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COVID-19
DAILY BRIEFING
UPDATED:
June 3, 2020
BFT COVID-19 Guidance Manual
Wednesday, June 3, 2020 Page 1 of 14
The purpose of this document is to consolidate departmental information related to COVID-19.
The guidelines within this document (including Treatment Protocols) follow guidance from the CDC,
ISDH, IDHS, Medical Direction and Brownsburg Fire Territory Administration recommendations.
For the most up-to-date Stats and more information, click on this link: https://coronavirus.in.gov/.
The date on the cover of this document supersedes all prior communications pertaining COVID-19.
Officers, do you NEED the second working company on Cardiac Arrests?
When going into establishments (i.e. grocery stores) does every one NEED to go in?
All updates to this document will be in red.
Stay home if you feel sick
Continue to practice good hygiene at all times
Minimize risk to loved ones by doing the following:
Don and doff work uniform only in fire house, do not wear or take uniforms home. This
includes shoes, hats, jackets, etc.
Either wipe down shoes or leave at work
Shower at work or immediately once you arrive home before making contact with any family
members
Practice Social Distancing
When practical, practice the six-foot rule in the fire house
Questions regarding this document shall be delivered through the chain-of-command to the
appropriate Administrative Staff member.
OBJECTIVE
IMPORTANT INFORMATION
BFT COVID-19 Guidance Manual
Wednesday, June 3, 2020 Page 2 of 14
A novel coronavirus is a new coronavirus that has not been previously identified. The virus causing
coronavirus disease 2019 (COVID-19), is not the same as the coronaviruses that commonly circulate
among humans and cause mild illness, like the common cold. A diagnosis with coronavirus 229E,
NL63, OC43, or HKU1 is not the same as a COVID-19 diagnosis. Patients with COVID-19 will be
evaluated and cared for differently than patients with common coronavirus diagnosis.
COVID-19, Source of Virus
Coronaviruses are a large family of viruses. Some cause illness in people, and others, such as canine
and feline coronaviruses, only infects animals. Rarely, animal coronaviruses that infect animals have
emerged to infect people and can spread between people. This is suspected to have occurred for the
virus that causes COVID-19. Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory
Syndrome (SARS) are two other examples of coronaviruses that originated from animals and then
spread to people.
COVID-19, How it Spreads
This virus was first detected in Wuhan City, Hubei Province, China. The first infections were linked to
a live animal market, but the virus is now spreading from person-to-person. It’s important to note
that person-to-person spread can happen on a continuum. Some viruses are highly contagious (like
measles), while other viruses are less so. The virus that causes COVID-19 seems to be spreading
easily and sustainably in the community (“community spread”) in some affected geographic areas.
Community spread means people have been infected with the virus in an area, including some who
are not sure how or where they became infected.
COVID-19, Person-to-Person Transmission
The virus that causes COVID-19 is spreading from person-to-person. Someone who is actively sick
with COVID-19 can spread the illness to others. That is why CDC recommends that these patients be
isolated either in the hospital or at home (depending on how sick they are) until they are better and
no longer poses a risk of infecting others. How long someone is actively sick can vary so the decision
on when to release someone from isolation is made on a case-by-case basis in consultation with
doctors, infection prevention and control experts, and public health officials and involves considering
specifics of each situation including disease severity, illness signs and symptoms, and results of
laboratory testing for that patient.
1https://www.cdc.gov/coronavirus/2019-ncov/faq.html#anchor_1584386215012
BACKGROUND1
BFT COVID-19 Guidance Manual
Wednesday, June 3, 2020 Page 3 of 14
Limit Daily Events
No visitors or family at the firehouses. This will be in place until at least July 4th.
Previously approved time off and Kelly days could be recalled based on staffing needs
Limit trips to the store/errands to the minimum by planning meals ahead and personal
business/errands are prohibited
Maintain fuel above ¾ tank at all times
No students, riders or observers will be allowed to ride on any apparatus until further notice.
Paramedic students will be allowed to ride as of June 14th with same PPE expectations of our
employees. They will have their own mask, gowns and safety glasses.
All meeting rooms at the firehouses have been closed for public use until further notice.
