Technical Resources from HHS/ASPR TRACIE to Assist First Responders and Healthcare Providers

Technical Resources from HHS/ASPR TRACIE to Assist First Responders and Healthcare Providers HHS ASPR, the Technical Resources, Assistance Center, and Information Exchange (TRACIE) was created to meet the information and technical assistance needs of regional ASPR staff, healthcare coalitions, healthcare entities, healthcare providers, emergency managers, public health practitioners, and others working in disaster medicine, healthcare…

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Mitigate Absenteeism By Protecting EMS Mental Health

Document Developed by the Healthcare Resilience Task Force Behavioral Health Work group and Adapted by the Prehospital [911 and Emergency Medical Services (EMS)] Team. This guidance applies to all delivery models including but not limited to; free standing, third-service; fire-based, hospital-based, independent volunteer, and related emergency medical service providers.

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Mitigate Absenteeism by Protecting Emergency Medical Service (EMS) Clinicians’ Psychological Health and Well-being during the COVID-19 Pandemic

The resilience of our Nation’s healthcare system depends on our healthcare workforce’s ability to report for duty. Critical supplies, equipment, and surge capacity rely on dedicated, trained health professionals and support staff to enable care. This document contains general concepts to prepare and take action, such as those listed below, to help your EMS/911 agency protect your workers’ psychological health and well- being.

 

Prepare your workforce for what is to come before the surge takes place:

  • Organize peer support—staff-to-staff and family-to-family—to provide assistance with tangible needs like childcare, dependent care, pet care, and food and medication
    • Assist staff to locate resources to establish emergency plans for childcare, dependent care, pet care, and family communication to mitigate absenteeism due to urgent needs at
    • Encourage staff to pre-arrange their home to accommodate isolation should the staff member become ill (as not to spread infection to other household members).
  • Develop a plan to provide boarding on or near the work site for staff who are unable to commute, have a long commute, or concerned about infecting family and
    • Establish workforce housing by setting up dormitories, acquiring hotel space, or converting unused areas of the
    • Ensure plans account for non-medical staff (e.g., administration, billing, medical supplies, fleet maintenance, ).
    • Consider setting up shuttle service for employees, or designate drivers for staff working unusual shifts or prolonged
    • Check with your local and State Emergency Operations Centers to identify available resources and plans that may help with this
  • Encourage staff to develop a personal stress management plan to address exercise, nutrition, sleep, mindfulness, and
  • Pre-identify behavioral health resources in your area such as local behavioral health providers, Red Cross chapters, and Medical Reserve Corps units, tele-mental health services, as well as grief and loss resources for staff who may lose patients, colleagues, or loved
    • Use the SAMHSA Treatment Locator to locate behavioral health providers in your
      • Identify if any behavioral health providers in your area have experience treating EMS Clinicians.

 

Support your workforce effectively during the surge:

EMS Clinicians may not be able to use the coping mechanisms that they typically rely on to manage stress. Teaching and encouraging the use of simple relaxation techniques may help to decrease their physiological arousal levels and focus on something besides the situation at hand.

  • Maximize opportunities for effective
  • Relaxation techniques such as deep breathing, progressive muscle relaxation, and guided imagery can help clinicians focus on decreasing the intensity of their
  • Provide opportunities while working for stress reduction activities i.e. comfort dogs, exercise,
  • Direct EMS leadership and senior staff to role model good stress management, empathy, and psychological support. Organizational policy should support the workforce and a culture and climate of safety.
  • Establish bi-directional communication and a mechanism for staff to make recommendations to leadership through use of dedicated email or a physical suggestion
  • At each shift change provide briefings on the current status of the work environment, safety procedures, and required safety
  • Work with agency for plan of judicious and strategic days off or
  • Establish a behavioral health (or resilience or fatigue management) safety officer who will regularly monitor staff stress, coping, and fatigue management and provide guidance, recommendations, and corrective action as needed. This important role needs to be empowered by leadership and leadership should be committed to adjusting course based on feedback and ground
  • Stress compromises the immune system and affects physical health. Address staff stress and fatigue with organizational strategies.
    • Establish and adhere to regular breaks throughout the shift to mitigate fatigue. Limit overtime whenever possible
    • Rotate workers from high-stress to lower-stress functions and monitor and adjust to address fatigue related to diurnal/shift timing
    • Monitor and evenly redistribute increased workload resulting from staff illness or accidental exposure.
    • Establish communications capabilities so that staff can communicate with loved ones and connect with their social supports through internet, video, and
    • Designate a quiet room or area for staff to use to facilitate rest during
    • Develop a strategy to ensure that healthy food, water, refreshments, hygiene, and comfort items are readily available without the need to leave the
    • If staff are sheltering in place at the facility, ensure access to:
      • Wifi
      • exercise equipment;
      • information such as newsletters, social media, or television;
      • facilities and supplies needed for hygiene (e.g., showering, teeth brushing, laundry); and
      • a means to get needed medications and capability to support personal medical equipment (e.g., CPAP).
  • Assign experienced staff to mentor and support newer staff and develop just in time onboarding materials to orient staff new to work site, including screening and infection control
  • Ensure staff know how to access psychological support through available mechanisms such as Employee Assistance Programs, Critical Incident Stress Debriefing (CISM) team, members trained in stress first aid, and the Disaster Distress
    • SAMHSA’s Disaster Distress Helpline provides 24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters (1-800-985-5990 or text TalkWithUs to 66746).
    • Ensure staff know how to access telehealth/telemedicine resources

1,2,3 This is a non-federal website. Linking to a non-federal website does not constitute an endorsement by the U.S. government, or any of its employees, of the information and/or products presented on that site.

