Per State Office of Emergency Medical Services, and our medical director Steven Vetrano, DO, all responders MUST wear an N95 or greater for ALL patient interactions for entire time you are with patient.
In conditions where ventilation with a bag valve mask (BVM) is warranted, providers may utilize passive oxygenation in lieu of BVM ventilation.
South Branch Emergency Services will NOT be instituting the Triage to Home waivers. Follow normal treatment protocols and/or RMA/AMA.
Stephen J. Vetrano DO EMT LLC
Emergency Medicine and EMS Consulting
Temporary Clinical Practice Guideline
Due to: • The National State of Emergency
• New Jersey State of Emergency
• New Jersey Public Health Emergency
• Anticipated strain on hospitals as a result of the nationwide pandemic caused by the SARS-CoV-2
• Need for EMS to assist in protecting the healthcare infrastructure
• Need to minimize the expose of EMS and other health care workers
If BLS is called to a scene where the caller has no complaints and only wants to go to the hospital to be tested for the novel coronavirus, they are not to be considered a patient. The definition of a patent according to NJ OEMS, as found in NJAC 8:40: "Patient" means any person who is ill or injured, living or deceased and with whom a crewmember has established physical or verbal contact.
BLS should obtain demographics and do a chart describing in depth the situation and condition found. The caller will be told that hospitals are not testing asymptomatic individuals and BLS will not be transporting them solely for that purpose. If the individual is a healthcare worker, testing may be available, but this can also be accomplished thru the individual’s personal physician or employee health.
Verbal refusals are acceptable for the length of the public health emergency, if it is documented that a verbal refusal was obtained, and no signature was obtained due to the current state of emergency and public health emergency.
N-95 masks can be reused as per CDC guidelines. Store in a paper bag. Perform hand hygiene before putting on and after taking off.
Follow hospital guidelines for patient turnover, but EMS PPE is not to be removed until you are no longer caring for a patient. (ex. Removing gown to walk through the hall with the patient that contaminated the gown is not acceptable). Do not go into “clean” areas with PPE on (i.e. behind the nursing station). Hospital guidelines requiring multiple sets of PPE for a single patient can be followed if the hospital provides the PPE beyond the first set. Signatures of receiving staff and patients may be deferred if documented in the chart reason for deferral (State of Emergency/Public Health Emergency)
It is acceptable for BLS to recall ALS on mild shortness of breath patients with flu like symptoms, with a goal of minimizing exposures
Aerosol generating procedures are to be minimized as much as possible. These include, but are not limited to:
If an aerosolizing procedure must be performed, it must be performed in full recommended PPE for COVID 19 (Respirator [N-95 or greater], Eye protection [full face shield recommended], isolation gown, gloves) and should be avoided if at all possible in the back of the ambulance, particularly use of an albuterol nebulizer. Use of HEPA filters on albuterol nebulizers, BVMs and CPAP can substantially decrease aerosolization. Otherwise, exercise other treatment options.
If you have questions, contact me at 609-802-3433 or firstname.lastname@example.org
Stephen J. Vetrano DO, FACOEP, FACEP EMT
COVID-19 Reference Page. All information should be considered For Your Use Only and not to be shared publicly.