s benefit—including their own—is so important for EMS personnel.

In particular, “Prehospital professionals should take COVID-19 precautions seriously,” says Nudell. “It is our professional obligation to take precautions against becoming carriers of the virus ourselves personally, from our clothing, our equipment, or our vehicles. And if we become symptomatic, we should follow current CDC guidelines by avoiding public places and taking all appropriate measures to avoid exposing our coworkers and patients to illness.”

James Careless is a freelance writer and frequent contributor to EMS World.