Standard Operating Procedures for COVID-19 cases (ambulance and triage)

COVID-19 is a deadly respiratory infection caused by the SARS-CoV-2 virus and it spreads from an infected person to a healthy person through respiratory droplets. The main site of infection of the SARS-CoV-2 virus is the respiratory region and is capable of causing severe respiratory issues or pneumonia. Anyone who is in close contact with the infected person who is symptomatic or asymptomatic is capable of contracting the virus. These droplets can also remain viable after landing on surfaces. Transmission can occur from hands touching these contaminated surfaces and then coming into contact with the person’s mucosa such as nose, mouth and eyes. 

A written set of guidelines and guidelines is required for almost all the fields in healthcare. However with a virus as deadly and as transmissible as the SARS-CoV-2 virus, special Standard Operating Procedures (SOPs) are required in order to accurately treat the infected patient and curtail the further spread of the virus to other patients and healthcare workers. The SOPs for COVID-19 patients are stringent and include various situations such as handing the infected patient, bringing them to the hospital in an ambulance, transferring the patient to the doctor, sterilising the ambulance and disposing of the personal protective equipment (PPE) worn by the paramedics and the ambulance drivers. 

For ambulances and emergency medical technicians transporting severely infected COVID-19 patients from their homes to the hospital, the SOPs include: (according to the Ministry of Health and Family Welfare of India

  1. There should be ambulances identified specifically for transporting COVID suspect patients or those who have developed complications.
  2. Call centres after receiving the call will try to triage the condition of the patient and accordingly dispatch registered ambulances. However, 102 ambulances should only be used for transporting pregnant women and sick infants.
  3. Ambulance staff (technicians as well as drivers) should be trained and oriented about common signs and symptoms of COVID-19 (fever, cough and difficulty in breathing). 
  4. Both the EMT and driver of the ambulance will wear PPE while handling, managing and transporting the COVID identified/ suspect patients.
  5. Prior to shifting the patient, EMT will seek the above-mentioned details again to ascertain if the patient suffers from a COVID-19 infection and assess the condition upon reaching the patient’s home. The EMT will wear triple-layered masks and PPE. The EMT can assist the patient on to the ambulance if the patient is not stable enough and only one caregiver is allowed to accompany the patient. After which the EMT will contact the healthcare facility for preparedness and readiness.
  6. In the ambulance, the EMT will measure the patient’s vitals and give supplemental O2 therapy if required. The EMT will also follow the necessary ventilator protocols if necessary. 
  7. After handing over the patient, the PPEs will be taken off as per protocol followed by hand washing. The biomedical waste generated (including PPE) to be disposed of in a biohazard bag (yellow bag). Inside of the ambulance will be sprayed with Sodium Hypochlorite (1%) and the exterior will also be sprayed with the same. It would be disposed of at their destination hospital. This shall again be followed by hand washing. 
  8. In case of an inter-facility transfer, the casualty medical officer will ensure that the beds and the necessary equipment are ready. 

Some of the necessary guidelines that the hospital staff will follow at the hospital include (according to the CDC) 

  1. Healthcare facilities, along with national authorities, should consider telemedicine to provide clinical support without direct contact with the patient. However, patients with any emergency warning signs such as trouble breathing, persistent pain or pressure in the chest, or inability to wake or stay awake should seek medical care immediately.
  2. Hospitals should set up separate isolated and well-ventilated waiting areas for suspected COVID-19 patients where the chairs are separated by at least one-meter distance. The waiting areas should have dedicated toilets and hand hygiene stations. Patients who are suspected to have COVID-19 should not be mixed with COVID-19 confirmed patients in isolation areas.
  3. A medical mask should be given to patients with respiratory symptoms as soon as they get to the facility if they do not already have one. All patients in the separate COVID-19 waiting area should wear a medical mask.
  4. The healthcare professionals should immediately isolate/separate patients at high risk for having COVID-19 in single-person rooms with doors closed or designated COVID-19 waiting areas.
  5. The number of accompanying family members in the waiting area for suspected COVID-19 patients should be limited (do not allow children aged lower than 18 years unless a patient or a parent). 
  6. The triage area, including a separate waiting area for suspected COVID-19, should be cleaned at least twice a day with a focus on frequently touched surfaces. Disinfection can be done with chlorine.

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