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TRANSCRIPT
Novel Coronavirus Disease, COVID‐19 Awareness for the First Responder Personal Protective Equipment
Charles E. Gilbert, Ph.D., M.S.Suffolk County Division of Emergency Medical Services, Dept. of Health Services New York
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Personal Protective Equipment
FIRST HAND HYGIENE
• After Patient Contact• Between Patient Contact• World Health Organization (WHO) Hand Hygiene Protocol Is Scientifically Proven To Work
Hand.Wash
HandRub.
Body Substances Isolation.
Sample Protective Ensembles
Level of Protection Respiratory Skin
A Supplied Air Gas or Microbe Tight
B Supplied Air Appropriate to Contaminant
C Air Purifying CartridgesIncludes N 95
Appropriate to Contaminant
D No Respiratory Protection Appropriate to Contaminant
EMS commonly Use Level C & Level D
Sample Protective Ensembles
3 categories of resistance to filter efficiency degradation are labeledN, R, & P
filter efficiency
N for Not resistant to oil 95 = 95%
R for Resistant to oil 99 = 99%
P for oil Proof 100 = 99.97%
Bureau of Emergency Medical Services and Trauma Systems Policy Statement No. 20‐02Date: February 14, 2020Re: COVID‐19 EMS Practitioner Guidance (V3.0) NOTICE: THIS IS A RAPIDLY EVOLVING SITUATION. PLEASE CHECK BACK DAILY FOR ANY UPDATES TO
THIS POLICY. UPDATED 02.14.2020https://www.health.ny.gov/professionals/ems/policy/policy.htm
COVID‐19 EMS Practitioner Guidance (V3.0) Personal Protective Equipment (PPE): 1
1) EMS PPE shall be used to provide protection from patient suspected w/ COVID‐19. Patient Under Investigation (PUI)
2) EMS shall use PPE appropriately for interactions w/PUI patients, including contact w/the patient’s environment.
3) EMS practitioners shall wear PPE before patient contact & properly remove & discard PPE immediately after patient contact to contain pathogens. Hand hygiene shall be performed after removing PPE.
4) EMS providers shall use Standard, Contact, & Airborne Precautions & eye protection when treating a patient w/suspected COVID‐19. This PPE includes:a) Single pair disposable patient examination gloves;b) Disposable isolation gown;c) NIOSH‐approved, fit tested respirator (N95 or higher);
COVID‐19 EMS Practitioner Guidance (V3.0) Personal Protective Equipment (PPE): 2
i) EMS Practitioners may use PAPRs w/full hood & P 100 filter for Airborne Precautions for EMS practitioners that cannot safely fit test in N95 respirators due to facial hair, facial structure, etc.,
d) Eye protection (goggles or face shield that fully covers front & side of the face).
5) Drivers shall wear all recommended PPE, if providing direct patient care (e.g., moving patients onto stretchers).a) After completing patient care & before entering driver’s compartment, driver shall remove face shield or goggles, gown & gloves & perform hand hygiene.
COVID‐19 EMS Practitioner Guidance (V3.0) Personal Protective Equipment (PPE): 3
b) Respirator shall be worn during transport.
6) EMS Staff shall avoid touching their face while working.
7) Provide surgical mask for suspected COVID‐19 patients (N95 is not recommended).
8) Provide tissues to patients for secretion control & encourage patient hand hygiene & cough etiquette practices.
9) On arrival, after patient is released to the facility, EMS practitioners shall remove & discard PPE & perform hand hygiene. Used PPE shall be discarded in accordance w/routine procedures. Additional guidance: CDC Guidance for NYS EMS providers regarding 2019‐nCoV “Wuhan Coronavirus” (https://www.cdc.gov/coronavirus/2019‐ncov/index.html)
COVID‐19 EMS Practitioner Guidance (V3.0) Precautions for Aerosol‐Generating Procedures: 1
1) If possible, consult w/Medical Control before performing aerosol‐generating procedures for specific guidance.
2) In addition to PPE above, EMS clinicians shall exercise caution if an aerosol‐generating procedure is conducted.a) e.g., bag valve mask (BVM) ventilation, oropharyngeal suctioning, endotracheal intubation, nebulizer treatment, continuous positive airway pressure (CPAP), bi‐phasic positive airway pressure (biPAP), or resuscitation involving emergency intubation or cardiopulmonary resuscitation (CPR).
3) BVMs, & other ventilatory equipment, shall be equipped w/HEPA filtration to filter expired air.
4) EMS organizations shall consult their ventilator equipment manufacturer to confirm appropriate filtration capability & the effect of filtration on positive‐pressure ventilation.