FEMA Advisory | Supply Chain Stabilization

The following information was delivered by FEMA via email on April 9.

Coronavirus (COVID-19) Pandemic Supply Chain Stabilization 

The Supply Chain Task Force continues executing a strategy maximizing the availability of critical protective and lifesaving resources through FEMA for a whole-of-America response. Efforts to date have focused on reducing the medical supply chain capacity gap to both satisfy and relieve demand pressure on medical supply capacity. The task force is applying a four-prong approach of Preservation, Acceleration, Expansion and Allocation to rapidly increase supply today and expand domestic production of critical resources to increase supply long-term.

The preservation line of effort focuses on providing federal guidance to responders and the non-medical sector, such as public service (police, fire, EMT), energy distribution and the food industry on how to preserve supplies when possible, to reduce impact on the medical supply chain.

The  acceleration  line of effort provides direct results to help meet the demand for personal protective equipment PPE through the industry to allow responders to get supplies they need as fast as possible.

The  expansion  line of effort is charged with generating capacity with both traditional and non-traditional manufacturers, such as adding machinery or by re-tooling assembly lines to produce new products.

The  allocation  of supplies facilitates the distribution of critically needed PPE to “hot spots” for immediate resupply. States report on supplies and can request assistance when they experience a shortage.

The Supply Chain Task Force is working with the major commercial distributors to facilitate the rapid distribution of critical resources in short supply to locations where they are needed most. This partnership enables FEMA and its federal partners to take a whole-of-America approach to combatting COVID-19. The task force is providing distributors with up-to-date information on the locations across the country hardest hit by COVID-19 or in most need of resources now and in the future. The distributors have agreed to focus portions of their distributions on these areas in order to alleviate the suffering of the American people.

A key example of this partnership in action is Project Airbridge. The airbridge was created to reduce the time it takes for U.S. medical supply distributors to receive PPE and other critical supplies into the country for their respective customers. FEMA covers the cost to fly supplies into the U.S. from overseas factories, reducing shipment time from weeks to days.

Overseas flights arrive at operational hub airports for distribution to hotspots and nationwide locations through regular supply chains. Flight arrivals do not mean supplies will be distributed in the operational hub locations.  Per agreements with distributors, 50 percent of supplies on each plane are for customers within the hotspot areas with most critical needs. The remaining 50 percent is fed into distributors’ normal supply chain to their customers in other areas nationwide.  HHS and FEMA determine hotspot areas based on CDC data.

Working together, we can efficiently distribute these vital resources to hospitals, nursing homes, long-term care facilities, pre-hospital medical services, state and local governments, and other facilities critical to caring for the American people during this pandemic.

FEMA_Adv_SCTF_Supply Chain Stabilization.pdf

CDC: PPE Guidance and Burn Rate Calculator

U.S. Centers for Disease Control |  April 7, 2020 U.S. Strategies to Optimize the Supply of PPE and Equipment Personal protective equipment (PPE) is used every day by healthcare personnel (HCP) to protect themselves, patients, and others when providing care. PPE helps protect HCP from potentially infectious patients and materials, toxic medications, and other potentially…

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US News: AAA, NAEMT, IAFC Urge PPE for First Responders

DOL: Guidance for Respiratory Protection During N95 Shortage

U.S. Department of Labor  |  April 3, 2020

U.S. Department of Labor Issues Guidance for Respiratory Protection During N95 Shortage Due to COVID-19 Pandemic

WASHINGTON, DC – The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) has issued interim enforcement guidance to help combat supply shortages of disposable N95 filtering face piece respirators (N95 FFRs). The action marks the department’s latest step to ensure the availability of respirators and follows President Donald J. Trump’s Memorandum on Making General Use Respirators Available.

Due to the impact on workplace conditions caused by limited supplies of N95 FFRs, employers should reassess their engineering controls, work practices and administrative controls to identify any changes they can make to decrease the need for N95 respirators.

If respiratory protection must be used, employers may consider use of alternative classes of respirators that provide equal or greater protection compared to an N95 FFR, such as National Institute for Occupational Safety and Health (NIOSH)-approved, non-disposable, elastomeric respirators or powered, air-purifying respirators. 

When these alternatives are not available, or where their use creates additional safety or health hazards, employers may consider the extended use or reuse of N95 FFRs, or use of N95 FFRs that were approved but have since passed the manufacturer’s recommended shelf life, under specified conditions.

