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COVID-19 (PPE) PERSONAL PROTECTIVE EQUIPMENT PAGE (Updated 4-28-2020)

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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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N95/N100 Particulate Respirator Reuse Program (Updated 4-22-2020)

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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.

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

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Where to Store your Used Masks

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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.

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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:

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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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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:

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

  • Goggles (Better)

  • Disposable Surgical Mask with face shield (Good)

 

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

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Download the PPE Protocol Update

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

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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.

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MASK USE DECISION MAKING

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Surgical Masks can be used (N95/N100 preferred) on all patients (COVID suspected included) Except:

 

N95/N100 Mask SHALL be used on all calls where High-Risk Procedures are used:

 

  • CPR

  • BVM

  • CPAP

  • Suction

  • 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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AMR-SDFD PPE and Decontamination PROTOCOL and Zone Use Document

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Download the 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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COVID19 PPE ZONES Final v2 4-16-2020

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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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**NEW** 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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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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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.

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

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Where to Store your Used Masks

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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.

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Download the N95/N100 Particulate Reuse Program Document

N95/N100 Particulate Reuse Program Document CLICK HERE

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Important PPE Reminder: (Updated 4-12-2020)

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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.
     

**NEW** PPE Pictograph “COVID Medical Aid Zones”:

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  • 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.

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Download the COVID Medical Aid Zones

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

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Lessons Learned:

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  • 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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AMR Employees must wear facial mask coverings at all times while on duty (4-8-2020)

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AMR and SDFD have issued directives that all on-duty personnel shall wear facial mask coverings at all times while on duty. The only exception to this rule is when you are alone in a closed room (i.e in your room or office).

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All AMR Employees shall utilize surgical masks or approved facial coverings. All crew members will be given personal reusable facial masks by this weekend. 

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Please view the following VIDEO explaining the importance of wearing a mask on duty CLICK HERE

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Please read the directives on the mandate use of masks on-duty CLICK HERE

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Lessons Learned:

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  • If you have a breach of PPE, remove yourself from the environment prior to continuing patient care.

  • The same goes for anyone that walks into a call where High-Risk procedures are being performed.

    • You should remove yourself and don the appropriate PPE before re-entering the scene to assist with patient care.

  • Despite what ever you may read on the MDC, Assume every patient you encounter as COVID-19 positive

  • Donning the appropriate PPE may cause a delay in patient care.

  • As with any incident, continue to ensure all personnel are suited up to the appropriate level prior to engaging in any emergency.

  • Immediately placing a surgical mask on a patient will significantly reduce your exposure level.

  • Continue to stay up to date on all COVID-19 documents.

 

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PPE Page Update 4-5-2020

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Individually Issued Safety Goggles

  • Goggles are the preferred level of eye protection over glasses.

  • Please pick up your personally issues goggles at Storeroom 42A ASAP, they are the only safe eye protection for ventilating a patient

 

PPE Lessons Learned So Far:

  • Anticipate and prepare for information being inconsistent (i.e., call taker information, MDC, information provided by the family, bystander or patient).

    • Several crews encountered a completely different scenario once fully engaged in patient care.

  • Isolation kits should be readily available on calls. Bring them with you if traveling away from the apparatus.

  • Placing a mask on a patient should be a priority.

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Reminder:

  • PPE and medical equipment restock should be one for one with the responding ambulance.

  • Fire Crews should not be taking extra equipment or cleaning supplies (i.e., masks, CaviWipes) from ambulances or Storeroom 42A.

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What is Covered Here:

  • What PPE to use on calls

  • When to use PPE

  • SDFD PPE Guidelines

  • PPE Donning and Doffing procedures

  • Resupply and Scene Replacement of PPE

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IMPORTANT: We currently have limited PPE supplies for crews, so please limit number of personnel exposed on call.

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What PPE to Use on Potential COVID-19 Patients include:

  • Eye Protection 

  • Gloves

  • N95 or N100 mask

  • Protective Gown

 

NOTE: Gown Supply is limited, so please only utilize gowns in the event of treatment of confirmed COVID-19 patient, or highly suspected covid-19 patient (someone who's answers to questions or symptomology is consistent with COVID-19)

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REMEMBER: Please always bring extra sets of uniforms to your shifts.

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SDFD-PPE-Pictures-GUIDE-03-22-2020

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Please refer to the following Infectious Control PPE Photos and Restocking Guide, for reference to PPE our List of PPE.

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SDFD-PPE-Pictures-03-22-2020 CLICK HERE

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SDFD COVID-19-PPE-Guidelines (very important document to read) (Updated 3-25-2020)

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SDFD EMS has provided a very comprehensive set of guidelines for crews to follow, to protect themselves and their patients from contact of COVID-19 Virus.

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IMPORTANT: It is imperative that you take the time to review this document as a crew and be intimately familiar with the content of this Guide and have it handy if you should need to refer to it later.

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SDFD-COVID-19-PPE-Guidelines-3-23-2020 CLICK HERE

 

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AMR DICO Proper PPE Removal Instructions

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These are just some key points to PPE Removal (Doffing) safety:

  1. Don and Doff with a partner, they can correct what may be wrong as well as see different angles

  2. Always double check before patient contact

  3. Gloves should extend over the cuff of the gown when gown is worn

    • When Doffing can remove gown and gloves at the same time…. never touch the outside of the gown…That’s where the YUCK is

  4. Goggles/face-shield doffed prior to MASK’s being doffed, using elastic/straps--- remember gloves have already been removed with your gown if worn

  5. Never touch your N95/N100 by the mask when doffing…. That’s where all the YUCK is

    • Use the elastic/straps to pull over your head

  6. Dispose in RED BAG…. Not trash can

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AMR DICO Covid19 Update Safe Removal of PPE  CLICK HERE

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CDC-PPE-Donning-and-Doffing-Guide

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​SDFD EMS has provided an CDC illustrated guide for crews on the proper donning and doffing of their PPE to limit your accidental exposure to contaminants. 

REMEMBER:  You don't get second chances with exposures. So please take a moment to re-familiarize yourself with these procedures.

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CDC-PPE-Donning-and-Doffing-Guide-3-10-2020 CLICK HERE

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In an abundance of caution, in an effort to provide our personnel with up to date critical standardized recommendations, please reference the below VIDEO link for donning and doffing procedures:

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COVID-19 Donning & Doffing Techniques VIDEO (updated) CLICK HERE

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Video disclaimer: recommended equipment may not be readily accessible – it is an IAFF video that is general and well done (i.e. hand sanitizer, shoe covers).

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COVID-19 (PPE) Compliment, Resupply and Scene Replacement 

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​Currently, we have been directed to exchange (1 for 1) N95 and N100 masks with SDFD units on scene of calls.

REMEMBER: This 1-for-1 exchange of masks is ONLY for calls that involve the use of masks that were used on THAT call.

Check Your Stock Before Going Back In-Service at the Hospital

Unfortunately, some fire units are going to "self-resupply" on their own without your knowledge, so we ask that you diligently check your stock before leaving a hospital for another call.

If you find that you lack enough PPE for each member of your crew to run the next call, remain out of service and contact your duty supervisor to be directed on where to restock.

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Some crews have been locking their PPE up in the Narcotics Locker on the ambulance

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