Evaluating Prehospital Use of Personal Protective Equipment During the COVID-19 Pandemic 

Introduction: Challenges with personal protective equipment (PPE) availability during the COVID-19 pandemic have been well documented. However, the use and reuse of PPE has not been fully described in the prehospital environment. 

Objective: Describe the use and reuse of PPE among EMS providers during the COVID-19 pandemic.

Methods: This retrospective analysis used prehospital records from the national ESO data collaborative from March 5–June 15, 2020. Three impressions related to COVID-19 were incorporated into the primary and secondary impressions lists on March 5: COVID-19 confirmed by testing; COVID-19 exposure to confirmed patient; and COVID-19 suspected/no known exposure. All 9-1-1 records with a documented EMS provider primary or secondary impression indicating COVID-19 were included. The authors examined EMS provider-documented use of N95 respirators, surgical masks, powered air purifying respirators (PAPRs), face shields, and eye protection. Additionally, the authors evaluated reuse of N95s, surgical masks, and face shields. Reuse information was not available for PAPRs and eye protection. PPE was considered to have been used during the encounter if any of the above-mentioned PPE articles were documented for at least one EMS provider listed on the prehospital care record. Descriptive statistics are reported. 

Results: There were 34,984 records with a COVID-19 impression documented. Of those, 15% (5,263) did not have PPE documented. Among the 29,721 records with documented PPE, a mask (N95, surgical mask, or PAPR) was documented on 89% (26,529) of records. Of those, 82% (24,469) had documented N95 use, of which 42% (10,290) indicated reuse. Another 17% (5,261) recorded use of surgical masks, of which 42% (2,220) indicated reuse. PAPR use was documented on 3% (967) of records. Face shield use was documented on 19% of records (5,537), of which 37% (2,027) indicated reuse. Finally, eye protection was documented on 88% (26,175) of records with documented PPE. 

Conclusion: On 15% of 9-1-1 records where the EMS provider believed they were caring for a COVID-19 patient, no PPE use was documented. Reuse of PPE was documented often. Future research is needed to determine if the lack of documented PPE use was due to limits in availability, incomplete documentation, or simply failure to take adequate precautions.