This interim guidance will take effect immediately and remain in effect until further notice. This guidance is intended to be time-limited to the current public health crisis. Visit OSHA’s Coronavirus webpage regularly for updates.

For further information about COVID-19, please visit the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention.

Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA’s role is to help ensure these conditions for America’s working men and women by setting and enforcing standards, and providing training, education and assistance. For more information, visit www.osha.gov.

The mission of the Department of Labor is to foster, promote and develop the welfare of the wage earners, job seekers and retirees of the United States; improve working conditions; advance opportunities for profitable employment; and assure work-related benefits and rights.

###

Media Contacts:

Emily Weeks, 202-693-4676, weeks.emily.c@dol.gov

Release Number:  20-572-NAT

NIEHS Worker Training Program COVID-19 Resources

The National Institute of Environmental Health Sciences (NIEHS) Worker Training Program (WTP) has been tracking information about the coronavirus disease 2019 (COVID-19) as it pertains to protecting workers involved in emergency response and cleanup activities performed in the United States. This page contains health and safety resources for workers who may be at risk of exposure to COVID-19.

Training Resources

The National Clearinghouse creates training tools to aid in the development of awareness-level courses or other awareness-level materials. These tools provide health and safety guidance to workers who work in industries with the potential for exposure to COVID-19.

WTP Resources

COVID-19 is a new disease and we are still learning much about it, including how it spreads. This Training Tool will be updated with new information as the situation evolves.

WTP Awardee Resources

WTP Technical Workshops

Federal Links and Documents

Centers for Disease Control and Prevention (CDC)

CDC National Institute for Occupational Safety and Health (NIOSH)

Federal Aviation Administration (FAA)

National Institutes of Health (NIH)

NIH National Institute for Allergy and Infectious Disease (NIAID)

NIH National Library of Medicine (NLM)

Occupational Safety and Health Administration (OSHA)

U.S. Department of Labor

U.S. Environmental Protection Agency (EPA)

State/Local Links and Documents

Please refer to your local and state Department of Health for additional state-specific guidance on COVID-19.

Other Links and Documents

Wellbeing for Healthcare Providers During COVID-19

Thank you to the UK’s Dr. Alys Cole-King and Dr. Linda Dykes for putting together this resource for healthcare worker mental and behavioral health. The main document, Optimising staff preparedness, wellbeing, and functioning during the COVID-19 pandemic response, is still evolving. It will be updated and expanded in the next 10-14 days, so please check the page frequently for updated versions.

Free Webinar: COVID-19 Issues Affecting the EMS Workplace

Free Webinar | Fri, March 20, 2020 |1:00 PM ET

Register Now

Summary
The world has changed in just a few short weeks and we all want answers to the tough questions facing EMS. Coronavirus (COVID-19) is also redefining how we deal with many issues in the EMS workplace. Join us as the nation’s top EMS legal experts from the American Ambulance Association and Page, Wolfberg & Wirth address the hot topics such as patient privacy, workplace safety, staff shortages, pay practices, worker’s comp and leave, discipline practices, liability and more. The webinar will include a Q&A so that you can ask these experts about the issues that matter most to you.

Speakers

Scott Moore, Esq.
Scott Moore is the owner of Moore EMS Consulting, LLC and an active EMT for nearly 30 years. Scott has held various executive positions, including Chief Executive Officer, Vice President, Director of Human Resources & Operations, at several ambulance services in Massachusetts. Scott is a licensed attorney, specializing in Human Resources, employment law, reimbursement, and compliance matters. Scott is the Human Resources & Operational Consultant to the American Ambulance Association (AAA) and frequently lectures at EMS conferences.


Ryan Stark, Esq.
Ryan Stark is a Managing Partner with Page, Wolfberg & Wirth, and is the firm’s resident “HIPAA guru.” Ryan is a featured speaker in PWW seminars and webinars, including the firm’s signature abc360 Conference, where he hosts the abc360 Game Show. Ryan developed, and is the primary instructor for the nation’s first and only HIPAA certification for the ambulance industry. He also co-authored PWW’s widely used Ambulance Service Guide to HIPAA Compliance.


Stephen Wirth, Esq., EMT-P
Attorney/Founding Partner, Page, Wolfberg & Wirth, LLC
Steve Wirth is a founding partner of the national EMS law firm Page, Wolfberg & Wirth, LLC. Steve has worked in virtually every facet of EMS in a four- decade career – as first responder, firefighter, EMT, paramedic, flight paramedic, EMS instructor, fire officer, and EMS executive. Steve brings a pragmatic, compassionate, and business‐oriented perspective to his diverse legal practice and served for nearly a decade as senior executive of a mid‐sized air and ground ambulance service.

Sponsored By:

By registering for this program, you consent to share the registration information (not including your email address) with the program’s sponsor.

