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AMR-SDFD COVID-19 Operational Update 44  UPDATE 4-29-2020

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Changes to Medical Triage of COVID-Incidents-Dispatch Protocol: Suspected COVID-19

• Effective Tuesday, April 28, 2020, certain calls triaged through Metro will follow a revised protocol known as “Card 36” or the “Suspected COVID 19” protocol card.

  • Designed to rapidly identify COVID affected patients and accelerate the dispatch triage process.

  • The Problem/Nature “Suspected COVID 19” will be an indicator that the call type was triaged under this new protocol.

  • The dispatcher may add additional notes to the specific complaint within the call type.

  • Some calls may triage out to other call types (i.e., non-COVID related symptoms, immediate life threats). This does NOT mean the call is not COVID related.

  • Continue to treat calls with careful consideration for COVID related illness (i.e., call triaged out of Card 36 due to questioning).

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Updated & New Documents:

• SDFD PPE Photos & Restocking 04.27.2020

  • CPAP with Filter and In-Line Nebulizer (Option #1 – Limited Availability)

  • CPAP with Filter and In-Line Nebulizer (Incorrect – DO NOT USE)

  • N95/N100 Re-Use Procedures

  • N95/N100 Collection, Decontamination, and Reuse Information

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Download the Updated PPE Photo and Restock Document 

To view the AMR-SDFD-PPE Photo and Restock Document  CLICK HERE

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Updated list of COVID-19 symptoms per the CDC:

symptoms may appear 2-14 days after exposure to the virus, added symptoms are highlighted.

 

• Fever Cough

• Shortness of Breath

• Chills

• Repeated shaking with chills

• Muscle Pain

• Headache

• Sore Throat

• New loss of taste or smell

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IMPORTANT: REMINDER to do your twice daily on-duty temperature checks, link is on your iPad and checks are mandatory

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Reminder: N95/N100 Collection, Decontamination, and Reuse
• N95/N100 masks must be identified with your first initial, last name, permanent station/division with a permanent marker on the bottom of the mask.

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Download the FFR Collection and Reutilization Program 

To view the AMR-SDFD-FFR Reutilization Program CLICK HERE

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Behavioral Wellness update – Dr. Dave Bond

• Focus' YouTube Channel CLICK HERE

  • This is a short informational video to share at home 

  • Helping our kids (and ourselves) express emotions and work with uncertainty Video CLICK HERE

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AMR-SDFD COVID-19 Operational Update 42  UPDATE 4-27-2020

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Governor Newsom issued an executive order concerning emergency child care

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In response to the COVID-19 pandemic, Governor Newsom issued an executive order concerning emergency child care for children of essential workers who are not able to work remotely.
• To help determine type of care, age groups, hours, and location needed by workers please complete this short survey.

Take the Survey CLICK HERE

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Child care assistance though the YMCA
Financial Assistance for Child Care Services for Essential Workers and At-Risk Population

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To access this Program CLICK HERE

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Personal Protective Equipment Guidelines:

• Isolation kit with gown for all COVID patients and high-risk procedures

• Surgical mask and issued goggles required on all calls § Upgrade to N95 and gown if COVID suspected

• Facial coverings are to be used for duration of your shift

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N95/N100 FFR Collection for Reuse:

• Write your name on front bottom of FFR before use. This is to ensure you get your mask back after decon

  • i.e., J. McCormack – MS72A - AMR

• Reuse FFR as normal, per current practice

  • After high-risk procedure, instead of discarding, place FFR mask in bag

  • SDFD will restock FFR masks 1 for 1 from ambulance resupply bin like normal, will place their FFRs for decon in the ambulance bag also

  • New process coming where single FFRs will be placed into sandwich paper bag before going into larger bag

• When bag is full, drop off at 42A, and get a new bag and clip

• Keep bag in outside compartment with trauma bag

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Download the FFR Collection and Reutilization Program 

To view the AMR-SDFD-FFR Reutilization Program CLICK HERE

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​Lessons Learned:

• Health checks performed at work sites are like performing an assessment on a patient. Remember to keep your distance while asking questions and taking a temperature.

• Continue to limit the number of personnel involved in the initial assessment and throughout the call. Utilize a scout when appropriate.

