Dispatch Screening and Procedures

Discontinuation of ECC Use of Strict Respiratory Precaution Questioning

On March 2, 2020, the Seminole County Chairman executed Executive Order 2020-001, declaring a Local State of Emergency due to the serious health threat related to the Coronavirus Disease 2019 (COVID-19). On March 4, 2020, the Emergency Communications Center (ECC) implemented COVID-19 screening questions during Emergency Medical Dispatch (EMD) for callers requesting emergency medical assistance. The initial COVID-19 questions where related to recent travel, especially hot zones, and current symptoms. Responding units would receive a “Strict Respiratory Precaution” (SRP) announcement from the ECC via radio for all patients answering questions that met COVID-19 possible criteria. Responding units receiving the SRP notification would utilized full PPE to prevent possible COVID-19 exposure.

Throughout the month of March, the number of people under investigation (PUI) or monitored by the Department of Health (DOH) in Seminole County began to rise. Further evaluation of the initial PSAP SPR travel questioning became irrelevant as the number of exposures in the county were no longer related to travel. It became necessary to revise the initial questions, and in conjunction with CDC, DOH and the Joint Guidance for the Florida Fire Service recommendations, the PSAP SRP questioning was updated to current COVID-19 related symptoms followed by COVID-19 testing or DOH monitoring for anyone in the household. As the number of potentially exposed citizens continue to climb, the number of SRP notifications has also climbed. Seminole County has now reached the point in which asking questions related to symptoms no longer accurately reflects a possible COVID-19 patient. It is known that some people are asymptomatic though test positive for COVID-19. We have also encountered inaccurate information from the patient being given to the ECC call taker. Additionally, all fire department agencies must continue to respond to fire related alarms in which some of the occupants or responders are, in fact, PUI with the DOH due to COVID-19. Therefore, an updated response procedure for all alarms dispatch through the ECC will begin effectively April 1, 2020, at 0700 hours.

In conjunction with Emergency Management (EM) and DOH, a CAD caution note has been entered on every address where a person suspected of being exposed to or being positive for COVID-19 resides. This caution note can be seen in the ECT/MDT comments as “DOH Monitoring.” Note, this designation means anything from a person just being monitored to a person being a confirmed case of COVID-19. In order to streamline the dispatching process and continue to provide the field units with the best notification, the following changes are being made and procedures being implemented by all fire department agencies within Seminole County.

1. The ECC call taker will no longer ask the designated series of COVID-19 questions or utilize the EVD tool in PROQA.
2. This means discontinuation of the “Strict Respiratory Precaution” notification by the ECC to the responding units and the terminology of “SRP” will no longer be used.
3. For all address with a DOH caution note, the ECC dispatcher will announce via radio, this location “Flagged by DOH Monitoring” to responding crews. This also will display in the MDT notes section.
4. Crews receiving a “Flagged by DOH Monitoring” notification will indicate a suspected COVID-19 exposed person or someone who have been tested regardless of results.
5. ECC will ask ambulatory patients to come to the door and/or meet the units outside, if possible. This is being done in conjunction with the “Step Outside” program being used by many fire department agencies in the State to limit first responder’s exposure to COVID-19.
6. ECC will document in CAD any random concerns, statement or symptoms made from the caller referenced to COVID-19.
7. It is preferred the primary paramedic on the alarm utilize full PPE and using the “canary” or “scout” approach the patient and interview them using the questions below. The canary/scout approach will be done in an effort to limit crew exposure:

Any (2) answered in box (1) AND any (1) in box (2) equals a "Strict Respiratory Caution Alert” initiation.

Box 1

Does anyone on scene have a fever (or hot to touch in room temperature) or taking a fever reducing medicine (i.e.-Tylenol, Ibprofen)?

Does anyone on the scene have a cough?

Does anyone on the scene have difficulty breathing or shortness of breath?

Does anyone on the scene have recent diarrhea – within last 14 days?

Does anyone on the scene have any other flu-like symptoms (sore throat, cough, body aches)?

Box 2

Has anyone on scene been tested for Coronavirus/COVID-19 or currently under investigation/isolation for Coronavirus/COVID-19 by public health or any other health care provider?

Has anyone on scene been in close contact with someone known to be sick with or under public health investigation/isolation for Coronavirus/COVID-19?

8. “Strict Respiratory Caution Alert” notification will be made by the on scene paramedic to the ECC. This alert terminology is in conjunction with the regional offload procedure that recently went into effect March 25, 2020. The “Strict Respiratory Caution Alert” notification is also required to all receiving facilities prior to the transport unit’s arrival.
9. The use of “Strict Respiratory Caution Alert” will be documented in the Alert Section of the EMS report.
10. Because the ECC will no longer ask the screening questions for EMD and EFD, it is imperative responding crews to use and adhere to Seminole County Executive Order 2020-006 regarding social distancing and other measure on all alarms where it is applicable and safe. Crews responding to fire related alarms must consider distancing themselves and crewmembers from occupants and/or responders when practical.
11. Responding crews should assume all alarms are a COVID-19 potential exposures until proven otherwise AND ensure full PPE is used, the canary/scout method is utilized to initially interview the patient and others on scene, limit remaining crewmember’s exposure when possible, utilize the rescue driver as the “clean man” approach, and maintain social distancing on fire related alarms.