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Interim Recommendations for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points/Emergency Communication Centers (PSAP/ECCs) in the United States During the Coronavirus Disease (COVID-19) Pandemic

Updated July 15, 2020

Summary of Key Changes for the EMS Guidance:

Below are changes to the guidance as of July 15, 2020:

  • Reorganized recommendations into 2 sections:
    • Recommended infection prevention and control (IPC) practices for routine activities during the pandemic.
    • Recommended IPC practices when caring for a patient with suspected or confirmed SARS-CoV-2 infection.
  • Added recommendations that were included in healthcare IPC FAQs addressing:
    • Universal use of PPE for healthcare personnel working in communities with moderate to sustained transmission of SARS-CoV-2, the virus that causes COVID-19
    • Creating a process for responding to SARS-CoV-2 exposures among healthcare personnel and others.

Background

This interim guidance has been updated based on currently available information about COVID-19 and the current situation in the United States. EMS practices should be based on the most up-to-date clinical recommendations and information from appropriate public health authorities and EMS medical direction about SARS-CoV-2 infection. Most recommendations in this updated guidance are not new (except as noted in the summary of changes above); they have been reorganized into the following sections:

  • Recommended infection prevention and control (IPC) practices for routine healthcare delivery during the pandemic.
  • Recommended IPC practices when caring for a patient with suspected or confirmed SARS-CoV-2 infection.

EMS play a vital role in responding to requests for assistance, triaging patients, and providing emergency medical treatment and transport for ill or injured persons. However, unlike patient care in the controlled environment of a healthcare facility, care and transports by EMS present unique challenges because of the nature of the setting, enclosed space during transport, frequent need for rapid medical decision-making, interventions with limited information, and a varying range of patient acuity and jurisdictional healthcare resources.

When preparing for and responding to patients with suspected or confirmed SARS-CoV-2 infection, close coordination and effective communications are important among 911 Public Safety Answering Points/Emergence Communication Centers (PSAP/ECCs)— commonly known as 911 call centers, the EMS system, healthcare facilities, and the public health system. Each PSAP/ECC and EMS system should seek the involvement of an EMS medical director to provide appropriate medical oversight. When SARS-CoV-2 infection is suspected in a patient needing emergency transport, prehospital care providers and healthcare facilities should be notified in advance that they may be caring for, transporting, or receiving a patient who might have SARS-CoV-2 infection.

This interim guidance applies to all EMS personnel (i.e., prehospital EMS and medical first responders involved in 911 responses or interfacility transfers) across multiple EMS models including, but not limited to, free standing, third-service, fire-based, hospital-based, and related EMS providers. Note that fire services are also included as they respond to emergency medical calls and may do so with or without an ambulance.

Additional Key Resources:

1. Recommended infection prevention and control (IPC) practices for routine healthcare delivery during the pandemic

CDC recommends using additional infection prevention and control practices during the COVID-19 pandemic, along with standard practices recommended as a part of routine healthcare delivery to all patients. These practices are intended to apply to all patients, not just those with suspected or confirmed SARS-CoV-2 infection (See Section 2 for additional practices that should be used when caring for patients with suspected or confirmed SARS-CoV-2 infection).

Recommendations for 911 PSAP/ECCs

Municipalities and local EMS authorities should coordinate with state and local public health, PSAP/ECCs, and other emergency call centers to address the need for modified caller queries about SARS-CoV-2 infection, outlined below.

These modified caller queries should be developed in collaboration with an EMS medical director and informed by local, state, territorial, tribal and federal public health authorities, including the city or county health department(s), state health department(s), and CDC.

Modified Caller Queries

911 Public Safety Answering Points/Emergency Communication Centers (PSAP/ECCs) should question callers and determine whether the call concerns a person who might have SARS-CoV-2 infection (e.g., ask about signs and symptoms of COVID-19 or recent close contact with someone with SARS-CoV-2 infection). The query process should never supersede the provision of pre-arrival instructions to the caller when immediate lifesaving interventions (e.g., CPR or the Heimlich maneuver) are indicated.

Information about a patient who might have SARS-CoV-2 infection should be communicated immediately to EMS personnel before arrival on scene in order to limit the number of EMS personnel exposed to the patient and to allow use of appropriate PPE. As part of pre-arrival instructions, PSAP/ECCs should encourage the universal use of cloth face coverings for all persons who are safely able to wear them at the scene prior to EMS arrival. PSAP/ECCs should utilize medical dispatch protocols that are approved by their EMS medical director in consultation with the local or state public health department. These protocols should be updated, as needed, to accommodate changes in EMS availability, and/or the redirection of low acuity calls to alternate disposition (e.g., nurse triage line, telemedicine triage line).

PSAP/ECCs and EMS units that respond to calls for ill travelers at US international airports or other ports of entry to the United States (maritime ports or border crossings) should be in contact with the CDC quarantine station of jurisdiction for the port of entry (see: CDC Quarantine Station Contact List) for planning guidance. They should notify the quarantine station when responding to that location if a communicable disease is suspected in a traveler. CDC has provided job aids for this purpose to EMS units operating routinely at US ports of entry. The PSAP/ECCs or EMS unit can also call CDC’s Emergency Operations Center at (770) 488-7100 to be connected with the appropriate CDC quarantine station.

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