0 Preparation - start of shift

1. Check the latest information on the COVID-19 Clinical Response page along with other SJWA published resources relating to operational settings
2. Check that you have all required personal PPE in your PPE grab bag
3. 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)
4. 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

1. Assess the information on the call card to formulate a plan and consider risks
2. 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.
3. Anticipate what PPE may be required by the patient and the crew 

2 Don initial PPE

1. 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
   • PPE Donning Guide 
2. Ensure a PPE Buddy Check is completed as well as a respirator fit check

Read the COVID-19 Interim PPE Guidelines

3 On scene

1. Adopt a cautious approach and assess all risk
2. Consider whether both officers need to approach the scene
3. 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?
4. 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
   
5. 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

1. Patient to wear surgical mask (if tolerated and clinically appropriate) and carry out hand hygiene
2. Limit assessment to those necessary to minimise close contact time
3. Treat per COVID-19 Patient Clinical Management guideline and SJA Clinical Practice Guidelines
4. Limit aerosol-generating procedures (AGPs) where possible using alternate treatment methods (for example, MDI + Spacer as opposed to nebulisation) where available and clinically appropriate
5. Call CSPSOC for clinical advice if required
6. Encourage patient to mobilise and do as much for themselves as possible - attempt to limit moving and handling, again, where patient condition allows
7. 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
8. When completing your ePCR / PCRF include reference to suspected COVID-19 and PPE worn
   

5 Transporting the Patient

Treating officer

1. Maintain appropriate PPE
2. Avoid AGPs where appropriate inside vehicle
3. Setup treatment compartment airflow per WIAMB22 relating to ambulance airflow
   

Driver

1. Partially Doff prior to entering front cabin/drivers seat
   • Remove Gown and Gloves
   • Perform hand hygiene
2. Maintain P2/N95 respirator and, if able to without impeding road view, eye protection
3. Transport with good ventilation (see WIAMB22 linked above)

6 Doffing

1. 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

7 Cleaning

1. Don clean PPE
2. Clean vehicle per Ambulance Cleaning (WIAMB23) guide ensuring appropriate ventilation time
3. Clean all commonly touched areas of front cab (e.g. door handles, steering wheel, radio, vehicle keys)
4. Clean all equipment and surfaces that have confirmed or potential contamination in treatment compartment
5. Clean all surfaces frequently touched by anyone during patient care (kits/bags, medication pouch, etc.)
   
6. Ensure floor is clean
7. Make stretcher and return to ambulance
8. Doff PPE
9. Restock as required in line with existing operational guidelines