Georgia OEMS COVID-19 Guidance for First Responders (EMS, Fire, Law Enforcement)

The Georgia Office of EMS and Trauma will be hosting weekly update calls regarding COVID-19 guidance for EMS and the impact on the EMS Educational and Licensing pipeline. Call-in information will be sent to EMS Agency Directors, EMS Agency Medical Directors and EMS Initial Education Programs. Please contact your Regional EMS Director to be added to their contact list to receive the call-in information.

Previous Calls:

• 03-20-2020 - Notes
• 03-27-2020 - Notes
• Next call - Friday, April 3, 2020 - get information about the WebEx from your Regional EMS Director

Step 1: Use the ReadyOp link (get from your Regional EMS Director) to submit your request for PPE - submit your ReadyOp Form by 12:00 PM on the following days:

• Saturdays for Tuesday deliveries
• Mondays for Thursday deliveries
• Wednesdays for Saturday deliveries

Step 2: Requests will be reviewed, allocated, and assigned:

• Requests will go through an allocation process based on state priorities and available resources on hand.
• Requests will be considered filled based on the allocation amount.

Step 3: Filled Resources will be sent to the 5 zones on Tuesday, Thursday, and Saturdays.

• Districts will be notified of what is moving to the zones for their districts to share with their facilities.
• Items will then be dispersed to the districts for partners.

Step 4: For any resource request follow-up questions please call: (404-852-0250)

Please Note:

• The state warehousing team will perform allocations based on state-provided priorities.
• Inventory is critically low and not all items will be available at any given time.
• Unfilled items will be canceled to clear the fields. Resubmit any currently unfulfilled requests through the ReadyOp links that will be provided to you.
• If a requestor is provided with an allocation, it will be considered completed.

Licensed EMS Personnel have a responsibility to keep patients safe and are expected to exercise due diligence in following CDC and DPH guidance as well as Local Medical Director protocols to prevent the spread of infectious diseases. DPH Rule 511-9-2-.18 (22) Standards of Conduct for Licensees requires that:

• (22) A licensee shall take no action that would jeopardize the health or safety of a patient, including without limitation the abandonment or mistreatment of a patient.

Any unprotected exposure (e.g., not wearing recommended PPE) should be reported to your occupational health services, a supervisor, or a designated infection control officer for evaluation.Public Safety personnel (EMS, fire, law enforcement) who have been exposed to a patient with suspected or confirmed COVID-19 should notify their chain of command to ensure appropriate follow-up.

• Personnel should be alert for fever or respiratory symptoms (e.g., cough, shortness of breath, sore throat). If symptoms develop, they should self-isolate and notify occupational health services and/or their public health authority to arrange for appropriate evaluation.

National Institute of Environmental Health Sciences COVID-19 Worker Training Program Webpage (info on protecting yourself from COVID-19 in the workplace)

Public Safety Agencies should review or establish processes to:

1. Ensure personnel are aware of the current recommendations and guidelines issued by the CDC and Georgia Department of Public Health. Providing links to the CDC and GDPH Coronavirus web sites is the best method of ensuring access to the most up to date and current information.
2.  Coordinate with City or County management to update and or develop systems or process for reporting a possible or real exposure, coordinating with agency/department Medical Director and public health. As well as developing a quarantine/isolation plan.
3. EMS Agencies should work with your medical director to update your Infectious Disease Exposure policy and equipment/vehicle decontamination procedures as appropriate. The latest CDC guidance should be consulted for this.

Questions? Reach out to your Regional EMS Director.

The CDC has created guidance for the Implementation of Mitigation Strategies for Communities with Local COVID-19 Transmission, and that can be accessed here, and the latest guidelines for Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings can be found here.

The CDC has also created Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19), available here.

Links:

• EPA's Registered Antimicrobial Products for Use Against COVID-19
• Strategies for Optimizing the Supply of N95 Respirators
• National Institute of Environmental Health Sciences COVID-19 Worker Training Program Webpage (info on protecting yourself from COVID-19 in the workplace)
• ImageTrend COVID-19 Pandemic Operations Reference
• DPH Healthcare Worker Return to Work Guidance After COVID-19 Illness or Exposure
• Ambulances: CMS Flexibilities to Fight COVID-19

EMS Initial Education Programs should be in the process of planning and making decisions on how best to respond to the impact of COVID-19. Since the spread of COVID-19 is continuing, please know that the Georgia Office of EMS and for Paramedic programs, CoAEMSP, supports you as you work through this public health crisis. We will work with our programs to help them navigate issues that impact their students.

All initial education programs (not just Paramedic programs) should consult the CoAEMSP website homepage for the latest COVID-19 guidance related to the completion of initial education programs, as well as the Regional Training Coordinator for your area.

