By Marianne Meyers

David K. Tan, M.D., EMT-T, FAEMS, president of the National Association of EMS Physicians, an EMS1 Editorial Advisory Board member and an emergency medicine physician at Washington University in St. Louis, moderated a question and answer session with Michael Sayre, MD, emergency medicine physician at Harborview Medical Center and Seattle Fire Department medical director; and Thomas Rea, MD, MPH, internal medicine physician at Harborview Medical Center and medical director of King County EMS.

They discussed current protocols their EMS crews are using along with PPE recommendations, updates from the CDC and other COVID-19 related questions.

Top quotes on NAEMSP COVID-19 Town Hall

Here are a few quotes from the physicians.

“It’s a serious business, wear that PPE and don’t be cavalier about it.”

“Whenever you veer from your normalized routine, it’s an opportunity for missteps.”

— Dr. Thomas Rea

“What’s become apparent over the past few weeks is that PPE works and it prevents infections in the providers when they’re wearing PPE but they remain at risk because they don’t wear PPE at home or with each other when they’re at the stations in between calls.”

“The vast majority of patients in cardiac arrest do not have COVID-19 and I am very worried about the collateral damage here.”

— Dr. Michael Sayre

Top takeaways from the NAEMSP COVID-19 Town Hall

Here are 4 takeaways from the NAEMS Town Hall on COVID-19 implications for EMS.

1. Scale PPE, practice social distancing off calls

Full PPE (gown, gloves, surgical mask and eyewear) should be worn when working with suspected or confirmed COVID-19 patients. N95 masks instead of surgical masks should be worn when performing aerosolizing procedures such as:

• Airway management
• Positive pressure ventilation
• Chest compressions
• High flow nasal cannula
• Nebulizing treatment

Surgical masks are comparable to N95 masks when preforming routine patient care – it is only with possible aerosolization that an N95 mask is superior.

At this time, Seattle crews are not wearing full PPE on all calls or in the station but are practicing social distancing whenever possible.

2. Screen patients for COVID-19 symptoms

The Seattle and King County area has a two-tier system to help ensure that their first responders are protected. When the call comes in, the dispatcher will ask about respiratory symptoms and determine whether or not the patient is likely to have COVID-19. While the crew is on route to the call, the dispatcher will continue to talk to the caller and ask more COVID-19 related questions, therefore getting more information without increasing response time.

The second line is a “scout” who wears full PPE to evaluate a patient prior to the rest of the crew entering the scene. This scout will determine whether the crew needs to wear their full PPE both conserving resources and protecting providers.

3. When to transport COVID-19 patients

Some patients may have COVID-19 but do not have severe enough symptoms to be taken to the hospital. Seattle has implemented an algorithm to help BLS crews determine and discuss with patients why they don’t need to be transported to the hospital. They also have phone access to a physician who they can consult if they are unsure whether a patient should be transported.

Seattle has an established history of shared decision making between EMS and patients which means this isn’t a novel concept for first responders. Additionally, they have developed a handout for patients who are not transported that provides them more information and resources. You can find the King County algorithm and handout here.

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4. Be aware when changing routines

There is a risk of more mistakes or unintentional harm to patients when a new protocol is implemented. Obviously, we want to protect our first responders, but also want to ensure that we aren’t also harming non-COVID patients who are having a medical emergency.

Additional COVID-19 resources

Learn more about EMS treatment of COVID-19 patients with these resources:

• King County (Wash.) shares EMS resources for COVID-19
• Quick Take: Airway management lessons learned for COVID-19 patients
• Rapid Response: When demand outstrips supply: Decompressing the system by doing the best for the most
• Stretching your service’s supply of N95 respirators
• Airway management adjustments in the era of COVID-19
• MCHD emergency protocol to eliminate nebulized albuterol