Guidance for EMS on the Use of PPE in Long Term Care Facilities
The purpose of this communication is to share new guidance on the use of Personal Protective Equipment (PPE) by First Responders and EMS when entering a nursing home or rest home (long term care facility).
In alignment with the Centers for Medicare and Medicaid Services (CMS) and due to the widespread community transmission of COVID-19, the Department of Public Health (DPH) is advising all first responders, including but not limited to, fire personnel, law enforcement, and EMS personnel, to assume when responding to an event at a long term care facility that the individuals they are interacting with are infected with COVID-19. First responders and EMS personnel should don the appropriate PPE recommended for caring for individuals who are infected with COVID-19.
There is also a document with Nursing Home Frequently Asked Questions (FAQs) for First Responders & Municipalities.
OEMS to issue Temporary EMT Certifications
The Massachusetts Department of Public Health (DPH) continues to work with state, federal and local partners on the outbreak of novel Coronavirus 2019 (COVID-19), caused by the virus SARS-CoV-2, and we continue to appreciate the essential role you have in responding to this evolving situation.
In accordance with the Commissioner of Public Health’s April 3, 2020 order maximizing health care provider availability, to respond to Governor Baker’s declared State of Emergency, the Department is issuing temporary EMT certification, upon request, to applicants who either:
Currently hold EMT certification/licensure, at any level) in another state, which has not been revoked, suspended, surrendered or are otherwise not in good standing in another state; OR
Previously held Massachusetts EMT certification, but it has expired within the last 10 years (at any level). This does not include certifications that have been revoked, suspended or surrendered.
Applicants may request these temporary certifications by emailing oems.recert@state.ma.us, or by completing the attached application form (soon to be available on the DPH/Office of Emergency Medical Services website), and submitting it to the office by FAX or mail, along with copies of their current CPR credential (and ACLS for Paramedics). DPH will not accept or review requests for temporary certification from applicants who do not have current CPR or ACLS, as appropriate to their level, credentials. Note that due to the COVID-19 State of Emergency, any CPR or ACLS credential that expired on or after February 1, 2020, is deemed current through July 1, 2020. Applicants who currently or have previously held certification in other states will need to provide a verification from the other states (the applicant must request verification from the state in which the applicant is certified; that state (or states) must complete the form and submit it directly to DPH/OEMS). National Registry of EMTs (NREMT) certification is not required for temporary certification, and there is no fee.
Once OEMS receives a complete application, we will expedite review and processing, and temporary EMTs will receive an email confirmation once the temporary certification has been issued. Temporary certifications will be immediately visible at https://checkalicense.hhs.state.ma.us, and may be verified there at any time.
Temporary certifications will remain valid until the termination of the state of emergency for out of state EMTs, and 90 days following the termination of the state of emergency for previously MA certified EMTs. Temporary EMTs who wish to become fully certified as EMTs after their temporary certification expires must meet all the standard regulatory entry/reinstatement requirements (including holding National Registry certification).
Temporary EMTs may function in connection with a licensed ambulance service at the full scope of practice for their level – but must do so in accordance with Statewide Treatment Protocols and must have received authorization to practice from the service’s affiliate hospital medical director. Ambulance services are responsible for ensuring Temporary EMTs receive required education/orientation and authorization to practice before they begin to work.
Please contact oems.recert@state.ma.us with any additional questions
OEMS Issues Comprehensive Personal Protective Equipment (PPE) Guidance
The purpose of this communication is to share comprehensive guidance, based upon the Centers for Disease Control and Prevention (CDC) recommendations, to clarify the Personal Protective Equipment (PPE) that health care personnel (HCP) use in the clinical care areas, particularly during this time when we are optimizing our supplies.
This guidance includes information about facemasks, eye protection, isolation gowns, gloves, respirators, and PPE for COVID-19 Patient Care.
The Massachusetts Department of Public Health (DPH) continues to work with state, federal and local partners on the outbreak of Coronavirus Disease 2019 (COVID-19), caused by the virus SARS-CoV-2, and we continue to appreciate the essential role you have in responding to this evolving situation.
Temporary MIH Applications for COVID-19
The Massachusetts Department of Public Health (DPH) continues to work with state, federal and local partners on the outbreak of novel Coronavirus 2019 (COVID-19), caused by the virus SARS-CoV-2, and we continue to appreciate the essential role you have in responding to this evolving situation.
