Covid 19 Prevention Policy


Emporium Essex document is meant to be a living document that can be revised as circumstances or guidance changes. 

USE REQUIRED

 

CIRCUMSTANCE

 

PPE COMPONENT

 

COMMENT OR MODIFICATION

 

Standard Approach to Possible COVID-19 Patient

 

Gloves

 

 

Standard Approach to Possible COVID-19 Patient

 

Disposable Gown

 

 

Standard Approach to Possible COVID-19 Patient

 

Facemask

 

 

Standard Approach to Possible COVID-19 Patient

 

N95 Respirator

 

 

Standard Approach to Possible COVID-19 Patient

 

Eye/Face Protection

 

 

Aerosol Droplet Producing Procedures

 

N95 Respirator

 

 

 

CLEANING & DISINFECTION OF RESPONDER, VEHICLE & EQUIPMENT BEFORE RETURN TO SERVICE:

 

 

NEEDING CLEANING/DISINFECTION

 

EPA-APPROVED PRODUCT

TIME FOR DISINFECTION

Responder Skin & Forearms

 

 

Face or Other Exposed Skin/Part

 

 

 

 

 

Hard Surfaces (i.e. cot, walls, floor, etc.)

 

 

Fragile Hard Equipment(i.e. EKG Monitor, O2 Sat, Cables)

 

 

Soft Non-Disposable Equipment (i.e. BP cuff, EKG

 

 

Soft Disposable Equipment (i.e. suction cath, 4x4’s)

Discard in Biohazardous Bin

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MEDICAL DIRECTOR APPROVED GUIDANCE DURING CARE OF POSSIBLE COVID-19 PATIENT(continued)

 

SPECIFIC PROCEDURES WITH PROTOCOL & PROCEDURE MODIFICATIONS, AS INDICATED:

(note:  these are just examples of possible modifications; each agency should format to best meet their needs)

 

 

PRESENTATION

 

MODIFICATION TO PROTOCOL

MEDICAL DIRECTOR Approve /Disapprove

All personnel enter the scene to assess & manage patient care

Minimize number of personnel to those needed to assess and provide any treatment and prepare for transport.

 

 

Known or Suspected COVID-19 from Dispatch or other means

All appropriatePPE should be on each responder before entering the building where the patient is or engaging with patient, if outside, unless a responder will not be providing care or be within 2 meters/6 feet of the patient and the patient will not receiving aerosol generating procedures.

 

 

NO Known/Suspected COVID-19:

 

Use Standard precautions PPE applied per the dispatch situation. 

Can be always defended, but particularly if COVID-19 is in your community, add an N95 if report of cough.

 

Upon arrival, try to quickly gather more information before entering the premises and ask about S/S and travel, if indicated;

 

If no info quickly available, enter premises and initially assess no closer than 2 meters/6 ft, whenever possible.If probable COVID-19 found, quickly step outside rub hands with alcohol sanitizer and don appropriate PPE and return to provide assessment and care of the patient

 

 

Basic Assessment – Stable Pt.

Able to stand & move around easily; No complaints of chest pain or difficulty breathing/SOB

If patient is a GCS 15 and no complaint of shortness of breath/difficulty breathing, ask the patient to wash his hands, put a surgical or procedure mask over his mouth & nose. If he is going to sneeze or cough, he should put a hand(s) over mask to prevent mask from coming off.

 

 

Vital Signs – Stable Pt.

Limit vital signs to checking/counting radial pulse & respirations.  If radial pulse present, regular,& 60-100, with respirations 10-20 and no DB/SOB, no further vitals need be done as long as condition remains unchanged.

 

 

Airway/Respiratory Assessment

If the patient is having trouble breathing/SOB, then a non-rebreather face mask should be applied with O2 per protocol.  Do not put a facemask over an O2 mask.  Listen to lung sounds on the patient’s back in all quadrants. 

Use Pulse Oximeter (consider bagging the Monitor/Defib and just having the Pulse Ox cable and probe exposed)

 

Wheezing or Rhonchi with Adequate Chest Rise& Air Movement

Hold Nebulizer treatment until after conferring with Medical Direction;

Magnesium Sulfate can be given IM/IV as bronchodilator alternative; Monitor for changes; if worsening, move to appropriate patient status for care and/or consult with MD

 

Severe Wheezing / Rhonchi and/or Decreased Air Movement

Give Nebulizer treatment unless Medical Direction indicates otherwise.  Move to critical patient guidance unless significant improvement.  Consider MgSO4 or SQ Epi with Medical Direction approval. 

 

EKG Monitoring, Pulse Ox&IV Access

EKG& Pulse Ox:  if pulse > 100 and/or irregular or on Neb

IV:  per Protocol or per Medical Direction

 

 

Critical Patient Assessment

If the patient is not alert, or otherwise presents with needing more critical care, confirm that N95 Respirator is in place and check seal before beginning BVM or other life-saving procedures.  Assess ABCs.

 

Critical Patient Guidance

Provide Supportive Care per Protocol or MD Instruction

Apply EKG Monitor, BP (disposable or plastic cuff if available), O2 sat, ETCO2, CPR, BVM, Electrical Energy, as indicated; Hold intubation with ETT, if adequate chest and ETCO2 indicates good exchange, but consider alternative airway, per Protocol or MD direction.  There is less droplet scattered if the patient is intubated but the person placing it is going to be much closer to droplets while intubating.  Consult MD for instructions.

 

Patient is without vital signs on arrival and known or suspected COVID-19

Provide BLS (CPR with BVM); Assess rhythm and discuss situation with MD