Temperature Checks will be conducted Twice Daily (0700 & 1900)
Until further notice, each employee will have their temperature checked and a symptom screening
done when reporting to work and at 19:00. This additional step is being done to ensure that we
continue to keep a healthy workforce and protect the public that we encounter.
All personnel reporting for work at the firehouses shall enter through the assigned door regardless of
where they are parking at the firehouse.
Station 131: Southwest entry door by the station generator
Station 132: Southwest entry door by the antenna
Station 133: West (front) entry door beside the bay door.
The temperature of all personnel arriving for duty at the Brownsburg Fire Territory firehouses or
other worksite will be taken utilizing the provided thermometer issued to each firehouse (this ensures
consistency in obtaining temperatures). Company officers, fill- ins, or designee will be responsible for
ensuring that all personnel assigned to their station complete this requirement. This will be done with
a non-contact infrared thermometer. Each person will be assigned a cover for the thermometer.
There will be a basket for each shift at each station with a few extras for the floats that may need
DEPARTMENT OPERATIONS
PERSONNEL TEMPERATURE CHECKS
BFT COVID-19 Guidance Manual
Wednesday, June 3, 2020 Page 4 of 14
one at each station. You should wipe it off after you use it. and place it back in the bag then back in
the basket.
Personnel will record their temperatures and symptom screening on the form provided in the log
book at the firehouse.
Personnel with a temperature above 100.4 degrees F or higher will not be permitted to work their
shift. They will not be permitted to remain at the firehouse or workplace. The Battalion Chief should
be contacted immediately if any employee needs to be sent home. Please see the attached document
“COVID-19 Personnel Screening Criteria/Procedure.”
Personnel that have been sent home may return to duty when their temperature has remained below
100.0 degrees F for 72 hours without the use of medications and 7 days since the symptoms first
began.
The HCCC is screening all callers who are requesting EMS. They are asking the following questions:
Have you recently traveled to an area with known or community spread of COVID-19?
Do you or does someone at this address have a fever (>100.4 F) AND/OR symptoms of lower
respiratory illness such as cough, shortness of breath, difficulty breathing or sore throat,
including chills and body aches?
Answers will be documented in CAD to notify responding units, and they will prompt you to check
your MDTs for additional information.
Please understand that dispatch can only relay the information they are given by the caller and not
everyone thinks like a medical provider so they may not have or be able to obtain all of the
information you wish you had received prior to arriving on scene.
Gloves shall be worn for every patient contact.
Eye protection shall be worn for every patient contact.
Half face respirator shall be worn for every patient contact.
HENDRICKS COUNTY COMMUNICATIONS CENTER (HCCC)
PPE GUIDELINES
BFT COVID-19 Guidance Manual
Wednesday, June 3, 2020 Page 5 of 14
A surgical mask shall be placed on every patient unless their condition warrants airway management.
Gowns shall be worn on any patient contact, by those who will be within 6 feet of the patient, that is
dispatched as sick person-flu like symptoms or any time an aerosolizing procedure is being
performed. Aerosolizing procedures are defined as: nebulized medications, CPAP, BVM, CPR,
suctioning, i-gel placement, intubation and crics. Gowns shall also be worn if the patient is actively
vomiting.
Face Shields are available for use as necessary.
Disposable shower caps are available for use as necessary.
Filters for the half face respirator should only be changed when they become difficult to breathe
through, the inside becomes wet and/or the filter becomes damaged.
Utilize the PPE log in the online incident report system for PPE utilized on each run. You DO NOT
need to log the surgical mask for each patient as that should be documented in the ESO EHR.
It is recommended that you keep your laundry inside a washable (not mesh) laundry bag or trash
bag inside your locker so that it is not coming into contact with your clean uniforms. Make sure that
you are doing your laundry on a very regular basis so that you have clean uniforms in the event that
you need to change clothes after a run.
You must change uniforms after any patient care that you were within 6 feet of a patient that was
receiving an aerosolizing treatment. It is recommended that you shower as well. If you were on the
run but were not within 6 feet of the patient (such as on an engine and were outside but they did a
neb treatment in the house), you do not need to change clothes or shower unless you feel it is
necessary.