In response to the COVID-19 outbreak, DPH is releasing the below document:
Memorandum providing guidance on applying for a temporary Mobile Integrated Health Care (MIH) license during the duration of the COVID-19 emergency. DPH will waive fees and expedite review for applicants that meet the requirements outlined in the guidance.
For any questions about the Protocol, please contact please contact the MIH manager at MIH@state.ma.us or via phone at (617) 753-8484.
The DPH COVID-19 website, which is updated on a daily basis, can be accessed at www.mass.gov/2019coronavirus.
Guidance: Health Care Personnel with Potential Exposure to Patients with COVID-19
From DPH:
Dear Colleagues,
The purpose of this communication is to share the attached new guidance from the Department of Public Health (DPH) on health care personnel with potential exposure to patients with COVID-19, issued in accordance with guidance from the Centers for Disease Control and Prevention (CDC), Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19).
DPH strongly encourages all health care facilities and providers in Massachusetts to monitor the Centers for Medicare & Medicaid Services (CMS) website and the Centers for Disease Control and Prevention (CDC) website for up-to-date information and resources:
CMS website: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
CDC website: https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/index.html
Additionally, please visit DPH’s website that provides up-to-date information on COVID-19 in Massachusetts: https://www.mass.gov/2019coronavirus.
Order of the Commissioner of Public Health Regarding the Sharing of Critical Information with First Responders
The Massachusetts Department of Public Health (DPH) continues to work with state, federal and local partners on the outbreak of novel Coronavirus 2019 (COVID-19), caused by the virus SARS-CoV-2, and we continue to appreciate the essential role you have in responding to this evolving situation.
In response to the COVID-19 outbreak, the Commissioner signed the attached Order requiring local boards of health to disclose to the official with the responsibility for administering the response to emergency calls in their jurisdiction the addresses of any individuals living in their jurisdiction who the local board of health has been informed have tested positive for COVID-19. The disclosure of this information is limited to an individual’s address only. No other identifying information, including names, will be provided to emergency responders. Information disclosed as part of this Order is to be used for responding to emergency calls only.
UPDATED INFORMATION - REGION IV PPE CACHE BEING RELEASED
The Metropolitan Boston EMS Council, Inc (MBEMSC) in 2010 purchased a regional cache of PPE using funds from a private grant. The intent of the cache was to be able to provide Region 4 EMS services with access to PPE in the time of a severe supply chain demand issue for service providers unable to receive ordered supplies through their routine vendors during a pandemic or other incident. MBEMSC purchased enough PPE for 25,000 patient encounters. The supply of PPE includes gowns, surgical masks, and goggles. While the cache does have N95 masks in them they will not be released, initially due to expiration. The Council is actively working with the FDA, CDC, and NIOSH to expand the shelf-life of the N95s.
As of March 16, 2020 the Metropolitan Boston EMS Council has elected to release its PPE cache based on these guiding principles:
1. The cache is for MBEMSC EMS Services only. While many entities across the state are short on supplies, this cache was implemented for Region-4 EMS distribution only. As such, only the EMS services that fall within Region 4 are eligible to participate.
2. The cache must be replenished. When the supply chain is restored, replacement PPE will be ordered.
3. In order to replenish the inventory, participating services will need to purchase the cache items. Since the cache was developed with private funds (and not state/federal funds), services wishing to participate will be required to purchase the supplies they receive. Pricing is based on industry pricing. Items will be sold at market value incorporating estimated associated costs such as shipping/handling.
4. Expired items will not be distributed, initially. This only applies to N95s, which are all expired. MBEMSC is actively working with the FDA, CDC, and NIOSH to expand the shelf-life of the N95s that are in the cache. Likely, the only way these will be used is if all other methods of N95s and surgical masks are depleted nationally.
5. Distribution must be equitable. Distribution of the cache will be based on an EMS services 2019 call volume. Many (if not all) services are facing various degrees of shortages. To best gauge need & risk, current PPE status will not be factored into the distribution. Instead, current PPE status is being collected to provide state and federal resources with a more accurate summary of our regional needs.
6. Distribution will be performed once. To facilitate the rapid release of supplies, once the quantity of supplies allocated per service is calculated, all available supplies will be released. It is important to note that some services may not immediately need all items that they are allotted. In the event your service is allotted supplies you do not need, please notify us prior to payment/receipt of supplies so that redistribution can be evaluated.