• Carry gowns with you when traveling a distance from the apparatus. PPE should be easily accessible by all crew members throughout the call.

• Notes on the MDC regarding potential COVID-19 hazards should not be solely relied upon when
  entering a scene. Continue making your scene survey and scene safety a top priority upon arrival.

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Download the Daily Operational Update

To view the AMR-SDFD-Operational COVID-19-Daily-Update-44 CLICK HERE

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AMR-SDFD COVID-19 Operational Update 38  UPDATE 4-22-2020

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N95/N100 Particulate Respirator Reuse Program

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As everyone is aware, with the dwindling supply of PPE, we are looking at the possibility of having to re-utilize or N95 and N100 masks.

​

SDFD has purchased a Hydrogen Peroxide Sanitizer to sanitize our used masks.

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Where to Store your Used Masks

​

Please start collecting serviceable used N95 and N100 masks in the Brown paper bag (folded and clipped) stored in the Trauma bag compartment on the apparatus.

​

REMEMBER: Please turn the bag into supply when it is near full and get a replacement bag.

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Proper Positioning of the HEPA Filter and ETCO2 Device:

​

The Medical Director has clarified the proper positioning of the HEPA Filter and ETCO2 device.
 

• The proper positioning of the devices are as follows

  • Patient — Mask/Tube/King/etc. — HEPA Filter — EtCO2 device — rest of ventilation apparatus/delivery system

• For in-line nebulized treatments, the positioning of the HEPA filter is shall be;

  • Patient-Mask/Tube/King/etc. – ETCO2 device- in line nebulizer-HEPA Filter- rest of ventilation apparatus/delivery system

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Lessons Learned:

​

• Continue to educate bystanders, including other City employees, on the proper PPE and social distancing on scene with crews.

• When the MDC states “COVID POSITIVE” anticipate and/or request instructions from the unit already on scene via the tactical channel.

  • If unable to raise the on-scene unit, send in your scout to conduct a scene survey and coordinate.

• For continuity, ensure both HEPA filters are stored with the EKG monitor NOT in the airway bag.

• If you remove a piece of PPE when disengaging from patient care (i.e., support or contamination reduction zone) don’t forget to don it if you find yourself re-engaged with the call.

• Be cognizant when entering medical facilities for areas that may be designated for COVID-19 related patients (i.e., quarantined area).

  • Confirm with staff prior to entering areas that may require higher levels of PPE.

• Not wearing a face mask or respirator will place you into CDC’s high-risk exposure category if interacting with a suspected or known COVID-19 patient that was not wearing a facemask.

  • This applies even if the patient is asymptomatic (i.e., no fever or cough).

  • Maintain your situational awareness on “routine calls” (i.e., traffic accidents, lock out, ringing alarm) that can quickly develop into a potential exposure.

  • Treat all calls with precautionary measures to limit any unnecessary exposures.

​

​

Download the Daily Operational Update

To view the AMR-SDFD-Operational COVID-19-Daily-Update-38 CLICK HERE

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SDFD Photos & Restocking 04.21.2020

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• New pictures for options when using the Humid Vent Filter, Humid Vent Filter with In-Line Nebulizer, Options for using the BACT-TRAP Mini, BACT-TRAP Mini Filter with In-Line Nebulizer

• Pictures of re-usable face shield for all first responder apparatus

• Distribution to begin on April 21, 2020

• The re-usable face shields are constructed of plastic. The adjustable Velcro elastic headband is constructed of synthetic fiber.

• The forehead comfort pad is a non-porous, closed cell foam which restricts absorption of water, air and gases.

• The re-usable face shields shall be cleaned in the same manner as goggles.

• The preferred eye/face protection for suspected/confirmed COVID-19 patients are:

• Goggles (Better)

• Disposable Surgical Mask with face shield (Good)

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NOTE:​ Re-Usable Face Shield (Best) (AMR this is on Order and not yet Issued)

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Note: Goggles may be used in conjunction with the Re-Usable Face Shield.

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Download the PPE Photos and Restocking 4-21-2020 Update

To view the AMR-SDFD-SDFD PPE Photos and Restocking 04.21.2020- CLICK HERE

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AMR-SDFD COVID-19 Operational Update 35  UPDATE 4-20-2020

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​

Facial Coverings must be worn at all times on shift!!