There are 2 laundry baskets as each firehouse with red bags in them for crews to place exposed
clothing that needs to be washed in them. This laundry should be done prior to any other laundry
that is being done. The washer in the bay at Station 131 is reserved for exposure clothing only until
further notice (unless the upstairs washer is malfunctioning).
Footwear Disinfectant Mats:
Effective Date: 4/11/2020 after the firehouse cleaning by the company Assurance Restoration.
BFT COVID-19 Guidance Manual
Wednesday, June 3, 2020 Page 6 of 14
The Process:
The disinfectant mats will be placed at the designated location with a solution of synergize mixed at a
ratio of (1/2) ounce to (1) gallon of water. Crews will need to determine at first just how much the
mat will hold but I have been told between one-half to one gallon of mixed solution. Buckets have
been provided with markings and the cleaning solution bottle has a built in measuring system.
The solution will be changed at a minimum of every shift change and recommended again at 1900
hours, though higher run volume stations may need to be changed more often as needed.
All personnel will walk thru the disinfectant mat every time they go into the living area of the
firehouse from the bay. This includes in the morning when you arrive for work after you have had
your temperature taken, and each time after that throughout your shift. Rugs have been purchased
and will be placed after the disinfectant mat to dry the excess from your shoes before you go any
farther into the living area so as to prevent a slip and fall hazard on hard surfaces. Note: you will not
need to walk thru the mat on your way out into the bay.
Cloth Masks
These masks will be issued to you in the next few days. These masks will NOT replace the N95/APR masks for our daily responses.
Once the soft facemasks have been issued, all Fire Territory personnel will be required to wear them while in/on Territory property, apparatus and in public places with a few exceptions. If you want to wear them while in the fire house or apparatus, you are welcome to do so but it is optional. You should still adhere to the social distancing guidelines when in groups of 2 or more. Soft facemasks are to cover both your mouth and nose to help in blocking the large particle droplets and splatter to help reduce the spread of your secretions to others.
If you choose to purchase your own soft facemask such as a bandana or neck sock these should look professional.
DO NOT place the masks in the microwave as some of them have metal sewn inside them.
Exceptions: During eating and drinking Showering
Wash your mask as needed with conventional washing methods and continue to maintain good hand hygiene.
BFT COVID-19 Guidance Manual
Wednesday, June 3, 2020 Page 7 of 14
Use minimal number of providers necessary to properly attend to patient. There are currently no
changes being made to run strings.
Nothing should be stored outside the zipped compartments on the head of the cot except the
following:
1 towel
1 blanket
1 sheet
These items, whether used or not, should be placed in the soiled linen bin at the receiving
facility.
Any equipment left out of a cabinet or drawer in the back of the ambulance shall be kept to a
minimum. This includes stethoscopes, blood pressure cuffs, cell phone, etc. This is especially
important if you are performing an aerosolizing procedure in the patient compartment.
Conduct a “door triage” of each residence you enter. Ask from the door, if at all possible, if anyone is
currently ill and/or has symptoms related to the COVID-19 virus. It is understood that dispatch is
asking about the patient and anyone else in the residence but they may not always be able to obtain
that information and the patient may not always tell the whole story to the dispatcher, especially
about others inside the residence.
The entire engine crew should remain outside the residence or building where the patient is located
unless there is information noted in the run or the call type dictates the need for immediate
assistance (such as unconscious person or cardiac arrest). Once the medic crew arrives at the
patient, they should determine if they need the engine/ladder crew and if so, exactly how many
people need to enter.
Surgical Mask shall be placed over oxygen masks or cannula unless there are extenuating
circumstances that do not allow for that.
Dr. Nossett has issued guidance stating that tachycardia and tachypnea can be additional
indicators of possible COVID-19 patients. Of note, patients may have breath sounds that
may not match their signs and symptoms (COPD in severe distress with mild
wheezing). These patients may not appear in acute distress and/or even look bad but
can have low O2 sats.
PATIENT CARE
BFT COVID-19 Guidance Manual
Wednesday, June 3, 2020 Page 8 of 14
As a medication modification, avoid use of nebulized medications if possible – avoid if the patient is
not hypoxic with no increased worked of breathing or significant wheezing
Preferred: Use patient’s own Metered Dose Inhaler
Bring respiratory equipment to hospital (patient’s inhalers, spacers, CPAP or BiPap
masks/tubing/machines, etc.) if at all possible. If you do transport these items with the patient, you
must document them in the patient belongings section of the ESO HER.