7. Payment must be received before receipt of supplies. To ensure the future replacement of the cache, once your service’s allotment has been determined, you will receive an order form with the amount due. Prior to receiving your supplies, you will need to submit payment to MBEMSC in the form of check or money order.
In order to participate in the cache release, please submit this survey by 12:00 PM on Wednesday, 03/18/2020. https://www.surveymonkey.com/r/MBEMSC-PPE-03162020
We’re pleased to be able to offer this service. If you have any questions, don’t hesitate to call our Office.
Updated Guidance: Policies and Procedures for Restricting Resident Visitors in Nursing Homes and Rest Homes during COVID-19 Outbreak
The purpose of this communication is to share updated guidance from the Department of Public Health (DPH) on policies and procedures for restricting resident visitors in nursing homes and rest homes and Personal Protective Equipment (PPE) recommendation updates during the COVID-19 outbreak.
Updated Guidance on Strategies to Optimize Use of Personal Protective Equipment for Health Care Facilities and Providers
For up-to-date information on COVID-19 and resources, please visit DPH’s website at https://www.mass.gov/2019coronavirus.
COVID-19 Updates - CDC for EMS Personnel
Important updates from the Centers for Disease Control and Prevention (CDC) on interim guidance for EMS personnel who anticipate close contact with individuals with suspected or confirmed novel Coronavirus 2019 (COVID-19) in the course of their work:
The interim guidance has been updated based on currently available information about COVID-19 and the current situation in the United States, which includes reports of cases of community transmission, infections identified in healthcare personnel (HCP), and shortages of facemasks, N95 filtering facepiece respirators (FFRs) (commonly known as N95 respirators), and gowns.
The full guidance is available online at https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html. Please share this guidance broadly with EMS personnel working for your ambulance service.
Key points from the guidance updated on March 10, 2020 include the following:
Early reports suggest person-to-person transmission most commonly happens during close exposure to a person infected with COVID-19, primarily via respiratory droplets produced when the infected person coughs or sneezes. Airborne transmission from person-to-person over long distances is unlikely.Based on local and regional situational analysis of PPE supplies, facemasks are an acceptable alternative when the supply chain is limited.When shortages have been identified, available respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk to EMS and healthcare personnel.Eye protection, gown, and gloves continue to be recommended. If there are shortages of gowns, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of EMS and healthcare personnel. When the supply chain is restored, fit-tested EMS clinicians should return to use of respirators for patients with known or suspected COVID-19. Clean and disinfect the vehicle in accordance with standard operating procedures. All surfaces that may have come in contact with the patient or materials contaminated during patient care should be thoroughly cleaned and disinfected using an EPA-registered hospital grade disinfectant in accordance with the product label.The Environmental Protection Agency (EPA) has updated guidance about recommended EPA-registered disinfectants that meet the criteria for use against SARS-CoV-2, which is posted online at: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2.
Temporary AR-2-212 EMT Continuing Education Change
With the concern of COVID-2019, many facilities have cancelled their M&M Rounds and other training sessions. In response to these cancellations, and for the safety of our providers, the Department has temporarily changed AR-2-212 to allow for a provider who is renewing their certification during this renewal period to complete more of their training via Distributive Education.
· These restrictions are temporarily adjusted as follows:
o One-third (1/3) of the continuing education course hours to meet the National category may be done through Distributive Education.
o Two thirds (2/3) of the hours for the Local category can be done through Distributive Education.
o All of the hours to meet Individual category may be done through Distributive Education, in accordance with the NCCP.
As of April 1, 2020, the restrictions on distributive education will revert to the prior standard with respect to the Local category, as described above. There are no required courses or content that must be taken for this category at this time. Please keep in mind that all EMTs working for an ambulance service as EMTs have required courses in order to staff ambulances. If these courses receive OEMS Continuing Education approval numbers, they may be eligible towards renewal of an individual’s EMT certification.
Continuing Education - Special Credit Application
We are happy to share a new tool I think many will be excited to see—a form and instructions for Special Credit. This is designed for EMTs looking to receive continuing education credit for college courses (including RN/PA/MD), as well as other health education (conferences, etc.) The form asks EMTs to provide information about the courses, how they relate to EMS, and gives direction on what supporting documentation to attach.
the form has been posted on the mass.gov website, at https://www.mass.gov/service-details/ems-continuing-education and the form is at https://www.mass.gov/doc/special-credit-request-form/download.
