GVFRS Policies/Procedures

Company policy is, and has been, that you wear appropriate PPE.
With community spread now in Gloucester, you should consider all calls to be possible COVID19 cases.
Protect yourself, your co-workers, your family, and your friends. Wear your PPE.

As Of 4/16/2020

  • If you transport a patient who may have COVID19 (or the flu), leave the module doors open on the medic after you drop off your patient for a few minutes to allow sufficient air exchange in the module.
  • Decon with purple wipes. RWRER is running short so you may have to grab 2 or 3 wipes from a room to wipe down the inside of the truck
  • Spray (in a fog like pattern) everything in the back of the truck with the alcohol in the spray bottle. DO NOT SPRAY THE CO DETECTOR – Alcohol will destroy the sensor. I have plenty of rubbing alcohol, so spray often
  • You should spray the trucks with the alcohol spray before each shift

Some folks are saying they don’t want to wear PPE, or don’t feel it is necessary. We are working everyday to make sure we have the appropriate PPE available to protect you from COVID19 and other diseases. Even if you may not be worried about yourself, consider the safety of your family and others you may come in contact with.

As of 4/15/2020

  • MARY IMMACULATE HOSPITAL
    • Requiring EMS providers to don a mask while inside our facility
    • Very short supply of cleaning wipes. Please take only what you need to decon

AS of 4/7/2020

  • New guidance from Virginia Department of Health
  • If you arrive at a scene before the ambulance, and you do not have proper PPE, stage until the ambulance arrives
  • When Patient conditions permit, only one provider to enter the scene and assess the patient. obtain assistance from bystanders/staff to get the patient onto the stretcher or out of the residence. Limit exposure at every opportunity.
  • Do not bring family and friends into the station
  • If you come into the station, WASH YOUR HANDS before you leave and do not touch anything on your way out.
  • Duty Crews should bring a clean set of clothes when they have a duty shift. At the end of your shift, shower at the station and put on clean clothes to reduce the risk of carrying the virus home on your clothes or person. Protect your families.
  • See Dispatch screening questions and Code definitions below, or download here.
COVID-19-Dispatch-Codes

As of 4/6/2020 REMINDERS

  • PPE is in short supply. DO NOT TAKE ANY PPE HOME FROM THE STATION.
  • N95s, safety glass, and goggles may be reused. Wash safety glasses and goggles in warm water and soap after use.
  • CPR produces a lot of aerosolized particles so N95, Goggles, and gowns are required.
  • Limit the number of people on calls, or exposed to the patient, to the bare minimum
  • Patients are being diagnosed with COVID19 with unexpected symptoms, or no symptoms at all. Treat all patients as PUI
  • Nursing homes have various procedures for screening people entering the building. Please allow them to do their job – they are following Corporate orders.
  • Wear surgical mask and safety glasses when entering the emergency room
  • Please fill out the Outbreak Screening form in ESO
  • Decon the ambulance thoroughly. You may use the alcohol in the spray bottle to spray surfaces, bags, and equipment
    The CO detector on the jump bag is allergic to alcohol – be careful to keep alcohol away from it or it will be damaged beyond repair.
  • Discontinue Neb treatments and CPAP while entering the ER. Discontinue BVM when entering if time permits.
  • All Drug Boxes MUST be wiped down with purple or clorox wipes inside and out before exchanging.
  • Everyone must log in on IAR so we can track who was there in the event of an exposure. Even if you didn’t go on the call, you may have been exposed to those who did.

As of 4/5/2020

  • HEPA filters for the exhalation port of our Bag Valve Masks have been added to the plastic bag the BVMs are stored in. GVFRS is supplying these, so if you use one, you must restock the HEPA filter from the station. Use these every time you use a BVM until the COVID19 crisis is well behind us.
BVM Hepa Filter

As of 4/2/2020

  • Since I’ve just heard Dispatch use the term…
  • “CODE YELLOW” will be used by dispatch to alert us of the possibility of COVID19.
  • If you hear this, and you feel you need additional information, you may call dispatch at 693-3890. Do not ask for clarification over the radio.
  • This term is CONFIDENTIAL. Do not provide this information to non-members.
  • And please, do not use the terms COVID19 or Coronavirus on any radio. Use the phone.
  • Code Yellow means something completely different to Riverside Walter Reed.
  • ESO has added an “Outbreak Screening Form” to the forms page. Please complete this form on all medical calls.
  • On the form, Select COVID19 as the outbreak, and then fill in any applicable information.
  • Also, the PPE section should now be mandatory. This is how I am tracking PPE usage, and reporting it to the State.
ESO Outbreak Screening form
  • For your safety and that of your family, at the end of your duty shift and before leaving the station, it is recommended that you shower and change into a fresh set of clothes before leaving the station. Your duty clothes should be washed immediately.
  • Consider everyone as potential COVID-19 positive, since they can spread it while being asymptomatic, and wear a mask, and put a surgical mask on pt
  • Consider putting some hand sanitizer in patients’ hands and instruct them to clean their hands

