COVID19 Bureau of EMS and Trauma System Objectives Provide an overview of 2019 Novel Coronavirus and national and state response Facilitate a discussion about contact tracing and flattening the transmission curve ID: 1044445
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1. Emerging Situation:2019 Novel Coronavirus(COVID-19)Bureau of EMS and Trauma System
2. ObjectivesProvide an overview of 2019 Novel Coronavirus and national and state response Facilitate a discussion about contact tracing and flattening the transmission curve Provide guidance to dispatch Provide current EMS PPE recommendations Answer questions in a brief Q&A session (10 minutes)
3. Background2019 Novel Coronavirus (2019-nCoV)There is an outbreak of respiratory illness that originated in Wuhan, China caused by a new type of coronavirus (2019-nCoV). There have been cases identified in China with exported cases in a growing number of countries internationally, including the United States.https://www.cdc.gov/coronavirus/2019-ncov/locations-confirmed-cases.html#map
4. Background2019 Novel Coronavirus (2019-nCoV)Coronaviruses are a large family of viruses, some of which cause respiratory illness in people. Signs and symptoms are similar to the common cold or the flu, and may include a runny nose, cough, sore throat, fever, and general feeling of being unwell. Coronaviruses cause more severe disease in neonates, the elderly, and in individuals with underlying illnesses.For more information, please see the CDC’s coronavirus website.
5. 2019-nCoV in the USAirport screening was initiated at 3 US airports receiving the majority of direct flights from Wuhan (JFK, LAX, SFO) on January 17The first infection with 2019-nCoV in the United States was reported on January 21 in Washington StateThe first case of person-to-person transmission was reported by Illinois on January 30On February 2 airport screening was expanded to 11 U.S. airports (JFK, ORD, SFO, SEA, HNL, LAX, ATL, IAD, EWR, DFW, and DTW)
6. https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html accessed 2/7/2020
7. https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html accessed 2/12/2020*Cumulative since January 21, 2020.† Numbers closed out at 7 p.m. the night before reporting.§Includes specimens received and awaiting testing, as well as specimens in route to CDC.Number of states and territories with PUI: 41
8. Clinical data from U.S.: Still watching, but majority have milder manifestations.13 confirmed cases in the U.S. (As of 2/11/2020)Most admitted to hospitalNo deaths 2 cases without travel to Wuhan. Both were spouses with close contact to positive patients.
9. 2019-nCoV in AZThe first infection with 2019-nCoV in Arizona was reported on 1/26 in an adult living in Maricopa County with recent travel to Wuhan, China.MCDPH, ADHS, and CDC have coordinated the local response.Case contact identification, Person Under Investigation (PUI) classification, and arrangement of testing with the CDC was initiated.
10. Persons Under Investigation (PUI)Return Travelers
11. Persons Under Investigation (PUI) Criteria
12. Persons Under Investigation (PUI)Testing completed by public healthNegativePatient is cleared and no further action needed.
13. Persons Under Investigation (PUI)Testing completed by public healthNegativePositivePatient is cleared and no further action needed.Public health completes the following:Immediate isolation of patientContact tracingIdentification of healthcare exposures
14. Persons Under Investigation (PUI)Testing completed by public healthNegativePositivePatient is cleared and no further action needed.Public health completes the following:Immediate isolation of patientContact tracingIdentification of healthcare exposuresThe number of contacts and the recommendations for those contacts will differ for each case identified. At this time Arizona only has 1 confirmed case of nCoV.
15. Return TravelersTravel to Hubei ProvinceTravel to mainland China
16. Return TravelersTravel to Hubei ProvinceTravel to mainland ChinaIndividuals are funneled through 11 airportsThese individuals are quarantined in those states with the 11 airports.Sky Harbor and Tucson Airport are not one of the 11 airports.
17. Return TravelersTravel to Hubei ProvinceTravel to mainland ChinaThese individuals are funneled through 11 airports and go through a medical screening process.If they do not have any symptoms they are allowed to continue on to their destination.Public health is notified of these individuals and will follow up with these individuals for 14 days.Individuals are funneled through 11 airportsThese individuals are quarantined in those states with the 11 airports.Sky Harbor and Tucson Airport are not one of the 11 airports.
18. Recommendations for 911 PSAPsPer the latest CDC recommendation, published February 6, 2020, municipalities and local EMS authorities should coordinate with state and local public health, PSAPs, and other emergency call centers to determine need for modified caller queries about 2019-nCoV.At this time, The Arizona Department of Health Services, including the BEMSTS does NOT recommend screening all 911 calls.Should the situation change, a draft PSAP screening tool has been created to provide further guidance, and will be distributed via the BEMSTS GovDelivery distribution list.