Interim Guidance for EMS and PSAPs for the 2019 Novel Coronavirus
Image courtesy of the CDC
Please find a link to new interim guidance for EMS and PSAPs for the 2019 Novel Coronavirus issued by CDC. CDC’s Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for 2019-nCoV in the United States
You may search on the CDC.gov website for the title if you choose not to click on the link.
From the CDC: Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-nCoV)
From Mass DPH:
“The purpose of this communication is to share with you that we have confirmed Massachusetts’ first case of 2019 novel Coronavirus (2019-nCoV), identified in Boston, and to provide you with the most up-to-date guidance regarding patient screening and health department notification procedures. From Mass DPH
We reiterate that the risk to Massachusetts residents at this time remains low.
Please read and share the attached Centers for Disease Control and Prevention (CDC) documents with your colleagues and organizations.
Following the clinical evaluation, contact the Massachusetts Department of Public Health (DPH) 24/7 at (617) 983-6800 for assistance in determining if the patient meets the criteria of a Person Under Investigation (PUI) requiring testing.
DPH has launched a new website that provides up-to-date information on the status of 2019-nCoV for all clinicians and residents: https://www.mass.gov/2019coronavirus”
CDC HAN 47 Update 2019—nCov 02 01 2020
Identify and Asses 2019-nCov
Man Returning from Wuhan China is First Case of 2019 Novel Coronavirus Confirmed in Massachusetts
Emerson Hospital CMED
All services utilizing Emerson Hospital please be advised that the CMED connection to the emergency department has been repaired and is fully operational.
All EMS services are advised to contact the Emerson Hospital ED via the CMED radio through Boston CMED for all entry notifications, alert notifications, and medical control.
Should you have any questions regarding this please contact the regional office.
BID-Milton CODE BLACK 11/16 - 11/17/19 beginning at 20:00 Hours
Please be advised that BID-Milton will be going on Code Black beginning Saturday, 11/16/19 at 20:00 hours for scheduled construction work at their facility and it will end on Sunday, 11/17/19 at 06:00 hours. Ambulance services are being requested to seek alternate transport destinations for patients during this time frame. Further details regarding the Code Black can be found below.
Code Black– Ambulance Diversion
Event: Scheduled water shut down – Complete Facility (Domestic ONLY, does not impact fire suppression devices)
Period: Date and Time (From): Saturday, November 16, 2019 @20:00 hours
Date and Time (Until): Sunday, November 17, 2019 @ 06:00 hours
Reason:
BID-Milton is currently conducting a construction project of its new pharmacy to ensure compliance with revised USP 797 regulations. The date of this event has been selected to ensure completion of the project within the identified regulation timeframes.
As part of this project, there is a need to reconfigure the domestic water supply piping in the construction area. The hospital does not have the ability to limit water shut off to specific areas of the hospital; therefore it will be necessary to schedule a shutdown of its domestic water supply for the entire facility for the period identified previously. At the direction of the hospital’s facilities leadership no other alternative scenarios are possible specific to water supply management for this project. It is important to note: This shut down will not impact the hospital’s fire suppression devices.
Response
As described below the hospital has activated its Incident Command System process to optimize the planning, response and recovery of this scheduled event.
Impact:
Apart from the Emergency Department, it has been identified that the hospital will be able to maintain limited operational capabilities for departments that are normally open during this period. The hospital has selected this period since it is normally sees the lowest volume of patients in its Emergency Department between late Saturday evening and early Sunday morning.
Plan:
Emergency Department:
— BID-Milton is requesting ambulance diversion during this period – requesting start 2 hours (20:00 hours) prior to actual shutdown (22:00 hours) to reduce volume of high acuity patients at time of shutdown.
— Patient’s arriving by private transportation will be rapidly triaged, a medical screening exam performed and if the patient’s medical management exceeds the capability of the hospital at that time – they will be transferred by ambulance to firstly an alternative Beth Israel Lahey Health System Hospital or a non-system hospital based upon patient needs and bed availability (Other entities have been notified of potential). The hospital will work with the ambulance service to cover the cost of these transfers – rather than the patient.
— The hospital has coordinated with Brewster Ambulance Services to have an Ambulance permanently stationed at all times outside the Emergency Department to expedite patient possible transfers.
— Patients that do not require transfer will be managed and either admitted (< 20% of ED volume patients) or discharged.