Jackson County Fire Rescue Chief Charlie Brunner assembled team members Wednesday to absorb another of their ongoing updates about measures first responders are taking to prevent the spread of COVID-19 on their watch.
On the front lines as they are, they’re at risk of infections of many kinds every day as they care for the people of Jackson County and must always take extra precautions to protect themselves and the people they serve.
At shift change and between calls in shift, they already go through a series of routine cleanings, from overhead rails and hand bars to big pieces of equipment and down to the skinny leads used to hook patients up to heart monitors in their ambulances.
With the COVID-19 pandemic ramping up, including at least one case now identified in Jackson County, they’re taking extra measures to insure their health and that of the patients they tend.
Their mid-week update was 11 pages long. Some of the information had been shared before but the memorandum put all the pieces together in one place.
Page one laid out the steps to be taken once they get a call requesting an ambulance. The 911 dispatchers ask a series of pertinent questions in an over-the-phone initial screening. If, based on the information provided, the patient meets “potential COVID-19 criteria,” — like fever, dry cough, shortness of breath, a recent history of international or in-country travel into areas where widespread pockets of the virus are known, and/or having had contact with a known infected person or someone with an unexplained respiratory illness — the call-takers will alert the first responders. At that point, responders will know they must put on extra personal protective gear, like special-risk masks that protect them better from particulates, along with gowns, gloves and goggles.
Those must be put on by the responders that tend to the patient. There’s a proper sequence to that process, staring with the gown, the mask or respirator, goggles, and finishing with the gloves, and a prescribe sequence in removing the protective apparel. The last step in that removal process is the use of hand sanitizer or soap and water.
The dispatcher will determine in conversation with the caller whether the patient to be seen can come outside on his own or her own, in order to have more distance — at least six feet — between the patient and attending responder as the crew arrives for an initial assessment. When circumstances allow, only one responder is to make that first contact, and will apply a surgical mask to the patient if the individual is thought to potentially have the virus.
To save on materials, which can be in short supply as the pandemic rages, the crew limits as much as possible the number of people making contact with the patient, as circumstances allow. The state has also recently directed that certain expiring treatment drugs should not be disposed of as usual at this point because of those potential short supplies.
If the caller just wants to be tested, not showing the symptoms that put them in the “potential” category, they’ll be asked to call the Jackson County Health Department at 526-2412.
If the patient requests /requires transport, the number of responders in the ambulance box is to be limited as much as possible and still ensure adequate care. And before the patient is placed in that treatment area, crews are to shut the window that stands between the cab and the box, and open the windows to the side and back doors of the ambulance.
They’re also to notify the receiving hospital as soon as possible that they’re bringing in a potential COVID-19 patient.
The attending paramedic cannot remove any of his or her personal protection equipment until the patient is turned over to the receiving facility. They’re to then take those items off immediately, following Florida Department of Health guidelines — there’s a certain way to take off gloves, for instance, that can keep the responders’ uncovered hands from ever touching the surfaces of those gloves which have been in contact with the patient.
They’re to then disinfect.
The remaining pages include specifics for dispatchers, illustrations showing the proper sequence and method of personal gear donning and removal, patient screening criteria, and includes references to steps that should be taken by the health care providers that collect and handle test specimens when testing is deemed advisable. There are also sections dedicated to guide to decision-making regarding the use of certain strategies, like aerosol-generating procedures, and about cleaning ambulance after the transport of a COVID-19 patient.
The guide also outlines the steps to be taken in reporting instances of having cared for a patient confirmed with, or under assessment for, COVID-19. State or local public health authorities are also called upon to make sure their policies include means of assessing exposure risk and management of personnel potentially exposed to the virus.
They also include several links for health care professionals and entities to use in best safeguarding their facilities, other patients and themselves during this crisis. The guide also talks about how to determine whether a person should be tested at a commercial lab or at a state Department of Health Bureau of Public Health Laboratory.
With guidelines constantly in flux, as more is learned, one thing has remained constant: The mission-critical need for coordination of efforts in dealing with the crisis.