Personal Protective Equipment Supply for Emergency Medical Services (EMS)

Document Developed by the Healthcare Resilience Task Force Emergency Medical Services (EMS) Prehospital Team.  Download PDF

Current Situation
Personal Protective Equipment (PPE) supplies, including N-95 respirators and gowns, are in short supply due to the COVID-19 pandemic. These shortages are anticipated to resolve over time as additional sources are identified and manufacturing capacity is expanded. In the interim, Emergency Medical Services (EMS) agencies that are unable to meet their PPE requirements through regular distribution channels are advised to submit requests for PPE supplies through their local and/or state emergency management officials, which are then submitted to Federal Emergency Management
Agency (FEMA) for sourcing and allocation.

Background
Due to the COVID-19 pandemic, health care providers are exhausting PPE supplies faster than
they can be sourced. EMS agencies are part of the critical infrastructure sector and are strongly considered in the decision-making process to allocate supplies.

Actions Taken to Address Supply Issues

• The Strategic National Stockpile (SNS) has been activated to provide PPE supplies to states for distribution to healthcare agencies. Supplies are being allocated to states on a pro-rata basis for distribution by the state.
• Initial distributions from the SNS were limited. Additional distributions are ongoing and the
  second and some third distributions from the SNS to states have occurred.
• FEMA and the U.S. Department of Health and Human Services (HHS) are actively working to source and purchase PPE supplies (including N-95 respirators) from all sources, including international and domestic vendors along with donations from the private sector.
• FEMA and HHS are also working with industry to increase the manufacturing of PPE supplies.
• The Food and Drug Administration (FDA) has issued emergency guidance to permit the medical use of all N-95 respirators approved by the National Institute for Occupational Safety and Health (NIOSH), including NIOSH-approved N-95 respirators that are not approved by the FDA for medical use (i.e., those intended for industrial use). A list of N- 95 respirators approved by NIOSH is available here. The FDA’s guidance also permits the use of NIOSH-approved N-95 respirators that have passed their recommended shelf- life and are undamaged.
• The FDA has also issued emergency guidance to permit the medical use of certain imported,
  non-NIOSH-approved respirators when used in accordance with Centers for Disease Control and
  Prevention (CDC) recommendations on the prevention of exposure to pathogenic biological airborne particulates. A list of non-NIOSH-approved respirators approved for use under this guidance can be found in Table 1 of the FDA guidance.
• The CDC has issued recommended guidance on the extended use and limited re-use of N- 95 respirators in situations when N-95 respirator supplies are low. Per the CDC guidance, extended use is favored over reuse because it is expected to involve less touching of the respirator and therefore less risk of contact transmission. For areas in crisis see also the CDC guidance on decontamination and reuse of filtering facepiece respirators.

How to Request PPE Supplies

1. Requests for reordering of PPE should be made through the normal request process. Due to shortages, the entire order may not be able to be filled.

2. To request additional PPE supplies from state or federal resources for unmet needs, you must submit requests through your established local emergency management structure. Depending on the state, your request may be processed through the emergency management chain or through the public health chain to state-level emergency management. From the state level, it will be transmitted to FEMA.

3. When submitting a request, please include the following information:
a. Agency
b. Specific material and quantity request
c. Detailed risk/exposure justification for the request
d. Current on-hand requested supplies
e. Burn rate of current supplies – to provide an estimate of time remaining of current supply
f. Other information pertinent to the request
g. Alternatives that are available, if any, and risks associated with pending gaps (For
information regarding PPE alternatives and optimization strategies, click here.)

This information will help inform the allocation of state and federal PPE resources. Please understand that your request is important and is being considered seriously in the context of similar requests from your peers. The shortage of PPE will continue to be a challenge during the COVID-19 pandemic. Following the appropriate process for requesting supplies is critical to ensuring that you are able to receive needed PPE supplies. For more information regarding EMS response and infection control during the COVID-19 pandemic, please click here.