Stay Safe - PPE 1/7/2020 vs. PPE 4/5/2020

This article is a hypothetical look at the way we may have made a call on 1/7/2020 and how we would make a call on 4/5/2020. What I have presented here is what I would do and may not work for you. You must consult with your Chief/Captain for their protocol on staying safe. Their rules supersede all others. Check with the CDC's latest updates for their recommendation.
 
If we take a look back in time, let say to January 7th, 2020, just think of the precautions you would have taken while making a call. Of course, you would have practiced scene safety and the usual PPE of gloves then hand washing. Most organizations are required to wear hi-vis outerwear on all calls, so I’m sure most of you would have worn proper gear. On January 7th, during your assessment, would you have probed if someone traveled outside the county? After the assessment, it would have been time to transfer the patient to a stair chair. But, just take a moment and think how you would have supported their balance while lifting them onto the stair chair. Then, how you’d put your hands and arms under the patient’s arms and trunk to lift them to a standing position so you could transfer them onto a stretcher. Hopefully, the driver would have taken their gloves off prior to entering the driver’s compartment.
 
Just think of all the things you may have touched in the rig, during the call. To mention a few, door handles, cabinets, seatbelts, a stethoscope, BP cuff, pulse ox, wipes container, rig phone to notify ER via voice or Twiage, tablet or laptop, paper call sheet, pen, and so much more.  Oh, and don’t forget O2 or anything in the jump kit.
 
Once you arrived at the hospital, you would have opened the rear door of the rig to remove the stretcher, but think how many times the patient’s feet reached over the end of the stretcher and touched your chest. Then, you would have transferred the patient from the stretcher to a hospital bed, and after giving your report, I am sure you took off your gloves, scrubbed up, and re-gloved, so you could disinfect the stretcher, make it, take off your gloves, scrub up again, grab your call sheet or tablet and leave. Then you would have entered the rig and notified dispatch that you were back in service.
 
Some of you may have done your charting during the call. Others may have waited until they returned to the building so they could use a PC vs. the rig’s tablet. Then, you’d restock the rig and it was time off until being paged out again. By the way, you probably got into your car with the same uniform on. Did you take off your shoes before entering your house? Did you stay at home with that uniform on?
 
Let’s fast forward to today. A call comes in and dispatch alerts your squad that it is a suspected Covid-19 call. It is best to look at the January 7th, 2020 call and notice all of the items that may have become contaminated.
 
If you respond from home, this may be what you can do. You change from your causal day clothes to your traveling clothes, which are left outside the house when you return. They might be a pair of jeans, t-shirt and sneakers. You will also carry one bag with your clean response uniform, and another bag with your work shoes that were deconned after your last call. You arrive at the building and change into your uniform.
 
You check the rig to make sure all PPE gear is available. You don a gown orTyvek suit, gloves (do a search to locate a video link for instructions “How to don and doff a Tyvek suit”), and leave some gloves outside the box so you do not contaminate the box during the call. Most police departments already have established protocols for their response.
 
If someone else is at the location besides the patient, you ask for them to meet you outside so they can provide as much information as possible before encountering the patient while keeping a distance of at least six feet. Care should be given on scene, in the rig, and at the hospital, when handling the call notes, clip board, and pen used on the call. It may even be wise to place them in a plastic baggy. You do not fold them and place them in your pocket. If you are using a tablet, all standard precaution should be followed so the unit is not exposed to contamination. If it is, it must be decontaminated prior to unprotected touching. Ask that person to place the appropriate mask, surgical, NRB, N95 on the patient. If the patient can walk, ask the person to escort the patient onto the stretcher. This person should not be allowed in the ambulance since they must be quarantined. They will probably be prohibited from the hospital anyway.
 
If the patient is not ambulatory, you would proceed to their location in the house. Now, you would not shake their sheets since this will cause the virus to become airborne. You would transfer the patient to the stair chair or Reeves using your clean sheets and you would not take or touch their contaminated pillow. You’d try to keep the patient’s body from touching yours as much as possible, trying to limit any touching to your double-gloved hands only. You’d keep changing the outer layer of gloves as often as needed. Then, you’d transfer the patient to the stretcher and carefully wrap the same sheet around the patient and strap them in, avoiding the patient’s feet from hitting your body when loading the stretcher
 
With clean gloves the driver should, close doors between the driving and patient compartments if the ambulance is equipped with this feature. The driver should wipe down the steering wheel, siren, mic, or any possibly infected surfaces before touching them. After cleaning, the driver should remove their gloves.
 
Hopefully, at this point you’d have on two sets of gloves so you can continue to change the outer layer as needed, and leave all equipment that you use in one place knowing that they will all need to be deconned before storing them. If available, the EMT in the rear should enable the ventilation button to filter the air, while you avoid shaking the patients clothing, towels, blankets, sheets, pillow, etc. since shaking can distribute the virus. Remember, when unloading the patient be careful that the patient’s feet do not hit your body. After triaging at the hospital, you’d transfer the patient to the hospital bed and, if possible, lower the stretcher and the bed and let them transfer themselves. If not, you’d carefully transfer by sliding the sheet and the patient. After giving call report, you’d leave the patient.
 
If possible, weather and facilities permitting, you’d move outside the ER ASAP to clean the stretcher, which would prevent your team from contact with other agencies and/or patients. It will also speed the drying time for cleaning the stretcher. You’d use the proper wipes for cleaning, and remember that the wipes have dry times before applying the sheets (purple tops are two minutes, red tops are four minutes, and bleach wipes are four minutes). Now, you’d wipe everything with the lives of your colleagues in mind - all equipment that was used for assessment, (hopefully you left it all in one place), all counters and surfaces, door handles, phone, PC, tablet, and front compartment.
 
You would take off and discard the Tyvek and all PPE at the hospital, put on new gloves, make the bed, and return to quarters.
 
Back in quarters, you would don a pair of gloves, and restock the rig. If you used a sheet of paper or a clip board for your ePCR call notes, consider it contaminated when you lay it next to the computer for entering it into ePCR. It is recommended that you make a copy of the original. Once copied, discard the original and decon the copier glass. You’d change gloves, yet again, and enter the report.
 
With gloves still on, you would decon shoe bottoms, take off uniform and shoes and place them into separate bags and change into traveling clothes and shoes for your return home.
 
When home, you’d put on a set of gloves, take off you traveling clothes, put uniform in the hot wash, take a hot shower and put on your day clothing (note: traveling clothes are also recommended if you were not an EMT and had to go to a store throughout this Covid-19 period).
 
As an EMT we save lives every day and now it’s time to up our game… It is time to save ourselves from becoming the 2nd patient. It is time to save our teammates from becoming a patient. And of course, it is time to save our families from coming in contact with the virus.

What I have presented here is what I would do and may not work for you. You must consult with your Chief/Captain/Medical Director for their protocol on staying safe. Their rules supersede all others. Check with the CDC's latest updates and recommendation..

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