Download Free Medical COVID-19 EMS Patient Screening & Training PowerPoint Presentation

COVID-19 EMS Patient Screening & Training PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Cardiac Arrest, which is titled "COVID-19 EMS Patient Screening & Training", to know about the implementation of treat and keep home, treat and refer, and COVID-specific EMS guidelines.

Tags : Cardiac Arrest, COVID-19, EMS, Patient Screening, Training

Published on : Jun 02, 2021 | Views : 1978 | Downloads : 0

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

COVID-19 EMS Patient Screening & Training Bureau of EMS & Trauma System July 6, 2020
Slide 2-

Goal of Training This is an optional training to assist agencies in implementation of treat and keep home, treat and refer, and COVID-specific EMS guidelines The decision regarding if and when to implement these guidelines should be made in coordination with your agency’s Administrative Medical Director and/or Base Hospital It is critical to determine the incidence of COVID-19 in your community, the EMS call volumes, and hospital ED/inpatient bed availability/status when determining whether or not to implement these guidelines 2
Slide 3-

COVID-19 Medical FAQs Incubation period: 2–14 days (median 4–5 days) Transmission: the virus is spread from person-to-person through close contact and respiratory droplets. Transmission can occur up to 48 hours before symptoms present. 3
Slide 4-

COVID-19 Medical FAQs 4 Risk factors for serious illness: Older age (age > 65 yo) Cardiac disease Diabetes Immunocompromised (e.g., cancer treatment, smoking) Chronic lung disease or moderate to severe asthma Kidney disease Liver disease
Slide 5-

COVID-19 Medical FAQs 5 Symptoms: Fever (≥100.4°F or 38°C) and chills Cough Dyspnea Sore throat Congestion or runny nose GI symptoms: nausea, vomiting, diarrhea Headache, weakness, fatigue, myalgias (muscle pain) Loss of taste or smell
Slide 6-

Overview of COVID-19 Medical Response 6 Dispatch Screening EMS Guideline for Care of Patients with Suspected COVID-19 COVID-19 Respiratory Treatment Guideline COVID-19 Alternative Destination Guideline COVID-19 Patient Scripting COVID-19 Patient Education
Slide 7-

Dispatch Screening - 2 Groups 7 Have you had fever or chills? Have you had a cough or trouble breathing? Yes to 1 AND 2 Yes to 1 OR 2 COVID-19 Alert Infectious Disease Alert with Symptoms
Slide 8-

COVID-19 PSAP Screening 8 PSAP Screening for COVID-19 has been in place for several months This is the first step in screening a patient for possible COVID-19 Note: Due to COVID-19 being classified as “community spread,” travel history is not a part of PSAP patient screening
Slide 9-

On-Scene Screening Questions It is critical to ask the screening questions a second time! Only essential EMS personnel should make patient contact Consider a “scout” paramedic to enter with ENHANCED PPE to perform these screening questions Ask these questions on every call to determine the type of PPE for all EMS personnel having patient contact All transported patients and patients with suspected COVID who are not transported should be given a surgical mask to wear upon initial patient contact 9
Slide 10-

Other Patient Screening Questions 10 Have you been exposed to anyone diagnosed with COVID-19? Has anyone in your [facility] been diagnosed with COVID-19? Do you work in a high-risk area? Healthcare (hospital, urgent care, doctor’s office, nursing home) Fire, EMS, or law enforcement Congregate setting (prison, residential facility for older adults, nursing home) Have you been tested for COVID-19? If so, do you have the result yet?
Slide 11-

COVID-19 Guideline Significant change in clinical practice from conventional to contingency/crisis standard of care Approved by Arizona State Disaster Medical Advisory Committee (SDMAC) Goal is to protect EMS personnel who may lack sufficient PPE, maintain prehospital workforce, and allow safe transfer of care at the receiving facility Updated version approved by ADHS 7/7/2020 11
Slide 12-

Why the change in patient management? 12 Goal is to eliminate or reduce the risk of aerosolization of COVID-19 The following procedures are associated with aerosolization: SVN treatments (albuterol and atrovent) BVM Endotracheal intubation CPR High-flow oxygen via non-rebreather Supraglottic airway placement There are things you can do to limit your exposure risk!
Slide 13-

Does this apply to all patients? 13 If the patient resides in a congregate care setting, assume they have been exposed to COVID-19 Due to the widespread community spread of COVID-19 in many parts of Arizona, you should assume that most patients you encounter who are symptomatic have COVID-19
Slide 14-

Stabilizing Measure Perform all basic and advanced airway procedure in enhanced PPE ** • Administer oxygen (NC preferred) and titrate to SaO2 of > 88%, using ≤ 6LPM O2. • Avoid high flow oxygen. • Place surgical mask over nasal cannula or oxygen mask. Obtain IV/IO access as indicated Administer IVF only to treat shock (SBP <90) Modify standard guidelines to minimize aerosolization of the virus.* When available, insert viral filter between BVM/SGA/ETT and bag/ventilator New language added includes emphasizing the use of viral filters when available 14
Slide 15-

Transport Considerations Transport to the closest appropriate receiving facility Provide receiving facility notification: “Possible COVID-19” and Primary Symptoms If any aerosolizing measures (SVN, CPAP, BVM, CPR) are in use If a patient is not transported, provide strict follow-up or call back instructions Key addition is the emphasis on strict follow-up or call back instructions for any patient not transported. Some of these patients may worsen, and it is critical that they understand when to access 911 services again. 15
Slide 16-