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Coronavirus (COVID-19) Impacts on the EMS Workplace

There has been a great deal activity and press coverage over the past few weeks relative to the Coronavirus (COVID-19). This activity has generated several questions from EMS organizations regarding how to handle the impact on the workplace. Healthcare workers have been identified by the Occupational Safety and Health Administration (OSHA) as a group of workers who are at an increased risk of exposure to COVID-19. There are many steps EMS organizations can take to best prepare their workplace and protect their personnel.

EMS agencies are already required to follow and maintain OSHA’s Infection Control Standards for Bloodborne and Airborne Pathogens (29 CFR 1910.1030). If EMS organizations and their employees are diligent in maintaining these standards, they will already be doing nearly everything that is being recommended for employers to combat the spread of COVID-19. The Centers for Disease Control (CDC) released their Interim Guidance for Businesses and Employers, which includes additional practical recommendations for employers to utilize to further combat the spread of COVID-19, including:

  1. Actively encouraging sick employees to stay home;
  2. Separating sick employees from the rest of the workforce;
  3. Encouraging workers to stay home when sick, respiratory etiquette, and hand hygiene by all employees;
  4. Performing routine environmental cleaning;
  5. Advising employees before traveling to take certain steps.

This guidance is intended to be a refresher for employers. The recommendations by the CDC are consistent with best practices for employers regardless of a potential pandemic. However, our workforce can become complacent and it is important that EMS organizations remind their teams to be diligent and have supervisory staff monitor for adherence to these practices and company policies.

Frequently Asked Questions

Over the past week there have been several questions posed by EMS organizations on employer related issues related to COVID-19. We thought we would share those questions and encourage members to reach out with questions not addressed in this FAQ. We will be sure to share those questions with members and will provide additional guidance as it becomes available.

Are there any limits to the medical questioning or screening of current or potential employees?

Yes, Employers are limited when performing medical screenings or making medically related inquiries of employees or job candidates regardless of the current COVID-19 virus concerns. Often, medical screenings or inquiries can identify medical conditions which are protected under the Americans with Disabilities Act (ADA). To the extent to which they are permitted, any medical inquiry or screening must be job related and consistent with business necessity. In those circumstances, any information must be kept confidential.

The Equal Employment Opportunity Commission (EEOC) re-released Pandemic Preparedness in the Workplace and the Americans with Disabilities Act which provides guidance for employers on how to prepare for a pandemic in the workplace while maintaining compliance with the ADA.

Employer Permitted Screening/Questioning

  1. Questions designed to identify non-medical reasons for work absences (such as public transportation interruptions)
  2. Post-offer medical examinations required of all similarly situated employees in same job category.
  3. During a declared pandemic, employers can ask employees if they are experiencing pandemic-like symptoms. Responses must be kept confidential, consistent with other employee-related medical information.
  4. Taking employee’s temperatures is permitted in a widespread pandemic but this may not be a reliable manner for identifying those employees ill with the COVID-19 virus.
  5. Employers can inquire about potential exposure to pandemic if the employee traveled to an area affected by the COVID-19 pandemic.
  6. Employers can ask an employee if the reason an employee missed work was for a medical reason.

What do we do if we have an employee who is concerned about exposure and wishes to miss work? Additionally, what if the employee’s concern is due to an underlying medical condition, such as pregnancy, and asks to stay out of work?

There are several important issues to address with both questions. First, employers need to review all company policies regarding leave from work to ensure compliance with the relevant leave laws including, leave as an accommodation under the ADA, Family and Medical Leave Act (FMLA), and state-level Paid FMLA or Sick Leave laws. Additionally, employers should review their policies regarding any other paid or unpaid leave to be certain that all policies clearly delineate how leave requests are handled under these policies.

For the most part, when an employee is seeking to miss work due to exposure concerns, employers should handle these requests as they would any other requested leave from work. This is where it is important to utilize your Human Resources (HR) professionals. HR can evaluate the request for leave to ensure that the reason the employee is requesting the leave isn’t due to an underlying disability under the ADA or a “serious health condition” under FMLA. In both instances, an employer has numerous obligations and may be required to approve the leave. In some instances, the employee could be seeking FMLA due to a family member who is ill with COVID-19 who they must care for. In these instances, employers would follow their normal FMLA practices.

As it relates to the first employee, the presumably healthy employee who is concerned with being exposed to COVID-19, any leave would be provided consistent with the employer’s attendance and time off policies. This is different than how you would address the employee who is pregnant and seeking to miss work due to concerns of virus exposure. Pregnancy and pregnancy related medical conditions can qualify as a “disability” under the ADA.

Pregnancy itself is not necessarily a “disability” under the ADA. Only when the pregnancy or a pregnancy related medical condition interferes with one or more major life activities, may it qualify as a “disability” under the ADA. Employers are required to engage in the “interactive process” to determine if the employee can be provided with a “reasonable accommodation” that would permit the employee to perform the essential functions of their position. A reasonable accommodation can include leave from work. It is important that you document these requests and the subsequent process to ensure consistent handling and record keeping.