​

• Facial coverings are to be used for duration of your shift

• Must wear at all times unless in station in your dorm

• This included while riding in the front cab of ambulance

• Re-usable cloth masks available at 42A, 2 per person

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Rolls of Visqueen are available to seal off the front and back of the Ambulance!!

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• Visqueen is available in your PPE bin, for you to seal off the front and back of the ambulance. 

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Station Car Crews must NOT wear uniform to work!!

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• Station units are being asked to please leave your uniforms at station and arrive/leave in plain clothes

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HEPA Filters Placement

• The Hepa Filters are to be placed closest to patient and EtC02 sensor goes on after that.

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Fogging of glasses and goggles:

• Anticipate rotating out personnel if fogging of goggles becomes a safety concern

  • Be cognizant of cross contamination when re-adjusting your mask and goggles

• Tips for preventing fogging of glasses and goggles

  • Ensure a tight seal over the bridge of the nose

  • Wash your glasses/goggles with soapy water and let them air dry

  • Move your classes towards the tip of your nose

  • Add anti-fog wipes, sprays or creams on your lenses (IMT Logistics is in the process of procuring)

  • Clean your glasses with a dab of shaving foam or cream

  • Video: How to wear your face mask without fogging up your glasses

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P-801 (3)(a) – Temporary Exemption/Waiver Granted for Mandatory Two medics on calls

​

• Two paramedics will not be required to be dispatched to an ALS response Granted through May 15, 2020 (with possibility of extension)

• Part of a strategy to contain and mitigate the COVID-19 pandemic

• One paramedic may be dispatched to ALS responses via first responder OR ground transport vehicle, as available

• When ALS ambulances are unavailable, SDFD will send a second first responder with a BLS ambulance to CPR calls

• Captains can still request additional resources, if required

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Balance During Covid-19 Webinar

Webinar specially prepared for first-responder spouses or significant others

All AMR and SDFD families are invited to join this meeting.

• SUNDAY, APRIL 26 • 2PM

• ZOOM MEETING ID: 922 2233 6270

• password: lets_talk

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Download Balance During Covid 19 Webinar Flyer

SDFD/AMR Balance During Covid 19 Webinar Flyer CLICK HERE

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Other Important Items

• Be cognizant when entering medical facilities for areas that may be designated for COVID-19 related patients (i.e., quarantined area).

• Not wearing a face mask or respirator will place you into CDC’s high-risk exposure category if interacting with a suspected or known COVID-19 patient that was not wearing a facemask.

• This applies even if the patient is asymptomatic (i.e., no fever or cough).

• Maintain your situational awareness on “routine calls” (i.e., traffic accidents, lock out, ringing alarm) that can quickly develop into a potential exposure.

• Treat all calls with precautionary measures to limit any unnecessary exposures.

​​

Download the Daily Operational Update

To view the AMR-SDFD-Operational COVID-19-Daily-Update-35 CLICK HERE

 

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AMR-SDFD COVID-19 Operational Update 33  UPDATE 4-17-2020

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Important Reminder: do not report to fire station units in uniform!!

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• Station Car Crews are NOT allowed to enter fire Stations in uniform. Please go to the station in street clothes and change before your shift.

• No Exceptions 

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New SDFD Isolation Guidelines Complete 04.16.2020

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Please refer to this very informative guide on COVID-19 exposure and Isolation.  AMR employees remember to contact the duty supervisor and the DICO Team for direction on shift removal and testing followup.

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Download the Isolation Guidlines

SDFD Isolation Guideline Complete 04.16.2020 CLICK HERE

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How NOT to Wear a Mask  04.16.2020

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The COVID IMT has released a new Pictogram of how NOT to wear your mask or on-duty face coverings.

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Please remember that these covers are required while on duty (including inside the ambulance cab) and the reusable cloth face coverings are not to be used on calls

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Please protect the spread to others and wear the mask!!

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Download the How NOT to wear the Mask Pictogram

SDFD/AMR How NOT to Wear a Mask  04.16.2020 CLICK HERE

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NEW Infectious Control PPE Photos and Restocking Guide 04-16-2020

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The COVID IMT has released a new Infectious Control PPE Photos and Restocking Guide.

