Blast for Fri 2.27.2020 (TGIF Edition)
New AHA guidelines came out recently.
Beware of Complacency – delayed consequences
Thanks to Bob V.
PPE in the hospital
Brian off the car (sort of) for the next 30 days
AHA COVID 19 Guidelines. I am not sure if anyone has heard about this but the AHA dropped some new guidelines about COVID 19 recently. I am not sure when this happened. I have only glanced through them. I’ll try to do a deeper dive tonight. Please read them. If you find something in there that we are not doing, and you think we should be doing please reply all to this email. I will miss some things for sure. Or if you see things we shouldn’t be doing—throw them out too. Finally, someone defined what “eye protection” in the setting of creating aerosol is – goggles or face shield, NOT glasses. I think unless you are in a PAPR or fully enclosed face shield respirator, an open-ended face shield is not going to do much for aerosols.
AHA COVID Guidelines for EMS and Resuscitation
The AHA medical compendium page for COVID is here: https://professional.heart.org/professional/General/UCM_505868_COVID-19-Professional-Resources.jsp?fbclid=IwAR109W4DT1T4vBbDv5vHM3UaG9bND9cg6ip52djqBBW_I9sZwo-SMRPUi2Y
There are some other things on the AHA site that are worth a look. https://cpr.heart.org/en/about-us/coronavirus-covid-19-resources
For example – what about pets?
Complacency. Beware of complacency out there. I have not seen it in our agency, but I have seen it elsewhere in healthcare this week and there is a very real possibility there are consequences from this. When the feedback from slips, lapses and drift is delayed by 5 days give or take (median time from exposure to symptoms) it is easy to not see cause and effect and let the confirmation bias slip in. Don’t.
Be diligent in your PPE, hand washing, and cleaning and putting masks on patients when you can. Don’t touch your face, restock hand sanitizer. We are doing well with it so far and are getting through this. This is a marathon, not a sprint. Just because no is getting sick, don’t be fooled, keep up what you are doing.
A huge thanks goes out to Bob V. for his work in exploring alternative mask sources. He got a fantastic looking prototype made by Oveja Negra and it is an amazing alternate plan if some things fall through. If you are looking for bike packs or packs in general, consider spending your money there as they really went above and beyond and are a local business.
Wear PPE in the hospital. Effective immediately you must wear a procedure (surgical) mask, gloves, and protective eyewear that wrap around your head—your corrective lens (aka normal glasses) are not enough. If you absolutely need prescription safety eyewear (and we are talking NEED, not want) let me know ASAP and we will see what we can do. Feel free to ask me more, but in a nutshell there are aerosol generating procedures occurring in the hospital in rooms that are not negative pressure with suspected/positive patients. I was going to put something about disciplinary action here, but if the threat of getting SARS-CoV2 isn’t enough, or the thought of infecting others isn’t enough to make you put it on, I’m not sure I can make you do it. This should also be practiced in any hospital you go to. Do not go into a room where aerosols are being generated without goggles and an N95 or better protection. I think you are safe in the hallways with a procedure mask and glasses.
Bail out Pocket Mask.
On the south end please talk to the shift supervisor – I believe there is a bag of these in BV—and get one of these masks and put in your pocket. This way if you inadvertently walk into a situation where you wish you had an N95, you will have an N95.
You do not need to fit test these.
Put procedure masks on every patient. With the unknowns out there about when a person can spread the virus—do they need to be symptomatic or is there a period before that when they can infect others? Consider putting a mask on almost every patient at this point and wear a procedure mask and glasses around every patient. Who is to say that you are not going to infect them as well? It is better for patients and better for us. While this may be overly paranoid, it is cheap insurance.
If there are any symptoms or doubts, escalate to an N95 mask without hesitation.
Consider the following – The CDC recommends:
Facemasks are an acceptable alternative until the supply chain is restored. Respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk to HCP. Eye protection, gown, and gloves continue to be recommended.
When the supply chain is restored, fit-tested EMS clinicians should return to use of respirators for patients with known or suspected COVID-19.
I read this as the CDC saying if we had enough N95’s that is what we should wear around known positive or suspected positive patients. I know many people are wearing surgical masks around this and while I think it certainly offers some protection, in the symptomatic patient, an N95 is likely to be better.
In the next few days, we will start the discussion about how to best prolong our supply of N95 masks. We have an adequate supply, but we should consider conservation strategies early, just in case the supply chain is not restored any time soon. I do not want to look back on this time and have regrets about our use.
Brian is coming off the car for the next month (sort of). I am going to work 12 hour shifts on my normal shifts. I simply am not able to keep the pace I am currently doing and run calls or transfers. In the past week I worked about, well too many hours, (sorry budgetary line item) and I can’t maintain that pace. I can do what I am doing or run calls/transfers but not both.
I will be putting out fires as they arise, dealing with clinical issues and protocols, exposures, follow-ups, some outreach, helping crews as needed and I can and trying to do whatever is needed for you guys. This is only for the next month, there are no long term plans for anything else. I can also help on transfers needing a third person when I am there and perhaps at other times. Of course if our staffing level needs dictates a different plan this can all be changed. I’ll also be in and out a fair bit and working evenings. My wife’s schedule has some flexibility, so if you need something call or ask.
As the cool guys say,