Newer information and quick reminders

From: AHS - VDH VTEMS <AHS.VDHVTEMS@vermont.gov>
Date: March 27, 2020 at 7:31:37 PM EDT
To: "ahs.emergencypreparedness@list.vermont.gov" <ahs.emergencypreparedness@list.vermont.gov>
Subject: [AHS.EmergencyPreparedness] COVID-19 Guidance from Vermont EMS - March 27, 2020 (Corrected Version)

The challenge of novel corona virus has already asked a great deal of the emergency response community and there assuredly will be more difficulties in the days ahead.  However, it is not at all surprising to see emergency responders coming together and working shoulder to shoulder to meet these complex challenges head on.   The citizens of Vermont are counting on us and together we will be strong enough to meet their needs.  As this pandemic unfolds, the Vermont Department of Health’s goals remain constant: keep our responders safe and enhance their hard work through thoughtful, scientific, and current guidance and support. 

Vermont EMS recognizes that practitioners are receiving many COVID-19 messages, often too many to stay current with.  In an effort to minimize confusion and to provide a reliable source of centralized information, we will do our best to batch messages and distribute guidance every Friday.  The exception to this rule of course will be urgent safety messages or time sensitive clinical guidance.  For those we will use the Health Alert Network and distribute as necessary.  

In support of the COVID-19 response, this week the Vermont Department of Health would like to share the following updates:

1. Clinical Updates

 i.  Updated COVID-19 Personal Protective Equipment (PPE) Guidance

1. Summary: It is now the recommendation of the Vermont Department of Health that personal protective equipment should be worn for all emergency medical situations that require a practitioner to make close contact (less than 6 feet) with a patient.  For full details please see 27 March 2020 Novel Coronavirus (COVID-19) Personal Protective Equipment Update (attached).

 ii.  Respirator Reuse Guidance

1. Summary: With interruptions in the PPE supply chain it may be reasonable for emergency responders to reuse N-95 respirators.  The Novel Coronavirus (COVID-19) Response N-95 Respirator Reuse Guidance document summarized CDC recommendations and risk mitigation associated with this practice.  For more information seeNovel Coronavirus (COVID-19) Response N-95 Respirator Reuse (attached).

 iii.  Supraglottic Airway Guidance

1. Please note that use of a supraglottic airway (King or i-Gel) is considered a high-risk aerosolizing procedure.  It is critically important to plug the side/gastric port on a supraglottic airway to prevent large volume spread of airborne pathogens.

 iv.  Please download these revised protocols for COVID-19: Field Triage Guide (revised March 27, 2020) and COVID-19: Assessment and Transport (revised March 27, 2020)which have been updated to reflect the most recent guidance.

1. EMS Workforce Sustainment
   1. Extending currently licensed practitioners - With authorization from Governor Philip B. Scott’s Emergency Declaration of March 13, 2020 (Executive Order 01-20), all EMT, AEMT and Paramedic licenses due to expire on June 30, 2020 are now valid until September 30, 2020. All other licenses will retain their existing expiration date. There is no need to request this extension.
   2. Formerly Licensed Practitioners Re-Licensure - Any former Vermont EMS practitioner whose license expired on or after June 30, 2018 may obtain a conditional Vermont license valid until June 30, 2021 without a current National Registry certification or documentation of continuing education, under the following conditions:
   • Attestation by an agency’s Head of Service and Training Officer that they are aware of the applicant’s gap in licensure and that they are satisfied with the applicant’s skills, knowledge and affective competencies to function as a licensed EMS practitioner
   • Attestation by the applicant that: 
     • They have disclosed their gap in licensure and training to the agency
     • They understand the conditional license is only valid until December 31, 2021
     • They understand that licensure beyond December 31, 2021 will require an NREMT certification
     • AEMT and Paramedic applications require the support of the District Medical Advisor
   1. Provisional Licensing of EMS Students Who Have Completed A Licensure Course - The Department of Health will issue a provisional Vermont EMS license to students who have obtained a National Registry provisional certification. NREMT is issuing provisional certifications to students who have passed the cognitive exam and are awaiting the opportunity to take the practical exam. This provisional license will remain valid for the duration of their NREMT provisional certification, with the following conditions:

• Acknowledgement by an agency’s Head of Service and Training Officer of the applicant’s provisional NREMT certification status
• Attestation by an agency’s Head of Service and Training Officer that the applicant has the skills, knowledge and affective competencies to function as a licensed EMS practitioner
• AEMT and Paramedic applications require the support of the District Medical Advisor

Applications for these temporary licenses are available in the Documents section of the Vermont EMS website.