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It contains images of our PPE and treatment support items with configurations.

 

Please take a moment to review this File.

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Download the NEW Infectious Control PPE Photos and Restocking Guide

SDFD/AMR NEW Infectious Control PPE Photos and Restocking Guide  04.16.2020 CLICK HERE

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COVID19 PPE ZONES Final v2

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The IMT has produced an updated COVID-19 PPE Zone document (V2) 

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Please replace your original with this on on your ambulance and phone.

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Download the COVID19 PPE ZONES Final v2

SDFD/AMR NEW COVID19 PPE ZONES Final v2  04.16.2020 CLICK HERE

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N95/N100 Particulate Respirator Reuse Program

​

As everyone is aware, with the dwindling supply of PPE, we are looking at the possibility of having to re-utilize or N95 and N100 masks.

​

SDFD has purchased a Hydrogen Peroxide Sanitizer to sanitize our used masks.

​

Where to Store your Used Masks

​

Please start collecting serviceable used N95 and N100 masks in the Brown paper bag (folded and clipped) stored in the Trauma bag compartment on the apparatus.

​

Download the N95/N100 Particulate Reuse Program Document

N95/N100 Particulate Reuse Program Document CLICK HERE

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​

Download the Daily Operational Update

To view the AMR-SDFD-Operational COVID-19-Daily-Update-33 CLICK HERE

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AMR-SDFD COVID-19 Operational Update 29  UPDATE 4-14-2020

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Important Reminder:  Replace your Cloth Mask with the appropriate respirator (i.e., N95/N100) prior to patient contact

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• Replace your reusable cloth mask with the appropriate respirator (i.e., N95/N100) prior to patient contact.

• Check your crew members prior to patient contact to ensure the appropriate PPE is donned every time.

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MASK USE DECISION MAKING

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Surgical Masks can be used on all patients (COVID suspected included) Except:

 

N95 Mask SHALL be used on all calls where High-Risk Procedures are used:

 

• CPR

• BVM

• CPAP

• Nebulized RX

• High-Flow 02 via NRB mask (remember to put surgical masks over these treatment deliveries)

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GOWN USE DECISION MAKING

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IMPORTANT!! If you are within 6 feet of a known or suspected COVID-19 patient you should be wearing a gown.

 

• Not wearing a gown is categorized as a low-level exposure by the CDC and San Diego County EMS.

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Download the Daily PPE Protocol Update

To view the AMR-SDFD-Operational COVID-19-Response and Decon Protocol and PPE Zones 4.5.2020- CLICK HERE

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Download the Daily Operational Update

To view the AMR-SDFD-Operational COVID-19-Daily-Update-29 CLICK HERE

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N95/N100 Particulate Respirator Reuse Program

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Maintaining availability of N95/N100 Filtered Face Respirators Through Sterilization

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• SDFD purchased a Hydrogen Peroxide vapor sanitization machine for FFR decontamination

  • Machine will not be delivered for about a month

  • Bags will be distributed tomorrow to start collecting FFRs for storage, anticipating more FFR shortages

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Masks will only be sanitized if unable to get new FFRs

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Download the N95/N100 Particulate Reuse Program Document

To view the AMR-SDFD-Particulate Respirator Sanitization Program- CLICK HERE

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AMR-SDFD COVID-19 Operational Update 28 UPDATE 4-12-2020

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Important Reminder:

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• Replace your reusable cloth mask with the appropriate respirator (i.e., N95/N100) prior to patient contact.

• Check your crew members prior to patient contact to ensure the appropriate PPE is donned every time.
   

PPE Pictograph “COVID Medical Aid Zones”:

​

• Please reference the pictograph to assist you in determining the level of PPE, tasks and the number of personnel within the three zones of a medical aid.

​

Download the COVID Medical Aid Zones 

To Download the PPE Pictograph “COVID Medical Aid Zones” CLICK HERE

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Lessons Learned:

• Common occurrence/repeating lesson learned:

  • Assume that all patients may have COVID-19 and place a surgical mask on them immediately, even if there are no indicators of COVID-19 from the dispatch notes or from initial information given by family/bystanders at the scene.

• Consider standing back until necessary information is gathered by the call taker when you have a short response time.