These can be incredibly difficult issues to handle, especially with all the information and media attention surrounding this virus. Members who need assistance with these potentially challenging compliance issues can contact the AAA and its consultants for assistance.

What should we do if an employee is exposed to, or suspected of having contracted COVID-19?

OSHA has created a COVID-19 Resources Webpage to assist employers with planning and addressing employer issues related to the Coronavirus. In addition, the CDC’s guidance for employers provides recommendations and strategies to prepare for, and deal with, COVID-19 in the workplace. This includes how to address the employee-related aspects of this virus.

However, under the General Duty Clause of OSHA, employers must “furnish to each of his employee’s employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.” This includes removing known hazards from the workplace, including sick or contagious employees.

Aside from the efforts to prepare and address exposures, employers have been seeking guidance from a workers’ compensation perspective and how to handle quarantines and exposures for employees. It is important to remember that an occupational exposure to COVID-19 is no different than any other occupational exposure. EMS organizations should be sure to do the following:

  • Review their company policies relative to work injuries, exposures, and illnesses to be sure that they are clearly drafted and instruct both employee and supervisors what to do in the event of an exposure.
  • Ensure you have reviewed the Infection Control and Bloodborne and Airborne Pathogens Standards and that your employees have access to, and utilize their Personal Protective Equipment (PPE).
  • Confirm that there is adequate workplace postings and communications to ensure that all employees understand how to report any suspected occupational exposure.
  • Confirm with all management personnel that they understand how to appropriately investigate any workplace exposure in collaboration with human resources or company safety or occupational health officer.
  • Contact the Infection Control Officer at the healthcare facilities in your catchment area to ensure that they have the appropriate contact information for your service in the event that they need to contact your organization due to a known exposure.
  • Contact the public health agency in your catchment area to ensure that your organization is engaged with public health officials in your service area to stay informed.
  • Be sure that employees understand and are leaving a copy of the Ambulance Patient Care Report at a receiving facility at the time of transport to ensure that the receiving facility’s Infection Control Officer can notify the EMS organization in the event that an ambulance patient is later determined to have, or be suspected of having COVID-19.
  • If an employee reports exposure to COVID-19, employers should notify their workers compensation insurance carrier to begin the claims process.
  • In most states, being exposed to a contagious disease or illness is not itself compensable under workers’ compensation. To be compensable under most state worker’s compensation laws, the employee has to actually contract the contagious illness or disease and be able to show that the contagious disease or illness exposure occurred in the course of their employment. Some professions, such as healthcare, are inherently more likely to be exposed to the contagious disease or illness. Often, healthcare workers are still required to show a “but for” causation. If the employee can meet this burden, then the workers’ compensation claim for this illness will likely be compensable.
  • Employees who have a workplace exposure and have been placed in quarantine or are being treated will be handled a bit differently. These exposures or illnesses would be handled like any other occupational exposure or illness. The employee should complete an Injury & Illness Incident Report form to ensure that the employer has all of the information needed to appropriately investigate and report the illness, both to their workers compensation insurance carrier and on their OSHA Log of Work-Related Injuries & Illnesses.

Can I make my employees stay home if they have been exposed or are exhibiting symptoms of COVID-19? If so, must I pay employees for the time missed?

Yes, generally you can require an employee to stay home from work. Employers have an obligation under the General Duty Clause of OSHA to provide a safe workplace for all employees. This would include protecting the health and safety of the other workers in your workplace.

The second part of this question will depend on numerous factors including, any applicable state paid leave laws, company sick or paid time off benefits, or other past company practices which paid employees for similarly missed time.

The bottom line, you must pay the employee consistent with any mandatory state sick leave requirements, paid company leave benefits, or consistent with any past pay practices for pay in such situations. The goal will be to treat the employee consistent with all federal or state laws, company policy, or past business practice. When employers treat similarly situated employee differently, they run the risk of potential discrimination claims.

Can I reduce staffing or require some workers to work from home or telecommute?

Yes, while most of the job duties performed by EMS organization workers are the kind that require presence at the workplace, there are some administrative positions that can be performed remotely or at home. In these instances, employers still have several things to consider before asking employees to work remotely.

First, employers who decide to have employees work remotely must ensure that the work performed remotely is done so in a compliant manner. For example, billing personnel working remotely will have to access Protected Health Information (PHI) during the course of performing their duties. It is important that the EMS agency ensures that the Administrative, Physical, and Technical safeguards required under the Privacy and Security Rule of the Health Insurance Portability and Accountability Act (HIPAA) are complied with in that remote setting.

Second, any FLSA non-exempt employee needs to continue to track all time worked to ensure the employer can accurately pay all employees. Employers must establish policies, to the extent that they do not already exist, that govern remote workers or telecommuting. Employers should review all existing organizational policies and ensure that they are adapted to address remote working or telecommuting. This includes addressing the steps employees need to take should they need to be absent from work, including how to “call out sick” or must miss work.