For Georgia approved EMT, AEMT and Paramedic programs who have students that are unable to complete their clinical experience at hospitals or other healthcare facilities due to those locations not allowing students as part of their COVID-19 response:

• Simulation may be used to supplement the clinical experience for their students affected by COVID-19 for up to 50% of the required minimums
  • The program must document the clinical sites and students that have been impacted
  • The simulation experience must be approved by the Program Director and Program Medical Director, and this approval must be documented
  • Program minimum patient contacts and skill performance requirements must remain unchanged
• If the program's graduation dates are delayed, please inform the Regional Training Coordinator for your area.

Please note that the EMS field experience, including the internship for paramedic programs, will not be waived, and it is not permitted to replace the EMS field experience or internship with simulation.

Given the current situation that faces Georgia and our country, it is vital that EMS initial education programs continue and prepare the students to enter the workforce as entry-level providers.  Please contact your Regional Training Coordinator if you need assistance.

We are also aware of challenges related to testing sites for the National Registry Cognitive exams. For the latest information from the National Registry related to COVID-19, please visit their website here.

Links:

• Guidance for interruptions of study related to Coronavirus (COVID-19)
• Pearson Vue NREMT Essential Services Testing
• Pearson Vue COVID-19 (Coronavirus) scheduling and rescheduling

• Recent Travel/Travel Locations
  • As a reminder, all EMS personnel are required to document the recent travel question (itExam.070 – “Has the patient traveled outside their community within the last 30 days?”) on ALL patient contacts in their ePCR.
    • “Community” is defined by the medical director and need not be limited to just travel outside of the United States.
    • Choices for the travel question include: “No,” “Yes,” “Unknown,” “Unresponsive,” “Refused.”
  • If the answer to the travel question is “Yes,” then the medic is required to answer the following additional questions:
    • itExam.072 - Beginning Travel Date
    • itExam.071 - Ending Travel Date
    • itExam.074 - Travel Locations (Document all places and locations the patient has traveled in the last 30 days)
• Narrative
  • • Include the term “COVID-19” in the narrative (eNarrative.01) for any patient that has a confirmed positive COVID-19 test, has an exposure to a confirmed patient, or is a suspected case or patient under investigation.
• Personal Protective Equipment Used
  • EMS Personnel should record what Personal Protective Equipment (PPE) was used on each Patient by each Crew Member by recording the appropriate choice in eOther.03 - Personal Protective Equipment Used. This is a multi-select field, so EMS crew members should record any and all PPE that they use related to the Patient.
• Potential Exposures
  • If EMS Personnel have a potential exposure during patient care, then this should be documented properly on the electronic patient care report.
    • eOther.05 - Suspected EMS Work Related Exposure, Injury, or Death (Choices are "Yes" or "No")
    • eOther.06 - The Type of Work-Related Injury, Death or Suspected Exposure (this is a multi-select field)
• Primary (eSituation.11) and Secondary Impression (eSituation.12)
  • The following COVID-19 ICD-10 codes are recommended as of 3/17/2020 for documentation related to COVID-19 - all of these codes have been made active in GEMSIS Elite, and all other software vendors and agencies should make sure that these are available as well:
    • Impression: COVID-19 – Confirmed by testing
      • ICD-10 Code: B97.29
      • Description: Prior to EMS interaction, the patient has confirmed COVID-19.  Examples include interfacility transports, transport from clinic or skilled nursing where diagnosis is known, etc.
    • Impression: COVID-19 – Exposure to confirmed patient
      • ICD-10 Code: Z20.828
      • Description: Patient has contact with a patient confirmed by testing.  Examples include household members, residents of healthcare facilities with confirmed case, etc.
    • Impression: COVID-19 – Suspected -- No Known Exposure
      • ICD-10 Code: Z20.9
      • Description: This is for all other concerns.  Examples include positive travel history, exposure to suspected/PUI but not confirmed cases, etc.
    • Impression: COVID-19 – Concern for disease, ruled out
      • ICD-10 Code: Z03.818
      • Description: Encounter for observation for suspected exposure but is ruled out after evaluation
• Other EMS or Public Safety Agencies at Scene (eScene.02) Other EMS or Public Safety Agency ID Number (eScene.03), and Type of Other Service at Scene (eScene.04)
  • It is important for EMS Agencies, especially transport EMS agencies, to record all other EMS or Public Safety Agencies that are present on scene. This information may used by the hospital and medical epidemiologists to notify all responding agencies of potential or confirmed COVID-19 cases.

As of March 6, 2020, COVID-19 was officially added to the Notifiable Diseases List in Georgia. All Georgia physicians, laboratories, and other health care providers are required by law (OCGA 31-12-2) to report patients with the conditions listed under Notifiable Disease Reporting Requirements.