• to any of the COVID questions.Family stated to members of a crew that they believed the patient would have not been treated if they told ECDC “Yes”

  • Realize that it may be difficult for ECDC to obtain relevant COVID information.

• For your situational awareness, calls originating from SDPD’s dispatch (that are not transferred over to ECDC) may have missing information.

  • These calls are not necessarily triaged for COVID-19.

• Remember to utilize an in line Hepa-Filter with a BVM, prior to placing an advanced airway.

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• Utilization of Masks:

  • N95/N100 is the preferred mask, especially for any aerosolized procedures.

  • With several types of masks available it is important to take the time to ensure you are not wearing a department issued cloth reusable mask on emergency responses.

  • Check your partner before conducting patient assessment and treatments.

• If an exposure report is required on an 11-44, the DICO will process the report.

  • It does not need to go through PD or the Medical Examiner.

  • The Health and Safety Office will conduct any follow up.

• Several low-level exposures have occurred due to crew members conducting patient assessments without gowns.

  • The level of PPE must always be your priority prior to approaching a patient.

• If you are within 6 feet of a known or suspected COVID-19 patient you should be wearing a gown. Not wearing a gown is categorized as a low-level exposure by the CDC and San Diego County EMS.

• Advise incoming responding crews if additional PPE is required prior to their entering of the scene.

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Download the Daily Operational Update

To view the AMR-SDFD-Operational COVID-19-Daily-Update-28 CLICK HERE

 

 

 

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AMR-SDFD COVID-19 Operational Update 26 UPDATE 4-10-2020

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DO NOT COME TO WORK IF YOU HAVE COVID SYMPTOMS 
If symptomatic, please call off to a supervisor and make sure they contact the DICO, we do not
wish to infect patients, co-workers or their families

 

Personal Protective Equipment Guideline: 

• Isolation kit with gown for all high-risk procedures

• Facial coverings are to be used for duration of your shift

  • Must wear at all times unless in station in your dorm

  • Re-usable cloth masks available at 42A

 

S-415(a): 

• Medic units only, per county policy paramedic assessment

• Please complete TargetSolutions training ASAP

  • 112/Bridged and 43/Medics still need to complete the assignment as of yesterday afternoon

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Safety Message: 

• All patients receive a surgical mask if tolerated

• Wear surgical mask, goggles and gloves on all calls

  • N95/N100 for high risk patients and skills

  • Several low-level exposures have occurred because of crew members engaging without gowns. 

• Continue to prioritize your level of PPE prior to engaging in patient care.

  • Advise incoming responding crews if additional PPE is needed prior to them entering the scene.

• To avoid unnecessary fogging of goggles, ensure you get a good face/nose seal on your mask.
   

Download the Daily Operational Update

To view the AMR-SDFD-Operational COVID-19-Daily-Update-25 CLICK HERE

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California Health Advisory Update #11: Corona virus Disease 2019 (COVID-19)

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• COVID-19  Infectious Potential Report

• Patients with COVID-19 are considered infectious 48 hours prior to symptom onset as per the Centers for Disease Control and Prevention (CDC)

• CDC Community Spread Report

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Download the CAHAN-Alert

To view the Californai Heath Advisory Alert CLICK HERE

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GMR Emerging Infectious Diseases Web Page Update 

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• COVID-19 Pay Reference Guide

  • Exposure Definitions

  • Contact Definitions

  • The Centers for Disease Control, local Public Health Departments and community protocols

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Download the Daily Operational Update

GMR Emerging Infectious Diseases Web Page Update CLICK HERE

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Expiring EMT/Paramedic/CPR/ACLS Certifications

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• Governor of the State of California issued an Executive Order N-39-20

• All EMS personnel (EMT, AEMT, and Paramedic) with licenses or certifications (or local accreditation) expiring in March, April, or June of 2020 shall have their license or certification expiration dates extended until July 31, 2020.

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Download the Daily Operational Update

Expiring EMT/Paramedic/CPR/ACLS Certifications CLICK HERE

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GMR COVID-19 Ground Ambulance Decontamination Guide

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• Vehicle Decontamination Guidelines

• Tri-jet fogger Use Instructions

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Expiring EMT/Paramedic/CPR/ACLS Certifications CLICK HERE