Medication Administration
If nebulized medications are unavoidable
Consider giving first dose on-scene rather than in ambulance and don’t use T-Piece
Inhaler dose for adults and pediatrics with mild dyspnea/bronchospasm
2 puffs, repeat in 5-10 minutes as needed
Inhaler dose for adults and pediatrics with moderate to severe dyspnea/bronchospasm
4 puffs, repeated every 5-10 minutes as needed up to total of 12 puffs.
Place surgical facemask over NRB, Nasal Cannula or Nebulizer Mask
Nasal cannula is preferred over non-rebreather mask
Airway Management
Paramedics-Do NOT Intubate!
Avoid endotracheal intubation if at all possible
Avoid cricothyrotomy, perform only as last resort
Move immediately to modified i-Gel insertion if advanced airway required
BFT COVID-19 Guidance Manual
Wednesday, June 3, 2020 Page 9 of 14
1. Connect BVM to Filter
2. Tape over the gastric port
3. Connect BVM with Filter to i-Gel
4. Insert BVM+i-Gel combo as one unit
A Surgical mask that covers the
patient’s mouth and nose will help
prevent droplet exposure from iGel
air leaks
Maintain tight face seal
Avoid forceful and over-ventilation (gastric insufflation and vomiting increases risk of
droplets/aerosol generation)
Oral Suctioning
Avoid if possible, if unavoidable, limit suction time
CPAP w/ Filter
Can be used but filter must be distal to nebulizer, as needed
Cardiac Arrest
Wear Full PPE during cardiac arrest management, especially by persons in close patient contact.
Transport
Turn on exhaust fan in patient compartment to maximize air-flow for all patients in the ambulance.
Keep the door between the patient compartment and the cab closed at all times.
Call ahead if the patient is highly suspicious of COVID-19
At Hospital
Discontinue CPAP and nebulizers before entering the hospital
Transition to nasal cannula w/ surgical mask over it if possible
Leave ambulance doors open (curbside and rear if possible) to allow for ventilation of the ambulance
while patient is being delivered to the ED.
Pediatric Considerations
Use Bag valve mask filter that does not increase dead space (i.e. an exhaust filter does not increase
dead space)
BFT COVID-19 Guidance Manual
Wednesday, June 3, 2020 Page 10 of 14
In the event of short-duration ventilation support (e.g. seizure), BVM ventilation is preferred over i-
Gel placement.
This chart is intended to give crews a general guideline as to hospitals that may have different
procedures for ambulance transports. Please understand that this is a fluid process and you will
ultimately need to follow the direction of the staff at the receiving facility upon your arrival.
Hospital Instructions
HRH Brownsburg
Notify of all patients being transported to their
facility.
Please have any facilities fax paperwork to
317.858.8088. Do not take patients here that
you feel will need an ICU/critical care bed unless
they need immediate airway management that
you can’t perform.
HRH Danville
Notify of all patients being transported to their
facility.
Staff will direct crew to use normal ED entrance
or linen closet entrance based on patient
symptoms.
Please have any facilities fax paperwork to
317.745.3766.
IU West
Notify of all patients being transported to their
facility.
Notify them prior to arriving if patient has any
symptoms of COVID-19 so they can be prepared
for your arrival.
Methodist
Notify of any ALERT patients.
You will be met by a screener in Ambulance
Triage who will direct you where to take your
patient.
Riley
Notify of all patients being transported to their
facility.
You will be met by Riley ED staff in the ED bay
and they will advise which entrance you will
need to take your patient in. No change in
ambulance traffic flow at this time.
VA
Notify of all patients being transported to their
facility.
They have instituted a “Respiratory ED” and the
Triage Nurse may assign you to take your
patient there after you give your radio report or
upon arrival. This is located in the tents to the
north of the usual ED bay.
Community East
ED bay closed to ambulance traffic to make
room for more patient care areas. You will need
Hosptial Information
BFT COVID-19 Guidance Manual
Wednesday, June 3, 2020 Page 11 of 14
Notify of any ALERT patients. to park outside and take your patient through
the assigned door.