• NHTSA Office of EMS webinar on COVID-19
• COVID-19 EMS Patient Management: Myth vs. Reality
  • Webinar (Recording will be posted soon)
  • PowerPoint
• Coronavirus Disease 2019 (COVID-19) Update and Infection Prevention and Control Recommendations
• National Institute of Environmental Health Sciences COVID-19 Worker Training Program Webpage (info on protecting yourself from COVID-19 in the workplace)
• Crisis Standards of Care and COVID-19: What EMS Needs to Know - March 26, 2020
• Addressing Your Questions About COVID-19

• CDC COVID-19 Website
• CoAEMSP website (information on COVID-19 for Education Programs)
• Mitigation Strategies for Communities with Local COVID-19 Transmission
• CDC Infection Prevention/Control for Pts with suspected/confirmed COVID-19
• Tips for Disaster Responders: Preventing and Managing Stress
• NREMT Page on COVID-19
• Risk Assessment for HCP with potential exposure to Pt with COVID-19
  • Be sure to review Table 1 related to monitoring and work restriction recommendations.
• Framework for Expanding EMS System Capacity During Medical Surge
• Strategies for Optimizing the Supply of N95 Respirators
• CDC Guidance for Mass Gatherings or Large Community Events
• Healthcare Supply of PPE
• EMS HHCD Awareness (National Ebola Training and Education Center)
• ASPR EMS Infectious Disease Playbook
• EMS Pandemic Influenza Guidelines for Statewide Adoption (NHTSA 2007)
• Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States, (CDC 2007)
• Crisis Standards of Care: EMS Toolkit (IOM 2013)
• PPE COVID-19 resources page from Emory with printable donning/doffing guide and conservation measures
• Strategies for Optimizing the Supply of PPE
• COVID-19 and HIPAA: Disclosures to law enforcement, paramedics, other first responders and public health authorities
• HIPAA Privacy and Novel Coronavirus
• National Institute of Environmental Health Sciences COVID-19 Worker Training Program (info on protecting yourself from COVID-19 in the workplace)
• PPE Burn Rate Calculator
• Hospital and Healthcare Providers Checklists for COVID-19
• Alternative Care Sites - Infection Prevention and Control Considerations for Alternative Care Sites
• Priorities for testing patients with suspected COVID-19 Infection
• EMS.GOV COVID-19 Resources
• DPH Healthcare Worker Return to Work Guidance After COVID-19 Illness or Exposure
• CDC Clinical Guidance for Management of Patients with Confirmed COVID-19
• Ambulances: CMS Flexibilities to Fight COVID-19
• DoD COVID-19 Practice Management Guide
• Public Health Recommendations for People in U.S. Communities Exposed to a Person with Known or Suspected COVID-19, other than Health Workers or other Critical Infrastructure Workers
• COVID-19 Screening Tool (Apple/CDC)

• US Fire Administration Coronavirus
• CDC COVID-19 Website
• Mitigation Strategies for Communities with Local COVID-19 Transmission
• CDC Infection Prevention/Control for Pts with suspected/confirmed COVID-19
• Tips for Disaster Responders: Preventing and Managing Stress
• Coronavirus: What Fire Chiefs Need to Know
• Strategies for Optimizing the Supply of N95 Respirators
• CDC Guidance for Mass Gatherings or Large Community Events
• PPE COVID-19 resources page from Emory with printable donning/doffing guide and conservation measures
• Strategies for Optimizing the Supply of PPE
• COVID-19 and HIPAA: Disclosures to law enforcement, paramedics, other first responders and public health authorities
• HIPAA Privacy and Novel Coronavirus
• National Institute of Environmental Health Sciences COVID-19 Worker Training Program (info on protecting yourself from COVID-19 in the workplace)
• Priorities for testing patients with suspected COVID-19 Infection
• Public Health Recommendations for People in U.S. Communities Exposed to a Person with Known or Suspected COVID-19, other than Health Workers or other Critical Infrastructure Workers

• What Law Enforcement Personnel Need to Know about COVID-19
• CDC COVID-19 Website
• Mitigation Strategies for Communities with Local COVID-19 Transmission
• CDC Infection Prevention/Control for Pts with suspected/confirmed COVID-19
• Tips for Disaster Responders: Preventing and Managing Stress
• Strategies for Optimizing the Supply of N95 Respirators
• CDC Guidance for Mass Gatherings or Large Community Events
• PPE COVID-19 resources page from Emory with printable donning/doffing guide and conservation measures
• Strategies for Optimizing the Supply of PPE
• COVID-19 and HIPAA: Disclosures to law enforcement, paramedics, other first responders and public health authorities
• HIPAA Privacy and Novel Coronavirus
• HIPAA Privacy Rule: A Guide for Law Enforcement
• National Institute of Environmental Health Sciences COVID-19 Worker Training Program (info on protecting yourself from COVID-19 in the workplace)
• Priorities for testing patients with suspected COVID-19 Infection
• Public Health Recommendations for People in U.S. Communities Exposed to a Person with Known or Suspected COVID-19, other than Health Workers or other Critical Infrastructure Workers