1. EMS Students Awaiting Access to the NREMT Cognitive Exam - Pearson Vue cognitive testing centers have begun to reopen on a limited basis. Vermont EMS will continue to work with local testing centers to increase certification testing availability.  The Pearson Vue website has updated information on test availability and hours of operation.

If there are any questions on this or any COVID-19 guidance, please contact the EMS office. 

Thank you again for all the hard work and dedication in this difficult time.  Please stay safe.

All the best,

Dan Batsie

From: Mark Podgwaite
Subject: [vtemsdistrict6] CVMC Minor Update
Date: March 25, 2020 at 5:33:59 PM EDT
To: "VT EMS D6 Complete Everyone 

 Folks: In an effort to  reduce the potential for droplet exposure, the following procedures will be followed when transferring a code from your truck into the ER.  All active ventilation (BVM) shall cease.  

For patients with no advanced airway in place a mask over the patient’s mouth and continue with compressions. 

For patients with an advanced airway in place, you will need to cover at least the tube. A washcloth, towel or the like comes to mind. Continue with compressions (open to input on this one). 

Please keep in mind that CVMC is closed to visitors at this time. We all are in the habit of telling family and friends “sure jump in the front seat” or “just follow us up”, we cannot do that anymore.  In cases where there is a parent, guardian, caregiver etc. needing to come to the ER, please advise the charge nurse  before proceeding. 

Any questions please let Jess, Jared or I know Mark  

Mark PodgwaiteExecutive DirectorWaterbury Ambulance Service, Inc.Chair Vermont EMS District 6

Vermont EMS,

Novel Coronavirus (COVID-19) has posed many challenges to the safe and effective delivery of emergency medical services (EMS) in Vermont.  The complex and unprecedented demands we will all face in the weeks to come will require hard work, creative thinking, and most of all teamwork.  In support of the brave men and women on the front lines of this pandemic, the Vermont Department of Health is taking the following steps to protect our workforce and support your operations.  These measures will take effect March 20, 2020:

1. With authorization from Governor Philip Scott’s Emergency Declaration of March 13, 2020 (Executive Order 01-20), EMS Rule 4.1.2, the requirement for two licensed providers for any EMS transport, is suspended for the period of the corona virus response.  Practitioners should use good clinical judgment to match crew configuration to patient need, but until further notice there is no longer a requirement to contact medical control to transport with a single licensed provider.
2. All EMS licensure classes are suspended until further notice.  Classes in progress may continue to complete didactic content in a distributive (online) fashion, but in-person sessions should not take place.  This includes practical, scenario, and clinical evolutions.  This also includes in person continuing education classes.
3. All EMS licensure testing is suspended until further notice.  This includes both cognitive (computer-based) and psychomotor.  All cancelled tests will be rescheduled once it is deemed safe to do so.

In the coming weeks, Vermont EMS will examine the feasibility of pushing back personnel license renewal deadlines to match similar actions taken with National Registry recertification and to address the significant interruption in continuing education.  More detailed information on these changes will be forthcoming.

PROTOCOL CHANGES AND ADDITIONS

In addition to the preceding administrative measures, the Vermont EMS Statewide Treatment Protocols will be amended to include the following additions:

1. COVID-19 Field Triage Guidance – This decision-making scheme is designed to identify potential COVID-19 patients who do not require transport to the hospital.  Practitioners will use the designated criteria to assess the need for transport then reinforce the decision by contacting medical control.  This protocol and its accompanying education can be found at www.vermontems.org.  or direct link field triage
2. COVID-19 Assessment and Transport Protocol – This protocol describes key elements of assessment and risk mitigating procedures for suspected COVID-19 patients. This protocol and its accompanying education can be found at www.vermontems.org. or direct link assessment and transport
3. Effective immediately, metered dose inhalers may be substituted for any nebulized medication.  This substitution does not affect scope of practice and practitioners should be familiar with the administration of any medication prior to administering it.  Refer to the Vermont Statewide EMS Protocols as needed.

We appreciate all that you are doing in response to COVID-19.  The Department of Health will continue to do everything we can to help.  If you have any questions regarding these updates, please feel free to contact our office.

