2019 Novel Coronavirus (COVID-19)
April 9, 2020 - 1:03 pm
Situation in CCEMSA Counties
Currently there are 381 presumptive positive cases of COVID-19 in CCEMSA Counties (Madera, Fresno, Kings and Tulare Counties in Total).
- 29 of these cases are now considered recovered from COVID-19 (8 in Madera County, 10 in Fresno County, 0 in Kings County, 11 in Tulare County)
- 15 COVID-19 cases have resulted in death in CCEMSA Counties (2 in Madera County, 3 in Fresno County, 0 in Kings County, 10 in Tulare County)
What to Expect
More cases are likely to be identified in the coming days, it’s also likely that person-to-person and community spread will continue to occur, including in the United States, California and CCEMSA Counties.
Mitigation Strategies for everyone to limit the spread of COVID-19
- Washing hands with soap and water.
- Avoiding touching eyes, nose or mouth with unwashed hands.
- Avoiding close contact with people who are sick are all ways to reduce the risk of infection with a number of different viruses.
- Staying away from work, school or other people if you become sick with respiratory symptoms like fever and cough.
The information below was developed utilizing current CDC guidelines and recommendations.
- Case Definition for COVID-19
- Recommendations for 911 Dispatch Centers
- Recommendations for EMS Providers and First Responders
- EMS Transport of a PUI or Patient with Confirmed COVID-19 to a Healthcare Facility (including interfacility transport)
- Documentation of Patient Care
- Cleaning EMS Transport Vehicles after Treating a PUI or Patient with Confirmed COVID-19
- Follow-up and/or Reporting Measures by EMS Providers/First Responders after Caring for a PUI or Patient with Confirmed COVID-19
Emergency medical services (EMS) play a vital role in responding to requests for assistance, triaging patients, and providing emergency medical treatment and transport for ill persons. However, unlike patient care in the controlled environment of a healthcare facility, care and transports by EMS present unique challenges because of the nature of the setting, enclosed space during transport, frequent need for rapid medical decision-making, interventions with limited information, and a varying range of patient acuity and jurisdictional healthcare resources.
When preparing for and responding to patients with confirmed or possible coronavirus disease 2019 (COVID-19), close coordination and effective communications are important among Dispatch Centers, the EMS system (EMS Agency, Providers and First Responders), healthcare facilities, and the public health system. When COVID-19 is suspected in a patient needing emergency transport, prehospital care providers and healthcare facilities should be notified in advance that they may be caring for, transporting, or receiving a patient who may have COVID-19 infection.
Updated information about COVID-19, Infection prevention and control recommendations and additional information for healthcare personnel may be accessed at the links below.
CDC’s most current case definition for a person under investigation (PUI) for COVID-19:
Fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing).
Any persons, including healthcare workers, who have had close contact** with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset, or a history of travel from affected geographic areas (China, Iran, Italy, Japan, South Korea) within 14 days of symptom onset.
It is the opinion of the Central California EMS Agency that there is no current need for modified caller queries about COVID-19, by our local Dispatch Centers
Recent event history modifying caller queries has shown, that it created more issues than benefit.
Information on a possible COVID-19 Persons Under Investigation and or suspect cases is rapidly and continually changing. The Central California EMS Agency is working closely with our Public Health Departments to be informed of these cases and to the extent possible providing addresses to our Dispatch Centers.
- If the Dispatch Center advises that the patient is suspected of having COVID-19, EMS Providers/First Responders should put on appropriate PPE before entering the scene.
- If information about potential for COVID-19 has not been provided by the Dispatch Center, EMS Providers/First Responders should exercise appropriate precautions when responding to any patient with signs or symptoms of a respiratory infection. Initial assessment should begin from a distance of at least 6 feet from the patient, if possible. Patient contact should be minimized to the extent possible until a facemask is on the patient. If COVID-19 is suspected, all PPE as described below should be used. If COVID-19 is not suspected, EMS Providers/First Responders should follow standard procedures and use appropriate PPE for evaluating a patient with a potential respiratory infection.
- A facemask should be worn by the patient for source control. If a nasal cannula is in place, a facemask should be worn over the nasal cannula. Alternatively, an oxygen mask can be used if clinically indicated.
- Limit the number of providers to essential personnel based on patient condition to minimize possible exposures.
- Determine if patient meets the criteria of case definition. CCEMSA is also recommending to ask about travel by Cruise Ship.
Recommended Personal Protective Equipment (PPE)
- EMS Providers/First Responders who will directly care for a patient with possible COVID-19 infection or who will be in the compartment with the patient should follow Standard, Contact, and Airborne Precautions, including the use of eye protection. Recommended PPE includes:
- A single pair of disposable patient examination gloves. Change gloves if they become torn or heavily contaminated,
- Disposable isolation gown,
- Respiratory protection (i.e., N-95 or higher-level respirator), and
- Eye protection (i.e., goggles or disposable face shield that fully covers the front and sides of the face).
- Drivers, if they provide direct patient care (e.g., moving patients onto stretchers), should wear all recommended PPE. After completing patient care and before entering an isolated driver’s compartment, the driver should remove and dispose of PPE and perform hand hygiene to avoid soiling the compartment.
- If the transport vehicle does not have an isolated driver’s compartment, the driver should remove the face shield or goggles, gown and gloves and perform hand hygiene. A respirator should continue to be used during transport.