Third, employers need to ensure that employees who require an ADA reasonable accommodation in the workplace can still be provided that accommodation when working remotely, if needed. It is important for employers to remember that they are still required to comply with all work-related laws and regulations even for remote or telecommuting workers.

Do employers have to pay workers who are out of work?

That depends on the reason for the employee being out of work, your state law, and the employer’s policies.

  • Voluntary absence from work due to employee’s concern of future exposure?

    Absent any state paid leave requirements, if the employee has voluntarily decided not to come to work due to their concern of exposure to the virus, then you would need to pay them consistent with your organization’s policy regarding paid time off. If the employee has no paid time off available, then the employer is not required to pay them.
    There is nothing that prevents an employer from paying their employees if they choose to, but it is generally not required. Employers with labor unions should consult their collective bargaining agreements (CBA) for any paid time off provisions.

  • Voluntary isolation or quarantine following suspected exposure?

    Generally, employees who are placed in quarantine due to exposure to COVID-19 are not compensable under most state’s workers’ compensation laws. Nothing prevents an employer from filing a claim with their workers’ compensation insurance carrier. However, it is highly unlikely that the insurance carrier will consider this a compensable illness or injury.

    As stated above, absent any state paid leave requirements, if the employee does not come to work due to their exposure to the virus, then you would need to pay them consistent with any state-mandated paid time off or your organization’s policy regarding paid time off. If the employee has no paid time off available, then the employer is not required to pay them.

    There is nothing that prevents an employer from paying their employees if they choose to, but it is generally not required. Again, employers with labor unions should also consult their collective bargaining agreements (CBA) for any paid time off provisions.

  • Employee absence due to acquiring or exhibiting symptoms of COVID-19?

    If an employee misses work due to acquiring COVID-19 or exhibiting the virus’ symptoms, the employer should follow their normal work-related illness practices as provided under workers’ compensation. Whether the illness is compensable under workers’ compensation is determined under state workers’ compensation law. Typically, if an illness is compensable under workers’ compensation, the first several days are unpaid and can be paid under any state mandated sick or employer paid time off policy.

    If the employee has no paid time off available, then the employer is not required to pay them. There is nothing that prevents an employer from paying their employees if they choose to, but it is generally not required. Employers with labor unions should also consult their collective bargaining agreements (CBA) for any paid time off provisions.

Does employee absence from work due to COVID-19 qualify for Family & Medical Leave under the Family & Medical Leave Act (FMLA)?

Generally, employees who exhibit a mild case of COVID-19, which does not require continuing treatment or hospitalization, it is highly unlikely that the individual’s condition would rise to the level of a “serious health condition” as defined under the Family & Medical Leave Act (FMLA) leave. If the employee has a more serious case of the illness, then the employee could qualify for job protected leave under FMLA. In that case, the employer should follow the required steps under FMLA, including furnishing the employee with a Notice of Eligibility and Rights & Responsibilities, Certification of Health Care Provider Employee’s Serious Health Condition, and subsequent FMLA Designation Notice as required under FMLA.

However, if the employee is caring for a parent or child with a serious health condition, the virus itself, or another underlying medical condition that is worsened by the virus, it may trigger job-protected leave under FMLA. Under FMLA, the employer would provide the employee the Notice of Eligibility and Rights & Responsibilities, the Certification of Health Care Provider for Family Member’s Serious Health Condition, and the Designation Notice and would handle consistent with FMLA. It is recommended that all employee leave is tracked and logged for record keeping purposes and to ensure consistent handling of leave requests.

Employee absences that are caused by their need to provide childcare due to their child’s daycare or school closure, would not trigger protected leave under FMLA. Such leave may be covered under an employer’s other paid or unpaid time off or leave policies or under state required paid or unpaid leave.

What options does an employer have when it comes to staffing shortages created by COVID-19?

Employers should set a staffing contingency plan and policies if the employer has difficulty with staffing due to a pandemic. This policy should be broadly communicated to all employees. Many EMS agencies have hold-over policies that provide that an employee may have to stay on duty for a subsequent shift due to staffing shortages.

In these instances, it is best practice to set parameters around these policies, including the circumstances under which the policy will be implemented, notice to the hold-over employee, and considerations for maximum continuous and total weekly working hours. In addition, the policy should provide for employee self-reporting and fatigue protocols which include non-retaliation protections for employees who express fatigue or safety concerns.

Employee who are held over must be paid consistent with federal, state, and local wage laws, including any applicable overtime provisions of the Fair Labor Standards Act (FLSA). Non-exempt salaried employees should be paid consistent with federal, state, or local overtime wage laws. FLSA Exempt employees do not have to be paid overtime for hours worked over forty (40) hours.

Employers who have a unionized workforce should refer to the Collective Bargaining Agreement (CBA) for any provisions impacted by hold-over or pay practices.

What can/should we do if an employee refuses to work with another employee due to concerns of exposure to COVID-19?