All the best,

Dan Batsie

EMS Chief

Division of Emergency Preparedness, Response and Injury Prevention

Vermont Department of Health

108 Cherry St.

Burlington, VT 05401

(802) 865-7735

Vermont EMS Information Memorandum

TO: Vermont Emergency Providers, Service Leaders, District Medical Advisors

CC:  Daniel Wolfson, MD - State EMS Medical Director

FROM: Dan Batsie, Chief of EMS, Vermont Department of Health

DATE: March 19, 2020

Subject: Novel Coronavirus (2019-nCoV) Personal Protective Equipment Update

_________________________________________________________________
SUMMARY – The Centers for Disease Control and Prevention recently updated their Interim Guidance for Emergency Medical Services (EMS) Systems.  Included in this update were recommendations on personal protective equipment (PPE) in situations of supply chain interruption.  Given that most Vermont emergency response agencies are facing similar challenges associated with PPE, it is now reasonable for responders to adopt the following personal protection standards.

PROCEDURE:

• Responders who will be in direct contact with a patient with possible COVID-19 infection or who will be in the compartment with the patient should follow Standard, Precautions and use the following PPE:
  • Facemask 
    • N95 respirators or respirators that offer a higher level of protection should be used instead of a facemask when in the presence of a confirmed COVID-19 case or when performing or present for an aerosol-generating procedure.
  • Eye protection (i.e., goggles or disposable face shield that fully covers the front and sides of the face). Personal eyeglasses and contact lenses are NOT considered adequate eye protection.
  • A single pair of disposable patient examination gloves. Change gloves if they become torn or heavily contaminated.
  • Isolation gown.
    • If there are shortages of gowns, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of EMS clinicians (e.g., moving patient onto a stretcher).

Please note that CDC guidelines consider a facemask equivalent to an N-95 mask when assigning risk to a potential COVID-19 contact.  Using a mask instead of an N-95 mask would not change isolation recommendations. 

For more specific information regarding EMS interaction with COVID-19 please see the attached Centers for Disease Control and Prevention Interim Guidance or visit:https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html.

If there are any questions with regard to this guidance, please feel free to contact the Vermont EMS office.

Dan Batsie

EMS Chief

Division of Emergency Preparedness, Response and Injury Prevention

Vermont Department of Health

108 Cherry St.

Burlington, VT 05401

(802) 865-7735

ER Tracking Sheets

EMS crews are required  to fill out a staff tracking forms for every patient (so we can call back personnel when a patient positives). There will be a stack of them out in the ambulance bay. Please fill them out and attach a patient label to them. This is the personal responsibility of the EMS providers. We can more efficiently let you know when there is a positive patient if you fill out the tracking sheets.

NEW: 3 NEG pressure rooms in old ambulance bay.  You may be directed to take a patient to the old bay!

Call  the ER as soon as you think you have a COVID19 patient, and again on arrival and await nursing assessment  before getting out of the ambulance.

Have Patience rooming patients

The ER is busy, and doing the best they can with this blossoming issue.  The rooms have to be thoroughly cleaned before being used again. 

Stay tuned for No Transport protocol if COVID patients will be brought by family to ER or to testing evaluation site.

Empty stretchers can use the MRI doors if desired. 

Given the concerns about COVID-19, this would be a good time for your agencies to review donning and doffing procedures for PPE (Personal Protective Equipment).  Below are links for three excellent videos that UVM HealthNet Regional Transport Service produced and kindly shared with Vermont EMS.

PPE Donning - https://youtu.be/Re2667Ho5UA

PPE Doffing - https://youtu.be/Zlwefwlg6fo

General Info on COVID-19 - https://youtu.be/YmZVR1dd0xM

Although the guidance on personal protection has not changed, it is appropriate to review the key steps an EMS provider should take when a potential COVID-19 risk is identified.  They are:

• Maintain a six-foot social distance when approaching and initially assessing the patient.  Ask the patient to wear a surgical mask or oxygen mask if tolerated.
• 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), and
  • Eye protection (i.e., goggles or disposable face shield that fully covers the front and sides of the face).
• After completing patient care, drivers should remove the face shield or goggles, gown and gloves and perform hand hygiene. A respirator should continue to be used during transport.
  
  
  
  For more information regarding health care provider personal protective equipment, please see:https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html.
  