Community South
Notify of all patients being transported to their
facility.
ED bay closed to ambulance traffic to make
room for more patient care areas. You will need
to park outside and take you patient through the
assigned door.
IU North
Notify of all patients being transported to their
facility.
You will be asked when giving your radio report
if the patient has a positive or negative
screening for COVID-19. If they screen positive,
you will take the patient to the main entrance of
the ED where they will be registered and
triaged. If the patient screens negative, you will
be directed to the ambulance bay where they
will do registration and triage. If your patient
will need intubation, they will direct you to go to
the outside Decon door. They have the decon
room set up to be able to do the intubation in
there and then they will move the patient after
that.
EMS Documentation
Make sure that your document is thorough and explicitly details the symptoms the patient has and/or
any potential exposures they may have had.
EMD Complaint shall be “Pandemic/Epidemic/Outbreak” for any call that is dispatched as “Sick
Person-Flu Like Symptoms.”
Utilize the “Outbreak Screening” form for any patient that meets COVID-19 criteria.
Document ALL personnel assigned to the run and ALL PPE that each person utilized on the run.
Under PPE: utilize “MASK-N95-REUSE” for your half face respirator.
Document any patient belongings in the patient belongings section.
ALL patients must have an O2 sat documented.
ESO EHR Documentation
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Wednesday, June 3, 2020 Page 12 of 14
ALL patients who are transported must have a temperature documented.
These fields have been made mandatory in the vital signs section.
If you are diverted from a facility utilize the following in the ESO EHR
Disposition>Transport Due To>Diversion
Diverted from>pick hospital you were originally transporting to
Document the following in your narrative: “Due to surg needs during COVID-19, patient
was diverted from __________ to ______________.”
Utilize the “Surgical Mask on Patient” under the flow chart (also in the quick treats) for all patients
(unless patient condition deems otherwise).
Utilize the “Infectious Patient Alert” on ALL patients. There is an option for “not performed.” If you
feel that the patent is not an infectious alert, please use the “not performed” button and select the
most appropriate response. Most all of the responses should be “other-not listed.” This will remain a
mandatory field on all run sheets until further notice. If it is not utilized, I will unlock the run sheet
and send it back to you for you to correct.
If you feel that your patient meets one of the following COVID-19 categories, please utilize one of
them in the primary or secondary impression field of the EHR. They are:
COVID-19—Confirmed by Testing
COVID-19—Exposure to Confirmed Patient
COVID-19—Suspected-No Known Exposure
All employees must follow all PPE guidelines in an effort to minimize the risk for an exposure.
Exposures will be defined as High Risk, Medium Risk and Low Risk based on the most recent
guidelines by the CDC and medical direction. The CDC guidance is from the following link:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
All employees who have contact less than 6 feet or a high or medium exposure with a person under
investigation for COVID-19 are encouraged to fill out a First Report of Injury form and submit it to BC
Brock. That form is attached to this document. You will be notified by BC Brock or DC Bowers if you
need to fill out an exposure form. This should be EITHER scanned in and emailed to BC Brock or
Exposures
BFT COVID-19 Guidance Manual
Wednesday, June 3, 2020 Page 13 of 14
placed in the EMS box at the firehouse. Please do not do both. If you scan it in and email it, you can
keep the original for yourself or put it in the shredder box.
If you have a medium or high-risk exposure on or off duty, you must notify your BC immediately so
that the administration can determine next steps.
Crews must be diligent about cleaning the firehouse and keeping their personal areas (lockers and
bunks) clean as well.
Ambulance Decontamination
While patient is being taken into the ED, leave rear doors and curbside door open to help airflow
through the ambulance. The current recommendation is that the patient compartment needs to have
approximately 10 minutes to air out prior to cleaning the patient compartment.
When cleaning the ambulance, you shall wear gloves, eye protection, and your half face respirator.
You shall use an approved disinfectant wipe or cleaner (such as the green Clorox wipes) when
cleaning surfaces and equipment in the ambulance.
Be sure to wipe down all cabinet and drawer faces, bench seat, airway seat, CPR seat and all other
hard surfaces in the patient compartment including walls and grab bars.
Be sure to wipe down all surfaces on the cot, including the belts and behind the head of the cot.