- All personnel should avoid touching their face while working.
- On arrival, after the patient is released to the facility, EMS Providers/First Responders should remove and discard PPE and perform hand hygiene. Used PPE should be discarded in accordance with routine procedures.
Precautions for Aerosol-Generating Procedures
- In addition to the PPE described above, EMS Providers/First Responders should exercise caution if an aerosol-generating procedure (e.g., bag valve mask (BVM) ventilation, oropharyngeal suctioning, endotracheal intubation, nebulizer treatment, continuous positive airway pressure (CPAP), bi-phasic positive airway pressure (biPAP), or resuscitation involving emergency intubation or cardiopulmonary resuscitation (CPR) is necessary.
If a patient with an exposure history and signs and symptoms suggestive of COVID-19 requires transport to a healthcare facility for further evaluation and management the following actions should occur during transport:
- EMS Providers shall make contact with the EMS Duty Officer
- EMS Providers will notify the receiving healthcare facility that the patient has an exposure history and signs and symptoms suggestive of COVID-19 so that appropriate infection control precautions may be taken prior to patient arrival. (this should be done via landline and not over the radio)
- Keep the patient separated from other people as much as possible.
- Family members and other contacts of patients with possible COVID-19 should not ride in the transport vehicle, if possible. If riding in the transport vehicle, they should wear a facemask.
- If vehicle has an isolated driver and patient compartments that can provide separate ventilation to each area.
- Close the door/window between these compartments before bringing the patient on board.
- 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.
- If a vehicle without an isolated driver compartment and ventilation must be used, open the outside air vents in the driver area and turn on the rear exhaust ventilation fans to the highest setting. This will create a negative pressure gradient in the patient area.
- Follow receiving hospital’s directions for the transfer of the patient in to the receiving healthcare facility.
- To reduce cross contamination, documentation of patient care should be done after EMS Providers have completed transport, removed their PPE, and performed hand hygiene.
- Any written documentation should match the verbal communication given to the emergency department providers at the time patient care was transferred.
- EMS documentation should include a listing of EMS Providers/First Responders and public safety providers involved in the response and level of contact with the patient (for example, no contact with patient, provided direct patient care). This documentation may need to be shared with local public health authorities.
The following are general guidelines for cleaning or maintaining EMS transport vehicles and equipment after transporting a PUI:
- After transporting the patient, leave the rear doors of the transport vehicle open if possible, to allow for sufficient air changes to remove potentially infectious particles.
- The time to complete transfer of the patient to the receiving facility and complete all documentation should provide sufficient air changes.
- When cleaning the vehicle, EMS Providers should wear a disposable gown and gloves. A face shield or facemask and goggles should also be worn if splashes or sprays during cleaning are anticipated.
- Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly, to include the provision of adequate ventilation when chemicals are in use. Doors should remain open when cleaning the vehicle.
- Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARS-CoV-2 (the virus that causes COVID-19) in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed.
- Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2. These products can be identified by the following claim:
- “[Product name] has demonstrated effectiveness against viruses similar to SARS-CoV-2 on hard non-porous surfaces. Therefore, this product can be used against SARS-CoV-2 when used in accordance with the directions for use against [name of supporting virus] on hard, non-porous surfaces.”
- This claim or a similar claim, will be made only through the following communications outlets: technical literature distributed exclusively to health care facilities, physicians, nurses and public health officials, “1-800” consumer information services, social media sites and company websites (non-label related). Specific claims for “SARS-CoV-2” will not appear on the product or master label.
- If there are no available EPA-registered products that have an approved emerging viral pathogen claim, products with label claims against human coronaviruses should be used according to label instructions.
- Clean and disinfect the vehicle in accordance with standard operating procedures. All surfaces that may have come in contact with the patient or materials contaminated during patient care (e.g., stretcher, rails, control panels, floors, walls, work surfaces) should be thoroughly cleaned and disinfected using an EPA-registered hospital grade disinfectant in accordance with the product label.
- Clean and disinfect reusable patient-care equipment before use on another patient, according to manufacturer’s instructions.
- Follow standard operating procedures for the containment and disposal of used PPE and regulated medical waste.
- Follow standard operating procedures for containing and laundering used linen. Avoid shaking the linen.
EMS Providers/First Responders should be aware of the follow-up and/or reporting measures they should take after caring for a PUI or patient with confirmed COVID-19:
- Local public health authorities will be notified about the patient so appropriate follow-up actions can occur.
- Decisions for monitoring, excluding from work, or other public health actions for healthcare providers with potential exposure to COVID-19 will be made in consultation with local public health authorities. Refer to the Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19) for their guidelines.
- EMS personnel who have been exposed to a patient with suspected or confirmed COVID-19 should notify their chain of command to ensure appropriate follow-up.
- Any unprotected exposure (e.g., not wearing recommended PPE) should be reported to occupational health services, a supervisor, or a designated infection control officer for evaluation.
- EMS Providers/First Responders should be alert for fever or respiratory symptoms (e.g., cough, shortness of breath, sore throat). If symptoms develop, they should self-isolate and notify occupational health services and/or their public health authority to arrange for appropriate evaluation.
If you have any questions, please contact: Curtis C. Jack, EMT-P, EMS Coordinator- Disaster Services