Hospital Screening and Procedures

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TO: All Seminole County EMS System Partners

FROM: Dr. Todd Husty

DATE: March 26, 2020

RE: Hospitals Subject: SARS-CoV-2 (COVID19) Update 5

This is the latest update regarding the SARS-CoV-2 virus and the associated infection COVID-19. The bulletin addresses many aspects of the screening and treatment of suspected COVID-19 patients. All screening and procedures described in this bulletin supersede all previous bulletins. The circumstances surrounding COVID-19 are changing constantly. There are now documented cases of community spread within Seminole County and other surrounding counties within the region.

Effective immediately, the following updates have been made to the prehospital screening of COVID-19 for all agencies in the Seminole County EMS System:

Patients who screen positive for “Strict Respiratory Precautions Alert” include those with any of the following symptoms/risk factors:

  • Fever (subjective or confirmed)
  • Cough
  • Shortness of Breath
  • Diarrhea (<14 days duration)
  • Close contact with a person with confirmed COVID-19
  • Close contact with a person who has been told to self-isolate for possible COVID-19 (not tested or awaiting results)

In order to have a common notification mechanism to all area emergency departments, EMS units will be calling in a “Strict Respiratory Precautions Alert” whenever transporting a patient who meets the above criteria. Please be aware, such notification denotes that EMS personnel will be donning appropriate PPE including N-95 mask, gown, gloves, and eye protection.

In order to facilitate timely transition of care while preventing excessive PPE usage and provider exposures of both pre-hospital and emergency department personnel, this process will now be standardized throughout the region including all agencies within the Orange County EMS System, Seminole County EMS System, Maitland Fire Department, Advent Health EMS, Winter Park Fire Department, Osceola County EMS and Lake County EMS. The following hospital systems have also agreed to the handoff procedure- Orlando Health, Advent Health, Nemours Children’s Hospital, HCA and the VA Medical Center. The procedure is as follows:

  • Turn on the exhaust fan during transport
  • EMS provider will call in standard patient report and advise a “Strict Respiratory Precautions Alert”
  • Upon arrival at the receiving facility, EMS providers may open the rescue doors, but must stay in/near ambulance until given further direction from receiving facility staff, do not wonder away from the rescue
  • Once cleared to enter ED by receiving facility staff, EMS personnel will discontinue all aerosol generating procedures (nebulizers, CPAP) before entering facility
  • Once assigned a room, EMS providers will accompany their patient (in full PPE) to the assigned patient room
  • Patient hand-off will occur within the assigned patient room
  • EMS providers will exit the room taking the most direct route out of the emergency department
  • EMS providers will decontaminate their vehicle prior to doffing PPE and performing hand hygiene
  • EMS providers may then return for signatures

At this time, “Strict Respiratory Precautions Alert” patients will not be transported to free standing emergency departments.

Additional information and updates will be provided as they arise. Please assure all personnel receive this information and institute this change immediately.

Thank you for your cooperation.