The Centers for Disease Control (CDC) released updated Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answer Points/Emergency Communication Center (PSAP/ECCs) in the United States During the Coronavirus Disease (COVID-19) Pandemic. The new twelve (12) page guidance is geared specifically for EMS and first responding agencies in response to the COVID-19 pandemic. This is a summary of the highlights from the Interim Guidance and services are encouraged to review the document with your leadership team as this guidance impacts multiple aspects within an EMS organization.
1) Infection Prevention & Control (IPC) Practices
The CDC recommends that EMS agencies use additional infection prevention and control practices during the pandemic. These practices are intended to augment your organization’s standard infection control practices with COVID-19 specific protective measures. The recommendations include:
911 PSAPs Modified Call Queries
CDC recommends the development of modified caller queries to be developed in collaboration with your local state public health officials and your medical director. The modified caller queries are geared towards identifying if the call concerns an individual who may have COVID-19 symptoms. Additionally, the recommendations include pre-arrival instructions to include facial coverings, if patient condition permits, and communications with responding units to take the appropriate precautions.
2) Recommendations for EMS Personnel
The CDC identified numerous requirements for EMS Employers including:
- Development of IPC policies and procedures for safely donning and doffing PPE
- Job-specific education and training on preventing the transmission of infectious disease
- Employee training for the appropriate use of PPE, including OSHA required Fit testing
- EMS units must have adequate supplies of hand sanitizer, cleaning supplies, and disinfectants
- Require all employee to wear facial coverings when in the workplace, at all times. This includes breakrooms, day rooms, etc.
- Encourage employees not to change facial covers unless absolutely necessary to reduce exposure.
Screen all EMS Personnel for Signs or Symptoms of COVID-19 at the Start of Each Shift
The Interim Guidance calls for screening of all EMS personnel and visitors for symptoms consistent with COVID-19. This screening should include active temperature screening and inquiring if they have been advised to quarantine due to exposure. The guidance suggests restricting workplace access.
Assess all patients for COVID-19 Infection
EMS personnel should don the appropriate PPE when encountering patients, specifically those suspected of being infected with the virus. The guidance suggests social distancing when possible and limiting how many providers make contact with the patient. When appropriate, all patients should have the appropriate facial covering, this includes any family members or other persons accompanying the patient at the scene.
Encourage Physical Distancing
The CDC recommends limiting the number of EMS providers that accompany the patient in the ambulance patient compartment and suggests closing any walkthrough access to the driver’s compartment. The guidance also suggests limiting or prohibiting family members from accompanying the patient in the ambulance. The guidance also suggests that physical distancing be enforced in all workspaces, including break or eating areas where employees are going to be unmasked.
Implement Universal Use of Personal Protective Equipment
The CDC recommends that EMS personnel working in areas with moderate to substantial community transmission wear an N95 or equivalent or greater level respirator and eye protection. For EMS personnel working in low transmission areas, the CDC recommends that N95 and eye protection are optional but that personnel should continue to follow the Standard and Transmission-Based Precautions based on any anticipated or suspected exposures.
Create a Process to Address to COVID-19 Exposures Among EMS Personnel & Others
The CDC recommends EMS agencies develop a process for notifying the health department about suspected or confirmed cases of COVID-19 and that each should develop a plan for investigating exposures. This includes identifying:
- An individual who is responsible identifying and notifying potentially exposed individuals.
- How notifications will occur
- The actions and follow-up required.
3) Recommend IPC practices when caring for a patient with suspected or confirmed COVID-19 infection
The CDC guidance also includes recommendations for the Personal Protective Equipment (PPE) that EMS personnel caring for suspected or confirmed COVID-19 infection should adhere to. This includes:
- Hand Hygiene
- PPE Training
- PPE Equipment, including:
- Respirator or Facemask
- Eye Protection
The guidance includes a warning regarding EMS personnel performing Aerosol-Generating Procedures.
4) EMS Transport of a Patient with Suspected or Confirmed COVID-19 Infection to a Healthcare Facility (Including Interfacility Transport)
Lastly, the CDC Interim Guidance included recommended actions when EMS personnel are transporting a patient who is suspected or confirmed to be infected with COVID-19. It is recommended that the EMS crew notify the receiving healthcare facility prior to arrival to permit them to take the necessary precautions. Additionally, the guidance suggests the following:
The patient care record should include documentation of a listing of all EMS personnel and public safety provided involved in the response, the level of contact with the patient, and if PPE was worn.
- Cleaning EMS Transport Vehicles after Transporting a Patient with Suspected or Confirmed COVID-19 Infection.
The guidance includes additional information which includes guidelines for cleaning and maintaining EMS vehicles and equipment following the transport.
The updated CDC Interim Guidance included practices that most EMS organizations and personnel are practicing currently and have been since the outset of this pandemic. However, it serves are an important reminder that the risks are very real and that EMS personnel must remain vigilant in their practices to ensure the safety of all individuals.