As of 3/31/2020

  • Riverside is not requiring EMS to wear PPE. Our policy, however, it to follow their recommendation that we wear, at a minimum, surgical mask and eye protection whenever we enter the ER.
  • Virginia Beach EMS has produced a COVID-19 training video that covers changes in procedures and using your PPE properly. Its only about 5 minutes long. Give is a look:

As of 3/26/2020

Please do not use the term COVID19 on the radio. It creates a panic among the people listening to their scanner. Dispatch should ask you to call for details if they meet their screening criteria. When calling in a HEAR report, just say “we are using precautions”. If you feel they need more details, call on the phone. WRER is not using the DECON room to screen patients so, COVID or not, your patient is likely going to a regular room (per the ER). Also, make it a habit to wear surgical masks and eye protection on most all medical calls. Lewis

As of 3/25/2020

In an effort to protect you, your family, and our patients, we have been working with the various nursing facilities to reduce our exposure to them, and they’re exposure to us.
First, some of the facilities have modified some of the “transport everyone” policies to reduce the number of patients being transported.  They recognize that the ER is one of the most dangerous places they can send their patients in terms of flu and COVID-19.  They also recognize that we are exposed to diseases in our normal course of treating and transporting patients to the ER.
Second, anyone entering one of these facilities should wear full PPE including mask (surgical at minimum, N95 based on patient condition), gloves, eye protection, and disposable gown.  Some facilities require this, but we should do so for all of them.
For any unstable or critical patient, our response will continue as always with a proper number of medics to assess and treat the patient.
For stable patients, such as injury from a fall, we would like to limit the number of medics going into the facility.  Ideally, a single medic can enter the facility with the stretcher and necessary equipment, assess the patient, provide necessary treatments, and then request facility staff assist with transferring the patient to the stretcher.  This will reduce our exposure and conserve PPE.  The driver should be prepared to enter to assist with PPE at the ready.
In all cases, once we arrive at the patient, we will assume complete responsibility for the patient (as normal) and it is up to us to ensure the patient is properly and safely moved to the stretcher, including c-spine control if necessary.
The facilities are willing to help with this as follows:
Walter Reed Convalescent Center:

  • They will allow their staff to assist us with moving the patient to the stretcher during day and evening shifts.  During the midnight shift, they are very limited on staff and may not have enough staff to help
  • The driver should wait in the lobby (inside the locked doors) with PPE available in case they are needed.

Gloucester House:

  • They will allow their staff to assist us with moving the patient to the stretcher
  • They are screening everyone who enters the building by checking their temperature
  • They have said they will try to bring patients to the door, if possible, so we do not have to enter the facility
  • The driver may wait just inside the door, if necessary

Sanders /  Heron Cove:

  • They will allow their staff to assist us with moving the patient to the stretcher
  • They are screening everyone who enters the building, checking a temperature and completing a 5 question form asking about travel, fever, symptoms.

Please do not try to bypass the staff when being screened at the door.  Even though this may delay access to the patient by a minute or two, trying to bypass the screening is just going to cause a further delay.  If you have issues with the process, or any staff member, do not address with them while on the call.  Document the issue and contact Stacey Williams to address after the fact.
I took a call at Sanders this morning and they did take my temp and complete the screening form and it only took a minute.  They also assisted me with the patient, so my driver was able to remain outside of the facility.
Again, these procedures are for stable patients with non life-threatening conditions.  For unstable or life-threatening conditions, we will respond normally.

  • We are being required to report daily to VDEM what PPE we use each day. When completing PPCRS in ESO, please edit each crew member and select any and all PPE used, including gloves. When the COVID19 crisis wraps up, this will assist us in getting money from FEMA to cover the cost of the PPE we used, so this is very important. If everyone adds this to ESO, I can run a report to get the numbers each day. For any special cases, please send me a message. Thank you for your assistance, and stay safe!

