Emergency medical services are a component of critical infrastructure. To protect personnel during the pandemic, the following Just in Time Standing Order (JITSO) is in effect throughout Greater Miami Valley EMS Council immediately.
To ensure effective patient care and minimize cross-contamination of EMS units and hospitals, EMS units will only allow family members or support persons to be transported with the patient when it is essential to patient care. All other requests for companion transports should be denied at this time.
- Examples of companions who must be transported in EMS units include parents or guardians of minors; historians for time-critical diagnoses such as stroke; or translators when significant language barriers exist.
- Companions who are demonstrating infectious symptoms such as fever, cough, illness should not be transported (unless being treated as an additional patient in the patient compartment).
EMS personnel should use aerosol-generating procedures (AGPs) only when they would be life-saving.
- Non-rebreather masks, nebulizer treatments, and CPAP generally are to be avoided in this current outbreak
- Use the patient’s metered dose inhaler (MDI) with a spacer instead of a nebulizer when available. Bring all such equipment to the hospital with the patient.
- Remember that you can place a surgical mask on the patient over oxygen equipment throughout the call.
- When AGPs such as CPR, CPAP, nebulizers, and intubation are needed, if feasible, perform those in an open-air environment, or with vehicle windows open while in transit.
- During transport, vehicle ventilation in both compartments should be on non-recirculated 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.
- Remove all aerosolizing devices from the patient just before entering the emergency department. Doing so will help prevent the spread of aerosolized viral particles throughout the ED.
- Always notify the hospital prior to arrival on any suspect COVID-19 case.
During this Pandemic Response, EMS personnel are to approach patients at as distance, determine potential infectious components, assess PPE needs, and have patients don surgical masks from a distance when symptoms present. EMS personnel must conserve PPE and use only as necessary. N-95 masks must be saved for aerosol producing procedures.
PPE conservation must begin now! Tomorrow is too late. There will be much more severe shortages in the future. Surgical masks, gloves, and possibly face shields or goggles are appropriate for most infectious patients. Plan to clean and reuse following CDC guidelines wherever possible. Expect expanded guidance and limitations soon. ALL PPE is coming into shortage, and this will become worse.
Exercise droplet protection when necessary with coveralls or gowns. Uniforms should be laundered frequently during the shift following the transport of potentially contagious patients. Thorough decontamination of the cab and patient compartments should be performed after each transport to protect crews and patients.
Consider using materials such as crash wrap to isolate the driver’s compartment to reduce the need for PPE for drivers.
EMS agencies should consider implementing pre- and post-shift screening for all personnel as recommended in previous guidelines.