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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

https://coronavirus.in.gov/



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

https://www.cdc.gov/coronavirus/types.html

https://www.cdc.gov/coronavirus/types.html

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html

https://www.cdc.gov/coronavirus/2019-ncov/faq.html#anchor_1584386215012



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



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



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.



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.



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



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



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)



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


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


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


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


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



Notify of any ALERT patients. to park outside and take your patient through

the assigned door.

Community South


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


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



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




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



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

https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html


Brownsburg Fire Territory Vigilantly Serving Our Community Division Chief of EMS

www.brownsburgfire.org Telephone: 317.456.0024 470 E. Northfield Drive [email protected] 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.

http://www.brownsburgfire.org/

mailto:[email protected]

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