AS of 3/23/2020

  • I’m sure some of you have heard there is CDC guidance saying to skip CPAP for certain patients and go directly to intubation. This is NOT AUTHORIZED in our protocols nor by our OMD and may violate VA scope of practice. Per Dr Gupta, if PT requires CPAP, place a surgical mask on the PT under the CPAP and attempt to do so in a large open area with good ventilation. Our crew should be in full PPE with N95, gowns and googles. Call me tonight you have questions.
  • New PEMS COVID19 response policies have been added to the front of the Protocol binder in each truck. Please take time to review these. As more documentation becomes available, it will be added to the front of these binders. The binders are being left out in the action area to make it easier to reference. Please review these each time you check on off the medic units for changes and updates. The 2020 protocols and other information should also be updated this week.
  • There are Safety glasses, tyvex suits, and disposable plastic gowns in the doors to the cab next to the reflective vests so you can access this PPE without having to go into the back of the truck.
    • If you have a respiratory illness or patient with flu like symptoms, please wear, at a minimum, a surgical mask and safety glasses
    • If you suspect COVID19, please wear gown, goggles, and N95
    • If you are performing any procedures that generate aerosolized particles (intubation, BVM, neb treatment, CPAP, etc), anyone in the back of the truck or around the patient must be in full PPE including N95, goggles, and gown
  • If you encounter any patient that has a potential to have COVID19, please let Karen Kramer know so we can track the patient and the providers who were in contact
  • I need everyone to be very diligent and accurate in entering their times on duty into the IAR schedule. I need this to track how many hours we volunteer, and to be able to identify who was at the station if we encounter a COVID19 patient. There may also be some prizes for most hours per squad…. If you do not have permission to update your schedule in IAR, let me know so I can fix. Thanks and please be extra careful on respiratory/flu calls. Use your PPE! Lewis

As of 3/20/2020

  • There is a confirmed case of COVID19 in Gloucester. The patient is self quarantined at home per Three Rivers Health District.
  • For ALL STUDENTS
    • If a call indicates respiratory issues or flu like symptoms, students are to REMAIN BEHIND and not participate in the call
    • If you are already out and a respiratory or flu like call is received, the student should remain in the cab of the truck
    • Students should be prevented from being exposed to any potential COVID19 patient
  • Limit the number of people exposed to potential COVID19 patients. If a single medic can bring the patient into the ambulance and provide appropriate care, do so.
  • All medics must be fitted for and issued an N95 mask. On or before April 1, only medics in possession of their N95 mask will be allowed to run calls. Get in touch with Karen Kramer for fit testing times and places.
  • Remember that GVFRS does not have an RSI procedure and PEMS protocols do not support sedating patients prior to intubation. If you must use CPAP on a patient, place a surgical mask on the patient and then place CPAP over the mask to reduce the spread of aerosolized particles.

As of 3/18/2020

  • DISCONTINUE all NEB treatments before entering the Emergency Room.
  • DISCONTINUE all CPAP treatments before entering the Emergency Room
  • Any calls to nursing home type facilities, all crew entering the building should wear gloves, surgical mask, and safety glasses at a minimum
  • Any calls to a report of respiratory illness or flu like symptoms, all crew entering the home/location should wear gloves, surgical mask, and safety glasses
  • Any procedures that may generate airborne particles, such as BVM, nebulizers, and intubation, require the crew to wear N95 respirators and goggles.
  • Surgical masks are on the truck. If you use one, try to replace it at the hospital if possible
  • Safety glasses will be on the trucks. You may re-use these. Wash with soap and warm water unless they become contaminated
  • You must be fit tested to be issued an N95. Contact Karen Kramer
  • For any potential Corona virus call, limit the number of people exposed. Minimum number of people necessary should enter the house or be in the back of the truck. Extra crew should ride up front.

As of 3/6/2020

If you have a patient with flu like symptoms, please complete the “Influenza Screening” From on the PCR Forms page. It’s only a few check boxes and shouldn’t take but a second. If you have a patient with any suspicion of Corona Virus, please complete the “Secondary Impressions”.   Items Related specifically to COVID-19 that are available now:
COVID-19 – Confirmed by testing
COVID-19 – Exposure to confirmed patient
COVID-19 – Suspected – no known exposure

I know this seems like extra work, but the information we enter into ESO really does get used and makes a difference in the research world.  It is important.
Remember, dispatch will be asking about travel and related exposure whenever they receive a call about flu like symptoms and will ask that you call them on the phone for details so you can properly prepare for your patient.

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