Make sure that you are wiping down any equipment that was used including computer, radios and
cell phones.
If a mop is available, mop the floor prior to leaving the hospital. If one is not available at the
hospital, mop the floor when returning to the firehouse.
Wipe down the cab of the ambulance as well, including door handles and steering wheel.
Plastic sheeting shall be taped over the opening to the patient compartment where the ALS box, red
bag, etc are kept and the pass-through door.
Seat covers are available to place on the seats of the ambulance (and other apparatus as necessary).
These are disposable but can be wiped down with a disinfectant wipe as well.
Cleaning and Decon
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Wednesday, June 3, 2020 Page 14 of 14
Spray the patient compartment with a disinfectant spray (such as Lysol or other similar product) after
you have wiped everything down. You can spray down the cab of the ambulance as well when you
return to the firehouse.
It is understood that there can be delays in returning from the hospital as this level of cleaning takes
time to complete. If you feel that you are going to be out for an abnormal length of time, please
contact your officer and let them know and ask for permission to mark in from the run and out for
decon. Just make sure that you are utilizing time wisely and not abusing it.
1. Droplet Zero Protocol
2. Post Exposure Guidelines
3. Infrared Thermometer Information
Attachments
Droplet Zero Protocol March 19th 2020
A. Effective March 19th 2020, until suspended by medical direction, all EMS
providers will adopt protocols (“Droplet Zero”) to limit the generation of droplets
and aerosols during clinical interventions. These protocols supersede current
protocols. It is understood that any ALS procedure referenced here is for ALS
personnel only.
B. The following procedures are defined as aerosol generating per the
CDC:
o Bag valve mask ventilation
o Oropharyngeal suctioning
o Endotracheal intubation
o Nebulizer treatment
o Continuous positive airway pressure (CPAP)
o Cardiopulmonary resuscitation
C. PPEIf an aerosol-generating procedure noted above is performed, the
recommended PPE includes:
o Gloves
o Respirator/N95 mask for personnel in patient room or ambulance
patient compartment where performed
o Eye protection/Face shield
o Gown, as available for personnel in close contact with patient
(especially vital for any person with respiratory illness or
suspected/possible Covid-19 illness)
o If gown is not available, personnel should change uniforms after
the patient encounter using appropriate droplet precautions
(mask, gloves) and disinfecting uncovered skin.
D. Nebulized Medications
o Use should be avoided if possible –
o Do not administer if the patient is (1) not hypoxic, (2) has no
increased work of breathing and (3) has only minimal wheezing
o If a patient has their own Albuterol Metered Dose Inhaler, or if EMS
has can provide, its use is preferred over a nebulizer
o Inhaler dose for adults and pediatrics with mild dyspnea/bronchospasm
o 2 puffs, repeat in 5-10 minutes as needed
o Inhaler dose for adults and pediatrics with moderate to severe
dyspnea/bronchospasm
o 4 puffs, repeated every 5-10 minutes as needed up to total of 12
puffs.
o If a nebulizer must be used:
o First dose of nebulized medicine should be given on-scene
(avoid delivery in back of ambulance if possible)
o Do not use T-Piece nebulizer, use only mask with flow rate
6lpm or less
o Use surgical face mask over nebulizer mask
o Discontinue nebulizer during patient movement from
ambulance into ED
E. Oxygen Administration equipment
o Nasal cannula is preferred over a non-rebreather mask
o Place surgical facemask over any use of oxygen delivery devices
(cannula, NRB or nebulizer mask)
F. BVM Ventilation
o If available, use HEPA filter in-line or exhalation filter with bag
o If filters are not available, utilize surgical mask to minimize aerosol
droplet exposure from BVM exhalation port
o Maintain tight face seal
o Avoid gastric insufflation and overly forceful ventilation
G. Advanced Airway Management
1. Effective immediately, the preferred 1st line advanced airway
management is the use of an i-Gel with filter system attached (if available)
