Transporting a Suspect

TRANSPORTING A SUSPECT/CONFIRMED
CASE OF COVID-19

SYMPTOMS OF COVID-19

The illness starts with a fever, followed by a cough, and then followed by a shortness of breath and some other respiratory symptoms like stuffy nose, weakness or malaise, nausea, vomiting, diarrhoea, or headaches.

Emergency warning signs for COVID-19 demanding immediate medical attention, include

  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion or inability to arouse
  • Bluish lips or face
  • Other symptoms that is severe or concerning

Algorithm for Ambulance transfer of COVID 19 patients

Orientation to ambulance staff
(technicians as well as drivers)

The people most at risk of COVID-19 infection are those who are in close contact with a suspect/confirmed COVID-19 patient and those who care for such patients in ambulance, and health care facilities

a) Training and Orientation of Ambulance Staff

Training and orientation about common signs and symptoms of COVID-19 (fever, cough and difficulty in breathing)

Awareness session about common infection, prevention and control practices including use of Personal Protective Equipment (PPE).

b) PPE & IPC measures:

Both the EMT and driver of ambulance will wear PPE while handling, managing and transporting the COVID identified/ suspect patients.

Patient and attendant should be provided with triple layer mask and gloves.

Simple public health measures like hand hygiene, respiratory etiquttes, etc. need to adhered by all.

PPE for Ambulance Staff

Management of patient on board

Monitor vitals of patient and ensure patient is stable

If required, give supplementary O2 therapy at 5 L/min and titrate flow rates to reach target SpO2 ≥90%.

For patients being transported on a ventilator to a higher center

  • Follow ventilator management protocols
  • Ensure either the EMT is trained or assisted by a doctor well versed in ventilator management

Handing over the Patient

  • On reaching the receiving hospital, the EMT will hand over the patient and details of medical interventions if any during transport.
  • After handing over the patient, PPEs to be taken off as per protocol followed by hand washing. Use Alcohol based rub /soap water for hand hygiene.
  • Biomedical waste generated (including PPE) to be disposed off in a biohazard bag(yellow bag).
  • Spray inside of the bag with 1% Sodium Hypochlorite
  • After tying, spray the exterior also with the same. Dispose off the bag at destination hospital Wash hands again
4

Disinfection of ambulance

  • Decontamination of ambulance needs to be performed every time a suspected/ confirmed case is transported in the ambulance
  • Gloves and N-95 masks are recommended for sanitation staff cleaning the ambulance
  • Damp mop floor with 1 % sodium hypochlorite disinfectant
  • Discard disposable items and infectious waste in a bio-hazard bag (yellow bag). Spray inside of the bag with 1 % Sodium Hypochlorite. After tying, spray the exterior also with the same. Dispose off the bag as per hospital policy
  • Change cotton mop water containing disinfectant after each cleaning cycle
  • Do not place cleaning cloth back into the disinfectant solution after using it to wipe a surface
  • Remove gloves and wash hands
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The following must be followed while Decontaminating The Ambulance

Disinfect (damp wipe) all horizontal, vertical and contact surfaces with a cotton cloth saturated (or microfiber) with a 1 % sodium hypochlorite solution.

These surfaces include, but are not limited to: stretcher, Bed rails, Infusion pumps, IV poles/ Hanging IV poles, Monitor cables, telephone, Countertops, sharps container.

Spot clean walls (when visually soiled) with disinfectant- detergent and windows with glass cleaner.

Allow contact time of 30 minutes and allow air dry.

Disinfection of Equipment

6

All surfaces that may have come in contact with the patient or materials contaminated during patient care should be thoroughly cleaned and disinfected using 1% Sodium Hypochlorite solution.

Clean and disinfect reusable patient-care equipment before use on another patient with alcohol based rub.

Cleaning of all surfaces and equipment should be done morning, evening and after every use with soap/detergent and water.

Equipment and surfaces are contaminated if they have come in contact with patient's skin, blood or body fluids. These can spread infection.

Ex: Stethoscopes, Blood pressure cuffs, Monitors, Stretchers , Backboards and immobilization devices, Door handles, Laryngoscope blades, Radios/Mobiles, Shelves. Other items and surfaces in ambulance or transport vehicle

It is mandatory that these are cleaned and disinfected. Using 1 % sodium hypochlorite or alcohol based Shelves at least once daily and after every patient contact.