19. Recommended Personal Protective Equipment (PPE)EMS clinicians who will directly care for a patient with possible 2019-nCoV infection or who will be in the compartment with the patient should follow Standard, Contact, and Airborne Precautions, including the use of eye protection. Recommended PPE includes:A single pair of disposable patient examination gloves. Change gloves if they become torn or heavily contaminated,Disposable isolation gown,Respiratory protection (i.e., N-95 or higher-level respirator), andEye protection (i.e., goggles or disposable face shield that fully covers the front and sides of the face).https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html
20. Specific Patient Care ConsiderationsA facemask should be worn by the patient for source control if 2019-nCoV is known or suspected.If a nasal cannula is in place, a facemask should be worn over the nasal cannula.Alternatively, an oxygen mask can be used if clinically indicated.Limit number of personnel in the patient compartment to essential personnel.If aerosol-generating procedures (BVM, suctioning, ETI, SVN, NIPPV) need to be performed, ideally they should be performed with the rear doors of the transport vehicle open & HVAC running prior to leaving scene.
21. EMS Transport of PUI or Patient with confirmed 2019-nCoV Drivers, if they provide direct patient care (e.g., moving patients onto stretchers), should wear all recommended PPE. After completing patient care and before entering an isolated driver’s compartment, the driver should remove and dispose of PPE and perform hand hygiene to avoid soiling the compartment.If the transport vehicle does not have an isolated driver’s compartment, the driver should remove the face shield or goggles, gown and gloves and perform hand hygiene. A respirator should continue to be used during transport.All personnel should avoid touching their face while working.EMS clinicians should notify the receiving facility that the patient has an exposure history and signs and symptoms suggestive of 2019-nCoV.Family members should not ride in the transport vehicle if possible. If they do accompany the patient, they should be provided a mask.
22. EMS Transport of PUI or Patient with confirmed 2019-nCoVIsolate the ambulance driver from the patient compartment & keep pass-through doors and windows tightly shut.On arrival, after the patient is released to the facility, EMS clinicians should remove and discard PPE and perform hand hygiene. Used PPE should be discarded in accordance with routine procedures.
23. Cleaning EMS Transport Vehicles after Transporting a PUI or Patient with Confirmed 2019-nCoVAfter transporting the patient, leave the rear doors of the transport vehicle open to allow for sufficient air changes to remove potentially infectious particles.The time to complete transfer of the patient to the receiving facility and complete all documentation should provide sufficient air changes.When cleaning the vehicle, EMS clinicians should wear a disposable gown and gloves. A face shield or facemask and goggles should also be worn if splashes or sprays during cleaning are anticipated.Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly, to include the provision of adequate ventilation when chemicals are in use. Doors should remain open when cleaning the vehicle.
24. Cleaning EMS Transport Vehicles after Transporting a PUI or Patient with Confirmed 2019-nCoVUse an EPA-approved agent that lists effectiveness in disinfecting Coronaviruses https://www.epa.gov/pesticide-registration/selected-epa-registered-disinfectantsClean and disinfect the vehicle in accordance with standard operating procedures. All surfaces that may have come in contact with the patient or materials contaminated during patient care (e.g., stretcher, rails, control panels, floors, walls, work surfaces) should be thoroughly cleaned and disinfected using an EPA-registered hospital grade disinfectant in accordance with the product label.Clean and disinfect reusable patient-care equipment before use on another patient, according to manufacturer’s instructions.
25. CDC ResourcesCDC: https://www.cdc.gov/coronavirus/2019-ncov/index.htmlEMS: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.htmlAirport or other port of entry to the United States, the PSAP or EMS unit should notify the CDC Quarantine Station for the port of entry. Contact information for CDC Quarantine Stations can be accessed at https://www.cdc.gov/quarantine/quarantinestationcontactlistfull.htmlN95 Guidance: https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-supply-strategies.html
26. Additional ResourcesADHS 2019 Novel Coronavirus (2019-nCoV): https://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/index.php#novel-coronavirus-homeADHS 2019 Novel Coronavirus (2019-nCoV) 911 & EMS: https://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/index.php#novel-coronavirus-ems-resourcesAZ Public Health Contact List: https://azdhs.gov/preparedness/epidemiology-disease-control/index.php#resources-county
27. https://www.cdc.gov/coronavirus/2019-ncov/index.html
28. www.azhealth.gov\coronavirus
29. https://han.health.azdhs.gov/
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31. Questions?If you have any questions about this presentation, please contact Gail.Bradley@azdhs.gov If you have any clinical or PUI-related questions, please contact your local public health department.