New NFPA Resource to Help First Responders Manage Infection Control During COVID-19
The National Fire Protection Association (NFPA) has released a tip sheet that highlights information within NFPA 1581, Standard on Fire Department Infection Control Program and guidance from the Centers for Disease Control and Prevention (CDC).
Written for fire departments, NFPA 1581 can be easily translated to fit other responder needs during this unprecedented time when personal protective equipment (PPE) supplies are scarce.
As COVID-19 continues to steadily spread around the world, infection control has become a critically important topic. EMTs, paramedics, firefighters, and law enforcement officers are on the front lines of the coronavirus pandemic.
Key Takeaways from NFPA 1581 and the CDC Guidance
Designate an Infection Control Officer. According to NFPA 1581, departments should have a part- or full-time employee serving as the infection control officer (ICO) to manage all aspects of infection control, from guidance on personal protective equipment (PPE) to post-incident management and cleaning. The ICO must be knowledgeable and cognizant of infectious disease pathogens, from bioterrorism weapons like anthrax to emerging infectious diseases like SARS or COVID-19. It is critical that the ICO also maintains a strong relationship with local medical and public health officials. Per the U.S. Department of Health and Human Services, hospitals and healthcare facilities must notify department ICOs any time their members are exposed to a known COVID-19 positive patient. When notified of an infectious exposure, the ICO is responsible for notification, verification, treatment, and medical follow-up, as well as case documentation.
Keep Yourself and Your Gear Clean. The most important action responders can take to limit their exposure is to carefully clean themselves and their reusable PPE. Employees should wash their hands or use hand sanitizer that is at least 60 percent alcohol as an alternative only when hand washing is not available. For those who are looking for guidance as to when it is most important for responders to wash their hands, NFPA 1581 identifies the following times:
- After each emergency medical incident
- Immediately or as soon as possible after removal of gloves or other PPE
- After cleaning and disinfecting emergency medical equipment
- After cleaning PPE
- After any cleaning function
- After using the bathroom
- Before and after handling food or cooking and food utensils
Use Personal Protective Equipment. PPE should be used appropriately based on agency policy, local protocol, and manufacturer recommendations. With the exception of a mask, any potentially contaminated PPE should be removed when operating a vehicle. NFPA 1581 requires departments to keep infection-preventing PPE, such as gloves, eyewear, and masks, onboard all department vehicles that support EMS operations. New PPE should be donned to assist (again) with patient care, if necessary. The level of PPE needed to prevent infection varies depending on the nature of the pathogen. For the COVID-19 virus, responders should be using droplet protection.[i] This protection includes the following:
- Respirators (N-95/P-100 or greater)
- Eye protection
- Splash protection (gowns, face shield, etc.)
Limit Your Exposure. Limiting exposure can reduce your need for PPE and assist with long-term staffing availability. As departments are looking for ways to conserve their available PPE, some measures that can be taken to reduce exposure include, but are not limited to, the following:
- Add an instruction to your emergency medical dispatch protocols where after screening a 911 caller, call takers request that when safe and able, the patient await responders outside in the open air. This reduces responder exposure to contaminated surfaces and puts them in an environment where droplets are diffused more quickly. [ii]
- Limit the number of members who interact with patients. Based on the patient’s presentation and medical needs have a minimum number of responders, who are necessary to provide care, don PPE and have direct contact with the patient.[iii]
- Once a member dons PPE, they should stay in the PPE for the remainder of patient care activities. This may necessitate having an additional member drive the ambulance during transport when the patient requires two or more members to render care, but will reduce the donning and doffing of PPE mid-call, which is frequently highlighted as a high risk of exposure to responders. The member driving needs to only wear respiratory protection as long as the cab of the ambulance is sealed with a vapor lock barrier from the patient care compartment.[iv]
Expand Your Options in Times of Shortage. Because of PPE shortages, there is guidance from the CDC advising departments to either modify the protection levels of PPE being used for patient care and cleaning or reuse the PPE, after following disinfection procedures, if your levels run low. Here are some recommendations for departments to consider until adequate levels of PPE can be acquired (note that any of these procedures must only be used when there is no way to increase your PPE supply and when approved by your ICO, risk management team, and medical director):
- Instead of going down a level in respiratory protection, consider going up a level, such as with a powered air purifying respirator (PAPR) with the appropriate filter or cartridge. PAPRs are frequently reusable and provide splash and eye protection at the same time. [v]It may be easier and more cost effective, in the long term, to invest and train your members about solutions such as these - while still providing baseline minimum droplet protection to your members.
- Work with your ICO, agency risk management, subject matter experts, and your medical director to develop protocols that allow for triaging the use of remaining higher-level PPE. [vi]For example, based on the CDC guidance for reserving the use of N-95 respirators, only use them on calls where there is a high-risk exposure level and on lower risk calls, use an approved lower level of protection or perhaps an expired piece of PPE that has been tested to meet CDC guidelines that may be more readily available. Examples of high-risk exposures include but are not limited to:
- Aerosolizing procedures like nebulizer treatments, or endotracheal intubation
- When a patient is actively coughing or generating sputum into the patient care environment
- When a patient has a positive test and respiratory symptoms, like a productive cough
- Increase your buying power by partnering up. In the current environment, leverage your contracts, mutual aid agreements, and memorandums of understanding to work with community partners and public health officials to try and acquire PPE together rather than competing against each other. If that is unsuccessful, use the National Incident Management System and your emergency management partners to run resource and logistical requests up the incident management chain.[vii] Note that in many states, this requires a gubernatorial emergency declaration; if your state hasn’t made one, please encourage your leaders to consider making one
Keep up with the latest COVID-19 news and information using the following resources below. As the world continues to grapple with this crisis, NFPA will continue to generate key resources and information that address responder safety, emergency planning, building, fire and life safety issues.
- Free online access to NFPA 1581
- Federal Coronavirus website
- CDC Interim Guidance for EMS
- NHTSA Office of EMS
- IAFC information page
- IAFF information page
- NVFC information page
- NAEMT information page
- American Ambulance Association information page
- HHS HIPAA advisory for infectious disease exposure information sharing
- World Health Organization
Points i-vi based on March 10, 2020 Covid-19 Interim Guidance for EMS Providers, Center for Disease Control and Prevention
Point vii - based on NFPA 1600; Standard on Continuity, Emergency, and Crisis Management