It is important for employers to learn or understand why this employee is refusing to work with the other individual. If the employee is refusing to work with the other individual because that individual is exhibiting virus-like symptoms, then that employee should not be in the workplace anyway. Under OSHA, employers have an obligation to furnish to employees a place of employment which is free from recognized hazards that are causing or are likely to cause death or serious physical harm to other employees. This would include exposure to employees suspected of having COVID-19.

Under OSHA, an employee is only entitled to refuse to work if they believe they are in imminent danger. OSHA has recommended actions for an employee to take if they believe performing the task or working would pose an imminent danger. The right to refuse work is protected if all of the following conditions are met:

  • Where possible, you have asked the employer to eliminate the danger, and the employer failed to do so; and
  • You refused to work in “good faith.” This means that you must genuinely believe that an imminent danger exists; and
  • A reasonable person would agree that there is a real danger of death or serious injury; and
  • There isn’t enough time, due to the urgency of the hazard, to get it corrected through regular enforcement channels, such as requesting an OSHA inspection.

You should take the following steps:

  • Ask your employer to correct the hazard, or to assign other work;
  • Tell your employer that you won’t perform the work unless and until the hazard is corrected; and
  • Remain at the worksite until ordered to leave by your employer.

However, if the employee is refusing to work with the other employee because of their belonging to, or being a member of, a category of people who are protected under Title VII of the Civil Rights Act or one of the other anti-discrimination statutes, that would violate law and an employer would be required to address this behavior. It is equally important that employers monitor workplace behavior, and the treatment of their employees by individuals not employed by the EMS organization, to ensure that they are not subject to direct or indirect discriminatory actions. This includes patients who refuse to be treated by your EMS personnel due to discriminatory motives or fears.

Important Reminder

Due to the nature of the work performed by EMS personnel and other healthcare workers, our workers are more likely than the general population to be exposed to workplace hazards, including viruses like COVID-19. It is important to remember that our teams face far greater a risk on a daily basis than those associated with this virus. Employers should remind their staff of the available benefits and services, such as Employee Assistance Programs, Support for Medics, Short-Term Disability, and available paid time off, should they wish to utilize them during this stressful time.

If we ensure that our employees are following our occupational safety practices and policies, they will significantly reduce the likelihood of workplace exposure or injury. This will not happen without every individual on the team taking ownership of fostering a culture of safety. Communication and monitoring are key to maintaining a safe work environment and significantly ease worker’s fears surrounding this virus.

As always, the American Ambulance Association and its team of staff and consultants can assist EMS organizations with these challenges. Be sure to visit the AAA website for more information.

CDC Interim Infection Control Guidance for COVID-19

On March 10, the CDC issued the following changes to its interim guidance pm COVID-19.

  • Updated PPE recommendations for the care of patients with known or suspected COVID-19:
    • Based on local and regional situational analysis of PPE supplies, facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demand.  During this time, available respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk to HCP.
      • Facemasks protect the wearer from splashes and sprays.
      • Respirators, which filter inspired air, offer respiratory protection.
    • When the supply chain is restored, facilities with a respiratory protection program should return to use of respirators for patients with known or suspected COVID-19. Facilities that do not currently have a respiratory protection program, but care for patients infected with pathogens for which a respirator is recommended, should implement a respiratory protection program.
    • Eye protection, gown, and gloves continue to be recommended.
      • If there are shortages of gowns, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of HCP.
  • Included are considerations for designating entire units within the facility, with dedicated HCP, to care for known or suspected COVID-19 patients and options for extended use of respirators, facemasks, and eye protection on such units.  Updated recommendations regarding need for an airborne infection isolation room (AIIR).
    • Patients with known or suspected COVID-19 should be cared for in a single-person room with the door closed. Airborne Infection Isolation Rooms (AIIRs) (See definition of AIIR in appendix) should be reserved for patients undergoing aerosol-generating procedures (See Aerosol-Generating Procedures Section)
  • Updated information in the background is based on currently available information about COVID-19 and the current situation in the United States, which includes reports of cases of community transmission, infections identified in healthcare personnel (HCP), and shortages of facemasks, N95 filtering facepiece respirators (FFRs) (commonly known as N95 respirators), and gowns.
    • Increased emphasis on early identification and implementation of source control (i.e., putting a face mask on patients presenting with symptoms of respiratory infection).

Read the full interim guidance►

COVID-19 Coronavirus EMS Advisory 1

This guidance is written to offer American Ambulance Association members the situational background and a list of resources and websites with which to draw guidance and further updates on the latest situation with COVID-19, colloquially referred to as “Coronavirus.” Key information for this update has been drawn from the NHTSA EMS Focus series webinar What EMS, 911 and Other Public Safety Personnel Need to Know About COVID-19, which took place on February 24, 2020. The on-demand recording is available below.

General Information

Background

The COVID-19 Coronavirus Disease was first reported in Wuhan China in December 2019. CDC identifies that it was caused by the virus SARS – CoV-2. Early on, many patients were reported to have a link to a large seafood and live animal market. Later, patients did not have exposure to animal markets which indicates person-to-person transmission. Travel-related exportation of cases into the US was first reported January 21, 2020. For reference the first North American EMS experience of  COVID-19 patient transport, including key lessons learned, can be found in the EMS 1 article Transporting Patient 1.

