0 Preparation - start of shift
- Check the latest information on the COVID-19 Clinical Response page along with other SJWA published resources relating to operational settings
- Check that you have all required personal PPE in your PPE grab bag
- Ensure that your vehicle has an adequate extra stock of PPE including:
- Gowns / Coveralls
- Eye protection (Safety glasses or Face shields)
- P2/N95 Respirator
- Surgical face masks (When attending to patients these are for patient use only)
- Check that the vehicle has an adequate supply of cleaning equipment including clinical waste bags, hand hygiene items and Clinell universal wipes
1 En-route to call
- Assess the information on the call card to formulate a plan and consider risks
- When infective respiratory conditions / COVID-19 are considered, discuss with your crewmate and formulate a plan for patient contact. This includes discussing alternatives if the primary plan cannot be followed.
- Anticipate what PPE may be required by the patient and the crew
2 Don initial PPE
- Based on your initial risk assessment, patient symptoms and epidemiological criteria, don PPE to allow a safe approach to scene to conduct a "From the Door" assessment
- Ensure a PPE Buddy Check is completed as well as a respirator fit check
Read the COVID-19 Interim PPE Guidelines
3 On scene
- Adopt a cautious approach and assess all risk
- Consider whether both officers need to approach the scene
- Conduct a "From the Door"/physically distanced assessment if this is possible and appropriate based on patient priority
Note: The Registered Paramedic or most senior clinician on the crew must perform the from the door assessment irrespective of crew roles on that shift
- Is anyone currently under home isolation / quarantine orders?
- Has anyone been overseas or to any known hotspots either locally or interstate?
- Does anyone inside have a fever or dry cough?
- Has anyone been in contact with a confirmed COVID-19 patient?
- Has anyone inside been diagnosed with pneumonia or any other medical condition?
or for inter-hospital transfers
- Is there a clinical concern around an infection (COVID-19 or otherwise)?
- Has the patient been tested for COVID-19 and is that result known?
- Establish the clinical complaint, urgency, risk of infective respiratory illness and the possible need for high risk procedures that may cause aerosolising of the virus
- Don additional PPE as required based on your risk assessment, if both officers are required to don PPE (if not already done) etc.
4 Patient Care
- Patient to wear surgical mask (if tolerated and clinically appropriate) and carry out hand hygiene
- Limit assessment to those necessary to minimise close contact time
- Treat per COVID-19 Patient Clinical Management guideline and SJA Clinical Practice Guidelines
- Limit aerosol-generating procedures (AGPs) where possible using alternate treatment methods (for example, MDI + Spacer as opposed to nebulisation) where available and clinically appropriate
- Call CSPSOC for clinical advice if required
- Encourage patient to mobilise and do as much for themselves as possible - attempt to limit moving and handling, again, where patient condition allows
- If patient able, consider the following when administering oral medication (e.g. Ondansatron wafer, Paracetemol, Olanzapine)
- Place the medication in the patient's hand
- Instruct the patient to self-administer
- Replace the mask
- Provide hand sanitiser to the patient
- When completing your ePCR / PCRF include reference to suspected COVID-19 and PPE worn
5 Transporting the Patient
- Maintain appropriate PPE
- Avoid AGPs where appropriate inside vehicle
- Setup treatment compartment airflow per WIAMB22 relating to ambulance airflow
- Partially Doff prior to entering front cabin/drivers seat
- Remove Gown and Gloves
- Perform hand hygiene
- Maintain P2/N95 respirator and, if able to without impeding road view, eye protection
- Transport with good ventilation (see WIAMB22 linked above)
- Doff per the PPE Doffing Guide
Doffing is a high-risk time for potential contamination - use a buddy check method and support your crew mate to ensure they doff safely
- Don clean PPE
- Clean vehicle per Ambulance Cleaning (WIAMB23) guide ensuring appropriate ventilation time
- Clean all commonly touched areas of front cab (e.g. door handles, steering wheel, radio, vehicle keys)
- Clean all equipment and surfaces that have confirmed or potential contamination in treatment compartment
- Clean all surfaces frequently touched by anyone during patient care (kits/bags, medication pouch, etc.)
- Ensure floor is clean
- Make stretcher and return to ambulance
- Doff PPE
- Restock as required in line with existing operational guidelines