Coronavirus Update for all staff– 13th March 2020

As you will be aware, the position on Coronavirus has changed. We are moving out of the contain phase and into delay, in response to the ongoing coronavirus (COVID-19) outbreak. In line with this, there are a number of changes for ambulances services and our Trust guidance is now updated. The following provides a summary of key changes and relevant information. Please note, you will find further details and a number of documents to assist you here. You can access all links at home from NTK. Copies are also available on East24.

Please ensure you keep updated with the information given the dynamic nature of the situation.

General Advice and Staff Guidance

The most common symptoms of coronavirus (COVID-19) are recent onset of:

• new continuous cough and/or
• high temperature

If you have symptoms of coronavirus infection (COVID-19), however mild, stay at home and do not leave your house for 7 days from when your symptoms started. If you need further advice on symptoms, you can also use the NHS 111 online coronavirus service or call NHS 111.

Please contact your line manager immediately if you need to self-isolate or are unable to attend work due to being unwell.

Case Identification and Management

COVID-19 infection should be considered in all cases of respiratory infection although an accurate travel history remains relevant. If the patient is a confirmed case, refer to the relevant high consequence infectious diseases guidance for confirmed cases. Currently, confirmed cases are transferred by a Hazard Area Response Team (HART).

EEAST will triage all emergency calls in AOC and will determine if a patient has potential coronavirus based on whether the patient has a fever or a new continuous cough. Clinicians making a face to face assessment should utilise similar methodology.

Personal Protective Equipment

If a risk assessment indicates the possibility of COVID-19, appropriate PPE must be donned safely before being within 1m of patient, or having contact with, the patient. The risk assessment should include information provided prior to arrival at scene as well as any additional information gained on arrival. The patient should be provided with a fluid repellent surgical facemask (FRSM) to wear for the duration of the care, if tolerated, unless oxygen therapy is indicated. When conveying a patient, the driver is not required to wear PPE whilst driving but they should ensure that the vehicle partition is closed or sealed throughout the transfer.

Aerosol Generating Procedures (AGP)

• AGPs generate tiny particles, small enough to remain in the air for extending periods, travel long distances and may be inhaled.
• AGPs relevant to the ambulance service include intubation, suctioning and procedures related to cardiopulmonary resuscitation.
• Unless absolutely essential AGPs should be avoided during the transportation of patients with COVID-19.    

 

A summary of PPE is shown as follows: 

	Close patient contact possible or confirmed case	AGP possible & confirmed cases
Hand hygiene	Yes	Yes
Gloves	Yes	Yes
Plastic apron	Yes	X
Fluid repellent coverall	X	Yes
Fluid repellent surgical facemask	Yes	X
FFP3 respirator	X	Yes
Eye protection	Risk assessment	Yes

 
In the event of a cardiac arrest and to minimise the delay of time critical interventions, a FRSM and eye protection should be worn for airway management.

Further advice on donning and doffing PPE can be found here.

Decontamination

Normal IPC procedures should be followed patient contact in relation to hand washing. Post conveyance (or where a patient has been in the vehicle) the following should be adopted:

• All linen should be disposed of as infectious linen, as per local policy, at the receiving unit.
• All waste should be disposed of as clinical waste, as per local policy, at the receiving unit.
• Wipe down any equipment and all surfaces with universal detergent/disinfectant wipes immediately following patient transfer – this should be completed before PPE is removed.
• The vehicle should be left to ventilate with windows open and extractor fan set to extract whilst travelling to station/ depot/ base-ensure this is done prior to removal of PPE.
• The crew are to remove PPE in the designated area identified within the receiving unit and all PPE to be disposed of a clinical waste, as per your local policy, at the receiving unit.

Further decontamination depends on whether or not an AGP is performed – please see EAST24 for details.

AOC Environments

Given the risk of transmission in a closed environment, close attention should be paid to hand washing. Wash your hands more often than usual, for 20 seconds using soap and hot water, particularly after coughing, sneezing and blowing your nose, or after being in public areas. Use hand sanitiser if available on entry or exit from AOC areas.

Clean and disinfect regularly touched objects and surfaces using your regular cleaning products to reduce the risk of passing the infection on to other people. In AOC, the commonly touched objects (keyboard, mouse, immediate desk area) should be wiped down with a Clinell wipe at the start and end of every shift.

Partnership Working

The Trust is currently working with a number of health system partners, including NHS England/Improvement and NHS 111. The Trusts is also participating in LRF related meetings such as Strategic and Tactical Coordinating Groups.

Horizon Scanning

The picture nationally and locally is changing dynamically and therefore communication will be released regularly. The Trust is currently reviewing a framework for minimising risk of transmission of COVID within EEAST. This will cover areas such as reducing travel between sites, moving meetings to virtual working and a lockdown in higher risk areas such as AOC. Further information will follow shortly.

 

Published 13th March 2020.