Author: Steve Weigold

Updated 20200321 – added additional recommendations and clarifications.

The Infection Control Chairs (Chief Chad Follick and Laura Clark, RN) for Greater Miami Valley EMS Council have been asked questions about what happens if an EMS crew suspects they have been exposed to the COVID-19. These questions were:

• Should the crew pre-notify the ED?  The answer to that one is ABSOLUTELY YES, and expect to be directed to a specific entrance.
• Does the crew follow the same exposure procedure that is in place? 
• Should they fill out an exposure form?
• Would the hospitals do testing?
• What should we do with that EMS crew while we are waiting for the patient tests to come back?
• If we don’t quarantine them and the patient test positive for COVID-19, have they now “exposedâ€� the entire station?

First , encourage all personnel to follow all of PPE and decontamination procedures appropriate to the patient situation. 

That will eliminate most exposures. Crews with an exposure (for example patient without a face mask coughs in the face of a first responder without PPE), the crew should follow the current GMVEMSC Infection Control Policy with regards to reporting these incidents.  

Notify the hospital ASAP when (if) they are transporting a suspected COVID-19 patient and/or if they are transporting a patient with a confirmed case.

In most scenarios we are suspecting that the patient is infected so we are going to use the Respiratory Exposure (C.) section of policy to guide crews in their reporting procedures.

Crews should notify the ED charge nurse of the exposure upon delivery of the patient

Complete the Request for Notification of Test.

In these cases being checked in as an ED patient may or may not be necessary. Upon receipt of the source patient’s diagnosis, follow-up care and prophylaxis may be necessary for those exposed.  At this point exposed employees will be notified by the EMS Coordinator and they may have to return to the receiving hospital and be checked in as a patient to receive care.

In other situations follow-up care and prophylaxis may come from your department’s workplace health provider or their personal physician. 

The decision to quarantine crew members is made by Public Health in your county. 

Currently Public Health will follow CDC specific quarantine and isolation requirements for individuals exposed to or sick from COVID-19. Regardless, if they are a part of the general population or a first responder the following measures will be followed.

• If a first responder has a known exposure to COVID-19 without proper PPE they should immediately see a physician.
• It should be explained to the physician of the known exposure, to ensure they are placed within an isolation room while gathering a culture if indicated.
• Exposure risk will be evaluated to determine need for testing and quarantine.
• Need for Quarantine will be determined by the local health department.
• With rare exceptions, the crew can remove PPE, perform hygiene, and put on clean uniforms and return to duty while awaiting decisions on quarantine.
• Those crew members are not an immediate risk for transmitting the disease.
• If quarantine does become indicated, that would most likely be in their homes unless an agency makes different arrangements for them..
• Information regarding quarantine would be shared with the first responder from the communicable disease section of Public Health explaining all requirements.
• If a case was severe they would be placed in isolation within the hospital until their condition improved.

Updated 20200321

Above are the exposure procedures developed by the GMVEMSC Infection Control Committee in concert with Public Health and hospitals.  However, there have been many questions asked about quarantine.  Quarantine is used to separate and restrict the movement of well persons who have been exposed to a communicable disease to see if they become ill.  Isolation is used to separate ill persons who have a communicable disease from those who are healthy.

In response to questions, Public Health provided the following additional guidance:

• Suspect cases would not require contact tracing and there would be no quarantine until a confirmed case.
• Once there is a confirmed case, Public Health will interview this person and gather information on their contacts.
• Public Health will then begin contact tracing based on the information gathered from the confirmed case.
• Individuals who came in close contact would be required to quarantine for 14 days.
• Individuals who are under quarantine should have their own individual space, preferably with their own bathroom.