  
  
  Many of you have understandable concerns about monitoring, social isolation, and quarantine risks associated with caring for a COVID-19 patient.    Please note that the proper way to minimize any of these risks is to use all appropriate PPE when in contact with patients of risk.  The current Centers for Disease Control and Prevention guidance for health care providers (https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html) notes that a provider wearing the full complement of PPE described above would be considered a low risk and although they would be monitored for 14 days (asked to self-assess for symptoms and  have regular check ins with local health), work restriction would not be necessary.  Please note that low risk is only applicable when ALL appropriate elements of PPE were present throughout contact.  It is also true that any contact would be evaluated on a case by case basis.   
  
  
  
  It is appropriate for agencies to consider adjusting response allocations in identified COVID-19 risk situations.  For example, if call takers identify concerning travel history, previous exposure to a COVID-19 patient, or respiratory infection symptoms, it may be reasonable to limit the number of responders entering the residence and approaching the patient.  It may also be reasonable to limit the number of responders in patient care areas of the ambulance.  As always, patient needs will dictate these decisions and appropriate PPE can be used to minimize risk.
  
  
  
  If first responders do not have appropriate PPE or they have not been trained in the use of appropriate PPE, they should not enter COVID-19 risk situations and should await oncoming transporting EMS providers.
  
  

This Wednesday at 2pm, the Vermont State Emergency Operations Center (SEOC) will begin hosting weekly COVID-19 conference calls with law enforcement, fire service, emergency medical services, and medical examiners. These calls are to provide an overview of the State’s response to the COVID-19 pandemic and to answer questions that emergency responders may have.  

If you have any specific questions you would like answered during this call, please submit them using the link below prior to the call so we can gather responses from SEOC Partners:  

https://forms.office.com/Pages/DesignPage.aspx?fragment=FormId%3DO5O0IK26PEOcAnDtzHVZxhdpxBF9DcNNvmu0GLrYpoFUQ0JWWTJGRzhKMUs1QTZLQUVNWVpSVFpHUi4u%26Token%3Da7dab46e8a114439ad5364c7fe395b8e

The first call is scheduled for Wednesday, March 18th, at 2:00PM.  

Please note, there will be a separate conference call catered specifically for municipal officials and emergency management directors (EMDs) that will be held on Fridays. 

There is a limit to the number of attendees the conference line can support. When possible, have a single representative from your organization and  call in and report back to others. 

We will share a document that captures frequently asked questions and answers following the call. 

Contact your head of service or Mark Pogewaite for details on how to join the call.

From: Lindquist, Leslie A.
Subject: RE: Transport of Patients with COVID-19 to UVMMC

Good Morning,

Slight changes to the attached guideline.  Part two, section J now has clearer guidance for when arriving with a complex or sick patient. Additionally, starting tomorrow the ED will start routing drive-up traffic to different locations outside of the ED.  They have taken over an adjacent parking lot for UVM and are working with the National Guard.  Their goal is perform triage outside, for anyone coming by car and avoid patients from entering the ED 0855unnecessarily.  They have different routes for patient who need no treatment but require isolation, patients who need treatment and isolation, and acute patients who need isolation.  As of right now, EMS will be unaffected and still utilizing the ambulance bay.  There will be flaggers to direct ambulances around any line-up of cars in the driveway as you approach the ED.

The EMS district is keeping the most current version of this document, on the website, vtemsdistrict3.org.

Please let me know if you have any questions.

Leslie

Leslie Lindquist, MS, NRP
Transport Team Site Supervisor
Regional Transport System / Burlington Base
(802) 847-6974
Leslie.Lindquist@UVMHealth.org

The University of Vermont Health Network
Critical Care Transport Team

From: Zoom <no-reply@zoom.us>
Sent: Thursday, March 19, 2020 12:01 PM
To: Bagg, Scott <Scott.Bagg@cvmc.org>
Subject: Cloud Recording - District Six COVID-19 Meeting is now available

This message came from an external source. Please exercise caution when opening any attachments or clicking on links.

Hi Scott Bagg,

Your cloud recording is now available.

Topic: District Six COVID-19 Meeting
Date: Mar 16, 2020 06:15 PM Eastern Time (US and Canada)

Share recording with viewers:
https://zoom.us/rec/share/x95Ec-v8qXFLa7P1wWbWUK94GZroX6a8h3Ue_PIFnkpsqSkBs6YMy8nf6KXBTNlG

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