COVID-19 safety update

COVID-19 safety update

EXPOSURE REVIEW METRICS

 

Many of you have received my exposure questionnaires and instruction sheets.  I’ve reviewed 238 individual encounters on 66 incidents.  The volume of cases to review is now becoming overwhelming.  Fortunately, some clear patterns have emerged, and are covered below.

 

KEEP UP THE GREAT WORK USING PPE!

 

We have quickly adapted to using proper PPE properly.  Keep in mind that we need to conserve N95 masks for when “prolonged close contact” and “aerosol generating procedures” are happening.  One study concluded that this virus may linger in stagnant air for hours (https://www.nejm.org/doi/10.1056/NEJMc2004973).

 

KEEP PROTECTING “EXTRA” PERSONNEL

 

Unless you need the extra hands in the back, have “thirds” ride to the hospital separately, or up front.

 

COVID-19 IS WIDESPREAD IN OUR CITY

 

There’s plenty of reason to believe that lots of our patients do indeed have COVID-19.  If you think the patient may have COVID-19, they probably do.  Put a surgical mask on them!

 

ATYPICAL PRESENTATIONS

 

Don’t be fooled!  The hallmark symptoms of COVID-19 are described as fever, dry cough, and shortness of breath.  But other symptoms – sometimes the only symptoms — are actually quite common, including:

 

  • Body aches
  • Back pain
  • Abdominal pain
  • Diarrhea
  • Nausea/vomiting
  • Headache
  • Hypoxia without dyspnea and with decent lung sounds
  • Chest pain of any quality
  • Loss of smell
  • Fatigue
  • New onset CHF

 

CONFOUNDING SITUATIONS

 

Patients and family members aren’t always getting, understanding, or reporting accurate information about their COVID-19 status.  We’ve been told all of the following about patients who ultimately turned out to be COVID-19 positive:

 

  • Patient was tested, but test came back negative  (That was then, this is now.  Also, the test is very sensitive – but not perfectly so.)
  • Patient was flu positive  (doesn’t mean they’re COVID-19 negative)
  • Patient was diagnosed with pneumonia  (which can be caused by many or multiple things, including COVID-19.  Doctors are sending some patients home with COVID-19 pneumonia.)
  • Patient hasn’t been around anyone with COVID-19  (How would they know? People can shed this virus before they develop symptoms.)
  • Patient is probably septic  (which could be caused by COVID-19)
  • Patient just fell and hit head  (Why did they fall?)

 

OUR CASE REVIEW AND SURVELLANCE PROCESSES ARE CHANGING

 

We are now seeing too many potential COVID-19 cases to review them all.  Going forward, we’ll only be reviewing High Risk Full PPE cases and reports of problems with PPE.  Let supervisors know about PPE problems immediately.

 

WE’VE BEEN LUCKY

 

Our PPE supplies haven’t been half bad, and we’re continuing to turn over every rock looking for more.  Notify a supervisor if you discover you’re running low.  (Squad officers, notify Brigade Chief Kerr.)

 

BE SURE YOU’RE APPRISING AND ADVISING BEFORE COMPROMISING

 

Every time you put on an N95 mask, do a User Seal Check:

 

  • Exhale gently through the mask.  The mask should puff out, and you should not feel air escaping next to your face.
  • Inhale gently and hold your breath for 10 seconds.  The mask should collapse slightly and stay that way while you hold your breath.

 

If you can’t get a good seal with an N95 mask, let a supervisor know immediately.  We might be able to get you a different style, or maybe someone else should be assigned to care for the patient.

CHANGES IN ELITE

 

We’ve made several changes to Elite to support COVID-19 operations.  Please review the attached 6-slide PDF file.

 

HELP FLATTEN THE CURVE!

 

Slowing the spread of COVID-19…

 

  • Keeps PPE on our units
  • Keeps beds open in the hospital
  • Keeps healthcare providers from getting sick
  • SAVES LIVES

 

So…

 

  • Per Deputy Chief Hundley’s guidance (attached), when on duty, wear at least a surgical mask whenever you’re:
    • Close to others (including indoors)
    • In the ambulance
    • On a call
    • In the hospital
  • Take social distancing seriously
  • Follow Governor Northam’s orders

 

— Division Chief Kevin Lipscomb, NRP

— Regulation & Support Services

— Va Beach EMS Department

“EMS Chief 7” (ECH07)