EMS COVID-19 Medication Changes No nebulizer use for patients with likely COVID-19, when nebulizer is absolutely necessary, administer in open air space and discontinue prior to entering any enclosed space, including hospital hallways. Consider using patient's own MDI, 1-2 puffs every 5 minutes. Administer 0.3 mg of IM epinephrine, 1mg/1mL, no more than once every 20 minutes, if needed for respiratory distress, use caution in patients over the age of 50 or with known cardiac disease. Nebulizers (SVNs) place all EMS personnel, bystanders, and hospital personnel at risk for exposure to aerosolized particles. 16
Slide 17-

Noninvasive Positive Pressure Ventilation (NIPPV): CPAP and BiPAP Avoid CPAP/BIPAP unless absolutely necessary and discontinue prior to entry into a public space, including hospital hallways. If viral filter is available, place between the mask and oxygen delivery port. 17 Viral Filter
Slide 18-

Advanced Airway Management 18 Early RSI is not recommended in the prehospital setting. Avoid endotracheal intubation and high flow O2. Insertion of supraglottic airways (SGA) is preferred. Passive oxygenation during cardiac arrest may be achieved with a SGA device with viral filter if available. When ventilation is necessary, agencies should use available devices to limit exposure to aerosolized particles (examples: viral filters, etc.)
Slide 19-

Why the recommendation for the Supraglottic Airways (SGA) 19 Placement is rapid Much shorter time to adequate placement in comparison to ETT Limited time-frame for higher risk exposure Once in place, risk is decreased, unlike BVM which is ongoing For agencies preforming passive oxygenation as part of their out-of-hospital cardiac arrest protocol: The i-gel® allows for passive oxygenation at 8 LPM through a separate passive O2 port. King® airways do not have a separate port for passive oxygenation port and will need to be connected to self inflating bag connected to oxygen source. Both methods can be used with viral filter for passive oxygen insufflation.
Slide 20-

Suspected COVID-19 & Oxygen Administration Summary 20 Administer oxygen sparingly Nasal cannula at maximum 6 lpm Maintain SpO2 > 88% Place surgical mask over nasal cannula or oxygen mask Do not use non-rebreather mask at 15 lpm (risk of aerosolization) Avoid RSI and intubation
Slide 21-

Suspected COVID-19 & Wheezing 21 Treatment options: Use patient’s own multi-dose albuterol inhaler: 1–2 puffs every 5 minutes Epinephrine 0.3 mg 1:1,000 IM, once up to every 20 minutes Use with caution in patients > 50 years old or with underlying cardiac disease Oxygen via nasal cannula, at maximum 6 lpm, maintain SpO2 > 88% •Remember: No nebulizer use for patients with likely COVID-19. When nebulizer is absolutely necessary, administer in open air space and discontinue prior to entering any enclosed space, including hospital hallways.
Slide 22-

Suspected COVID-19 & Cardiac Arrest 22 Enhanced PPE (N95, eye protection, face shield, gown) CCR – standard care Insert supraglottic airway, ie. King® or i-gel® If limited PPE, have EMS personnel with the most available PPE place airway Follow normal guideline: Return Of Spontaneous Circulation? Termination of Resuscitation?
Slide 23-

Cardiac Arrest: COVID-19 not suspected 23 CCR – treatment as usual Examples: Patient calls 911 with chest pain collapses on EMS arrival Patient with STEMI, has V-Fib arrest en-route to hospital CCR not indicated – treatment as usual, standard resuscitation Examples: Trauma code Drowning Overdose
Slide 24-

Alternative Care Sites Alternate Care Sites need to be identified by your agency prior to referring a patient to them These may include: Urgent Care Tent in a hospital parking lot State or Military temporary hospital or medical site This will continue to evolve rapidly As the COVID-19 patient volume increases, we may transition to taking relatively ill patients to alternate care sites 24
Slide 25-

Destination Determination - Alternate Care Sites Key deciding factors are: Oxygen saturation Work of breathing Risk factors (heart conditions, lung problems, diabetes, etc) If a patient meets ALS criteria for transport for other reasons (hypotension, arrhythmia, etc), they still need ALS transport to the hospital regardless of COVID severity If a patient has a positive response to an intervention, they still need transport based on their initial COVID severity Ex. Patient with initial room air oxygen saturation 68% meets severe category, even if oxygen saturation increases to 94% with supplemental oxygen 25
Slide 26-

Scripting It is critical to explain to patients why they may not be transported to the hospital This is sample scripting language provided by ADHS 26
Slide 27-

Patient Education 27 If patients are advised to stay home, we must provide them with printed patient education materials regarding COVID-19 The next slide is a 2-page document patient education handout from the CDC Be sure to point out to the patient or their family the following: When to call 911 again, or go to the hospital To self-isolate
Slide 28-

28
Slide 29-

Notification to Receiving Facilities 29 Notify any receiving facility using simple language: “This patient is high risk for COVID-19” Provide presenting symptoms: Fever and cough, hypoxemia, etc. Provide any additional information regarding interventions that might generate aerosols: Supraglottic airway, CPR, etc.
Slide 30-

30 THANK YOU Gail Bradley, M.D. | Bureau of EMS & Trauma gail.bradley@azdhs.gov | 602-364-3150 facebook.com/azdhs | @azdhs | azdhs.gov