5) If possible, the rear doors of the transport vehicle shall be opened, & the HVAC system shall be activated during aerosol‐generating procedures. This shall be done away from pedestrian traffic.
COVID‐19 EMS Practitioner Guidance (V3.0) Precautions for Aerosol‐Generating Procedures: 2
6) Bag valve masks (BVMs) do not have HEPA filters, EMS clinicians must wear N95 Respirators. Oropharyngeal suctioning, Endotracheal Intubation, Nebulizer treatment, EMS clinicians must wear N95 Respirators. Resuscitation involving emergency Intubation or Cardiopulmonary Resuscitation (CPR), EMS clinicians must wear N95 Respirators.
Continuous Positive Airway Pressure (CPAP), Bi‐phasic positive airway pressure (biPAP), must use HEPA filters on exhalation port.EMS organizations shall consult their ventilator equipment manufacturer to confirm appropriate filtration capability & the effect of filtration on positive‐pressure ventilation.
COVID‐19 EMS Practitioner Guidance (V3.0) Transport Considerations: 1
1) Standard transportation to appropriate hospital / facility.
2) Isolate ambulance driver from patient compartment & keep pass‐through doors & windows tightly shut.
a) It is recommended to have the patient compartment exhaust vent on high & to isolate the driver compartment from the patient compartment. It is also recommended to have the driver compartment ventilation fan set to high w/out recirculation.
b) If driver / pilot compartment is not isolated from the patient compartment, the vehicle operator shall don a NIOSH‐approved, fit‐tested respirator.
3) Family members & other contacts of COVID‐19 PUI patients shall not ride in the transport vehicle.
4) During transport, limit the number of providers in the patient compartment to essential personnel to minimize possible exposures.
COVID‐19 EMS Practitioner Guidance (V3.0) Transport Considerations: 2
5) EMS Practitioners must notify the receiving hospital before arrival if they are transporting a patient w/suspected COVID‐19, to their facility.
6) When providing hospital notification, please indicate if family or support persons are accompanying the patient, as they may need to be isolated. ** EMS agencies shall have a plan for family members wishing to accompany the patient that prevents crew exposures.
7) Hospitals may request EMS personnel deliver such patient(s) through a separate secure entrance.
8) Hospitals may not refuse patients w/suspected Coronavirus infection unless a municipal response plan says otherwise.
COVID‐19 EMS Practitioner Guidance (V3.0) Decontamination Considerations: 1
1) After transporting patient, leave rear doors of transport vehicle open to allow sufficient air changes to remove potentially infectious particles. Consider vehicle & equipment security if staff is not able to stay w/vehicle.
2) Time to transfer patient to the receiving facility & complete documentation shall provide sufficient time for air changes.
3) When cleaning vehicle, EMS clinicians shall wear disposable gown & gloves. Face shield or facemask & goggles shall be worn if splashes or sprays during cleaning are anticipated.
4) All horizontal surfaces must be (this is a 2 step process):1) Clean & 2) Decontaminate using an EPA ‐ registered hospital disinfectant according to
label directions. Products w/EPA approved Emerging Viral Pathogens claims are recommended for use for COVID‐19. These products can be identified by the following claim:
a) “[Product name] has demonstrated effectiveness against viruses similar to COVID‐19 on hard non‐porous surfaces. Therefore, this product can be used against COVID‐19 when used in accordance w/the directions for use against [name of supporting virus] on hard, non‐porous surfaces.”
COVID‐19 EMS Practitioner Guidance (V3.0) Decontamination: 3
b) This claim or a similar claim, will be made only through the following communications outlets: technical literature distributed exclusively to health care facilities, physicians, nurses & public health officials, “1‐800” consumer information services, social media sites & company websites (non‐label related). Specific claims for “COVID‐19” will not appear on the product or master label.
5) Ensure that environmental 1) Cleaning & 2) Disinfection procedures are followed consistently & correctly, to include the provision of adequate ventilation when chemicals are in use. Doors shall remain open when cleaning the vehicle.
6) Routine cleaning & disinfection procedures (e.g., using cleaners & water to pre‐clean surfaces prior to applying an EPA‐registered, hospital‐grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for COVID‐19 in healthcare settings, including those patient‐care areas in which aerosol‐generating procedures are performed.
COVID‐19 EMS Practitioner Guidance (V3.0) Decontamination : 4
7) Clean & disinfect vehicle according to standard operating procedures. Surfaces that may contact w/the patient or materials contaminated during patient care (e.g., stretcher, rails, control panels, floors, walls, work surfaces) shall be cleaned & disinfected using EPA‐registered disinfectant in accordance w/the product label.