during insertion
o Surgical mask with i-Gel through it, over patient’s mouth and
nose can be utilized as droplet shield from any air leak
2. Endotracheal intubation is to be avoided whenever possible.
H. Suctioning
o Unnecessary suctioning should be avoided
o The use of a droplet shield should be utilized if available
I. CPAP
o The use of CPAP should be avoided when possible
o The use of CPAP devices with filters is preferred over non-filtered
CPAP devices if CPAP must be used
o Discontinue CPAP and place on high flow O2 during patient movement
into ED from the ambulance
J. Cardiac Arrest o PPE as noted above should be worn for the management of cardiac
arrest, including the provision of CPR
K. Transport
o As much as possible, avoid aerosol generating procedures performed
inside the ambulance
o If intervention in the ambulance must be performed, minimize
individuals in the patient compartment during any aerosol generating
procedure
o Turn on fan to maximum compartment air flow
L. At Hospital
o Communicate with receiving hospital to ensure they are ready for
patient arrival
o Discontinue any nebulizers and CPAP prior to entering hospital
o Transition to nasal cannula with surgical facemask over patient while
moving from ambulance to patient room
M. Pediatric considerations
o Use bag-valve-mask filter that does not increase dead space (i.e. an
exhaust filter does not increase dead space)
o In the event of short-duration ventilation support (e.g. seizure), bag-
valve-mask ventilation is preferred over i-Gel placement
o In cardiac arrest, i-Gel w/ filter is preferred
N. Personnel Considerations
To minimize personnel exposure to potential Covid infection, it is
encouraged that crews limit the numbers of providers in close contact with
patients to the minimum necessary to provide appropriate care
4/2/2020 These are Medical Director recommendations for work exclusion/return and testing of personnel who either develop symptoms of Covid 19 infection, or have exposure to Covid + patients. It is understood that some agencies may prefer to expand upon these recommendations. Some principles to consider: 1. The CDC does not currently recommend performing Covid 19 testing on asymptomatic persons who had exposure to a Covid 19 + patient. 2. There is currently NO available data to determine the best timing to test asymptomatic persons who have had exposure to Covid 19. 3. It is clear that if testing is performed, testing too soon after exposure (1st few days) would likely result in a negative test, despite the fact that that person might become positive later. Therefore, if testing, it should be done at least 7 days post-exposure to “capture” more reliable results. 4. Asymptomatic persons who have had exposure to a Covid 19 patient can wear a surgical mask and, though nothing is perfect, effectively minimize risk of transmission to others when using appropriate hygiene. 5. The CDC provides direction that personnel with medium and high exposure to Covid 19 can safely work in the healthcare environment while wearing a surgical mask for 14 days after exposure. 6. A negative Covid test at day 7 post-exposure can negate the need to continue wearing the mask. 7. Symptomatic personnel should be evaluated in an Emergency Department if having severe symptoms, such as shortness of breath, syncope or chest pain. 8. Symptomatic personnel with milder symptoms who need referral for testing should be evaluated, at least by telehealth, by a primary care provider and referred for testing through that provider. Some options include: Personal PCP, Occupational Health, HRH Immediate Care Centers in Avon/Plainfield/Brownsburg.
Recommendations for EMS Personnel With Possible Covid 19 Exposure or Illness April 2, 2020
A. Personnel who develop symptoms consistent with possible Covid 19 infection
Criteria: EMS personnel with any of the following symptoms: Fever, Sore throat, Cough, Shortness of breath, Vomiting, Diarrhea for 48 hours, Severe Body Aches should be excluded from work immediately and: 1. No testing, and exclude from work until:
• At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications
• and improvement in respiratory symptoms (e.g., cough improved, and no shortness of breath);
• and, at least 7 days have passed since symptoms first appeared OR 2. (Optional) Refer for Covid 19 testing:
o If negative, return to work after fever-free for 24 hours without medications, and improved respiratory symptoms
o If positive, exclude from work until: o At least 3 days (72 hours) have passed since recovery, defined as resolution
of fever without the use of fever-reducing medications o and improvement in respiratory symptoms (e.g., cough improved, and no
shortness of breath); o and, at least 7 days have passed since symptoms first appeared
3. Upon return to work, providers without a NEGATIVE test should: • Wear a facemask at all times while working until all symptoms are completely resolved
or until 14 days after illness onset, whichever is longer • Adhere to hand hygiene, respiratory hygiene, and cough etiquette in CDC’s interim
infection control guidance (e.g., cover nose and mouth when coughing or sneezing, dispose of tissues in waste receptacles)
• Self-monitor for symptoms, and seek re-evaluation from occupational health or primary care physician if respiratory symptoms recur or worsen
• Temperature check at beginning and mid shift till 14 days after onset of illness. Temp > 100 requires exclusion from work and reassessment by primary care/Occupational Health.