Spread and Identification

Global investigations are now ongoing to better understand the spread. Based on what is known about other coronaviruses, it is presumed to spread primarily through person-to-person contact and may occur when respiratory droplets are produced when an infected person costs or sneezes. Spread could also occur when touching a surface or object that has the virus on it and when touching the mouth, nose, or eyes. Again, research is still ongoing, and advice and guidance will inevitably follow.

For the cases that have been identified so far, those patients with COVID19 have reportedly had mild to severe respiratory illness with symptoms including fever and shortness of breath. Symptoms have typically appeared 2 to 14 days after exposure. Both the WHO and CDC advise that patients that have been to China and develop the symptoms should call their doctors.

COVID-19 Prevention and Treatment

To date, 30 international locations, in addition to the US, have reported confirmed cases of   COVID-19 infection. Inside the US, two instances of person-to-person spread of the virus have been detected. In both cases, these occurred after close and prolonged contact with a traveler who had recently returned from Wuhan, China.

The CDC activated its Emergency Operations Center (EOC) on January 21 and is coordinating closely with state and local partners to assist with identifying cases early; conducting case investigations; and learning about the virology, transmission, and clinical spectrum for this disease. The CDC is continuing to develop and refine guidance for multiple audiences, including the first responder and public safety communities.

As at the date of publication there is still no specific antiviral treatment licensed for   COVID-19, although the WHO and its affiliates are working to develop this.

The following are recommended preventative measures for  COVID-19 and many other respiratory illnesses:

  • Wash your hands often with soap and water for at least 20 seconds.
  • Use an alcohol-based hand sanitizer with at least 60% if soap and water are not readily available.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Avoid contact with people who are sick.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw it away.
  • Clean and disinfect frequently touched objects and surfaces.

Interim Guidance for EMS and 911

The Centers for Disease Control (CDC) has issued its Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19 in the United States.

The guidance identifies EMS as vital in responding to and providing emergency treatment for the ill. The nature of our mobile healthcare service delivery presents unique challenges in the working environment. It also identifies that coordination between PSAPs and EMS is critical.

Key points are summarized below:

Recommendations for 911 PSAP Locations

The link between PSAPs and EMS is essential. With the advent of COVID19 there is a need to modify caller queries to question callers and determine the possibility that the call concerns a person who may have signs or symptoms and risk factors for COVID19.

The International Academy of Emergency Dispatch (IAED) recommends that agencies using its Medical Priority Dispatch System (MPDS) should use its Emerging Infectious Disease Surveillance (EIDS) Tool within the Sick Person and Breathing Problem protocols. For those that are not MPDS users, IAED is offering its EIDS surveillance Tool for Coronavirus, SRI, MERS and Ebola-free of charge under a limited use agreement.

Recommended Personal Protective Equipment (PPE)

The CDC recommends that while involved in the direct care of patients the following PPE should be worn:

  • Single pair of disposable examination gloves
  • Disposable isolation gown
  • Respiratory protection (N95 or higher)
  • Eye Protection (goggles or disposable face shield)

EMS Transport of a Patient Under Investigation (PUI) or Patient with Confirmed COVID19

  • Notify receiving healthcare facility so appropriate precautions can be put in place
  • Discourage family and contacts from riding in transport vehicle
  • Isolate the vehicle driver from the patient compartment by closing the windows between compartments and ensuring that the vehicle ventilation system is set to the non-recirculated mode
  • Document patient care

Cleaning EMS Transport Vehicles After Transporting PUI or Patient

  • Don PPE for cleaning with disposable gown and gloves, facemask, and goggles or face shield if splashes are anticipated
  • Routine cleaning and infection procedures should follow organizational standard operating procedures
  • Use protect use products with EPA-approved emergent viral pathogens claims

Once transport is complete, organizations should notify state or local public health authorities for follow up. Additionally agencies should (if not done already) develop policies for assessing exposure risk and management of EMS personnel, report any potential exposure to the chain of command, and watch for fever or respiratory symptoms amongst staff.

Employers Responsibilities

While not specific to COVID-19, agencies should:

  • Assess current practices and policies for infection control
  • Job- or task-specific education and training
  • PPE training and supply
  • Decontamination processes and supplies

Local EMS Considerations

  • PPE supplies
  • 911 and EMD call taking activities
  • Appropriate approach to potential patients
  • Educational resources for EMS personnel
  • Interaction with local public health/healthcare systems/emergency management
  • Interaction with local fire and law enforcement
  • Considerations for local jails

Further Reading

Conclusion

The COVID19 situation constantly evolving. Agencies should defer to their local EMS authorities, Public Health departments, and the CDC for definitive guidance. Going forward, the AAA will continue to both monitor the disease and alert issues to the membership.

Injury Tracking Application Update

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