8) Clean & disinfect reusable patient‐care equipment before use on another patient, according to manufacturer’s instructions.
9) Use standard operating procedures for containment & disposal of used PPE & medical waste.
10) Standard operating procedures for containing & laundering used linen. DO NOT shake linen.
11) Remove & dispose contaminated PPE & perform hand hygiene before transporting patients. Don clean PPE to handle patient at transport location.
COVID‐19 EMS Practitioner Guidance (V3.0) Documentation of Patient Care: 1
1) Documentation of patient care shall be done after EMS clinicians have completed transport, removed their PPE, & performed hand hygiene.
2) Written documentation shall match verbal communication given to emergency department providers at time patient care transferred.
3) EMS documentation shall include listing of EMS clinicians & public safety providers involved in the response & level of contact w/patient (for example, no contact w/patient, provided direct patient care). This documentation may need to be shared w/local public health authorities.
COVID‐19 EMS Practitioner Guidance (V3.0) Follow‐up & Reporting: 1
1) EMS who have been exposed to a patient w/suspected or confirmed COVID‐19 shall notify chain of command (Infection Control) to ensure appropriate follow‐up.
2) Unprotected exposure (e.g., not wearing recommended PPE) shall be reported to occupational health services, supervisor, or designated infection control officer for evaluation.
3) EMS clinicians shall be alert for fever, or respiratory symptoms (e.g., cough, shortness of breath, sore throat). If symptoms develop, they shall self‐isolate & notify occupational health services & public health authority to arrange appropriate evaluation.
Three categories of additional precautions: Contact precautions, Droplet precautions, & Airborne precautions
Contact Precaution Guidelines
PPE Private Room Visitors Patient Transport Cleaning
Gown, Gloves
Private room preferred or cohort patients.Must have own dedicated equipment.
Gown & gloves must be worn if providing direct care.Must perform hand hygienebefore & after care.Must not go into other patient rooms.
Patient: none requiredStaff: gown & gloves
Additional daily room cleaning may be required.
Data source: PIDAC, 2012; PHAC, 2013; Siegal, Rhinehart, Jackson, & HICPAC, 2007
Droplet precautions for COVID‐19
Droplet Precautions Guidelines
PPE Private Room Visitors Patient Transport Cleaning
Gloves, gown, & N 95 respirator in 2 M of patient
Private room preferred or cohort.
Must have own dedicated equipment.
Gown, gloves, surgical masks, & eye protection worn for activities in 2 M of patient.
Patient must wear surgical mask when leaving room.
Door may remain open.
Hand Hygiene
Gloves, gown, & surgical mask worn if providing direct care. Hand hygiene before & after care.
Visitors may not go into other patient rooms.
Patient: none required
Staff: gown & gloves, & N 95 respirator
Additional daily room cleaning may be required.
Data source: PIDAC, 2012; PHAC, 2013; Siegal, Rhinehart, Jackson, & HICPAC, 2007
Droplet Precautions Sequence Dressing PPE
COVID‐19 PPE CDCGood PPE
.
How to Undress
• Remove Gown• Hand Hygiene• Remove Face Shield or Goggles• Hand Hygiene• Remove Gloves• Hand Hygiene• Remove Respirator• Wash Face• Hand Hygiene
Poor PPE
Center for Food Security & Public Health‐ Iowa State Univ
Hand.Wash
HandRub.
Susceptibility To Disinfectants:
• COVID‐19 Virus: Susceptible to 3% acetic acid, 1% glutaraldehyde, alcohol‐based products, &
• 1:10 ‐ 1:100 for ≥10 minutes of 5.25% bleach (sodium hypochlorite), & calcium hypochlorite (bleach powder)
• WHO recommends cleaning up spills of blood or body fluids suggest flooding the area with:– 1:10 dilution of 5.25% bleach for >10 mins. for surfaces
tolerating strong bleach solutions (e.g., cement, metal)– Surfaces that may corrode or discolor & skin; clean to
remove visible stains followed by contact w/1:100 dilution of 5.25% bleach for >10 mins.
Target
Photo credit: Dwight Carter
I've learned that,
People will forget what you said,
People will forget what you did, but
People will never forget how you made them feel.
Maya Angelou
The web pages linked below are being continuously updated by the New York State Department of Health with the most up‐to‐date, relevant information
available.
• https://www.health.ny.gov/professionals/ems/policy/policy.htm
• https://www.health.ny.gov/diseases/communicable/coronavirus/providers.htm
Questions?