B. Personnel with exposure to: • Known Covid 19 + person or “Person Under Investigation” • Patient admitted to hospital and considered “Person Under Investigation” for Covid 19
infection 1. If symptoms develop, refer to Section A above. 2. Follow CDC guidelines to determine “Exposure Level” https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html 3. Restrictions should be based on exposure level a. If “Low Exposure” – no restrictions b. If “Medium or High Exposure”: Exposed personnel should wear surgical mask while working for 7 days from exposure.
o If no symptoms develop after 7 days from exposure: o (Minimum recommendation) No testing, and for 14 days post-exposure date
exposed personnel should continue wearing surgical mask while working OR
o (optional) Refer for Covid 19 testing 7 days after exposure § If negative, return to work § If positive,
• Exclude from work for 7 additional consecutive days, symptom free
OR § (optional) if physician recommends, exclude from work until
negative testing occurs
Hendricks County EMS Personnel COVID-19
Exposure & Testing Guidelines
April 1, 2020
EMS Personnel with Symptoms1
Exclude from work immediately
RETURN TO WORK:
>7 days since symptom onset and
At least 72 hours FFP2 and IRS3
Option 1NO COVID TESTING
Option 2REFER FOR TESTING4
RETURN TO WORK:
24 hours FFP2 and IRS3
Notes:1. Symptoms of COVID-19 are: fever, sore throat, cough,
shortness of breath, vomiting, diarrhea x 48 hours, severe body aches
2. FFP: Fever Free Period. Must be without the use of antipyretics (i.e. acetaminophen, ibuproven, naproxen). May be 24-72 hours depending on situation.
3. IRS = Improving Respiratory Symptoms. Cough is becoming less severe / less frequent and any shortness of breath has resolved or is minimal
4. Test results may take > 48 hours to result5. Hand hygiene, respiratory hygiene, & cough etiquette
found here: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html
6. PUI: Person Under Investigation. Someone admitted to the hospital with suspicion/testing for COVID-19
7. CDC Exposure Level: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
Negative ResultPositive Result
Workers returning after positive result MUST:
Wear a surgical face mask at all times until all symptoms resolve, up to 14 days since onset
andAdhere to strict hand and respiratory hygiene5
Check temperature at beginning and middle of shift.
Self-monitor for symptoms of COVID
Temp > 100
if symptoms recuror worsen
Seek evaluation from PCP or Occ. Health Physician
EMS Personnel with Exposure to
known COVID+ person or PUI6
+ Symptoms1
Asymptomatic
Determine CDC Exposure Level7
LOW
MEDIUM/HIGH
No Restrictions
Wear a surgical face mask at all times for 7 days from exposure
At 7 days post exposure
Option 1NO COVID TESTING
Option 2REFER FOR TESTING4
Asymptomatic
Continue surgical face mask at all
times for additional 7 days Negative ResultPositive Result
Return to WorkExclude from Work for 7 daysReturn once 72 hours FFP2 and IRS3
Brownsburg Fire Territory Vigilantly Serving Our Community Division Chief of EMS
www.brownsburgfire.org Telephone: 317.456.0024 470 E. Northfield Drive jbowers@brownsburgfire.org Fax: 317.456.0024 Brownsburg, IN 46112
June 3, 2020
RE: Infrared Temperature Monitoring
On June 3, 2020, the BFT will begin utilizing a non-contact infrared thermometer to conduct the twice
daily temperature checks in place of the current tympanic thermometer. Listed below are some tips for
using this thermometer. The package insert will be at each station with the thermometer should you
have any questions.
• When taking a temperature, hold the thermometer approx. 2 inches from the forehead
• Move any hair away from the forehead when taking the temperature
• Wipe away any sweat prior to taking temperature
• To turn the thermometer, simply click the trigger once and it is ready to go.
• Make sure the display says “body.”
• Once on, you can aim the lens at the forehead and then pull the trigger and it takes about one
second to scan and display the reading.
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