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Richmond Operations Update (01/15/21) - From Andy McMahan

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Please see below important information for the next few days, and some critical reminders:

Temporary Barriers: All AMR staff are reminded that temporary barriers are not permitted in ambulances during patient transport. The current recommendation is for the vehicles windows to be closed and the front HVAC system to be on “fresh air intake” with the blower on high for maximum air intake and positive pressure within the vehicle. In concert, the rear exhaust fan should be on to help pull fresh air through. Below is an excerpt from the “GMR COVID-19 Personal Protective Equipment Usage” document; a link to the entire document is given below:

9. All personnel must avoid touching their face and eyes while working and strictly adhere to donning and doffing procedures. After completing patient contact and before entering the driver’s compartment or aircraft, the driver or pilot should remove and dispose of PPE except for the appropriate mask (see provided donning and doffing procedures (provide hyperlink(s)) and perform hand hygiene with soap and water or an 60% alcohol based sanitizer to avoid soiling the compartment.

10. If the transport vehicle (aircraft or ambulance) does not have an isolated (separate) compartment, the driver or pilot for operation of the transport vehicle should remove the protective eye wear, gown and gloves and perform hand hygiene. An appropriate mask or respirator will continue to be used in accordance with these guidelines during transport by the driver or pilot. For pilots, the N-95 respirator is appropriate to wear in the presence of helmets, visors and/or night vision goggles.

11. The use of temporary partitions (sheets, blankets, plastic, etc.) is not approved in GMR ground or air vehicles. The value of these variable materials in this application is currently unproven and may present additional hazards for ground/air modalities during flight or ground transport and during decontamination procedures on these vehicles. The single most important risk mitigation strategy is the proper use of PPE in accordance with this guidance.

N95 Mask Reuse: Just to clarify, as AMR EMS providers we should be reusing our limited supply of N95 masks within the following guidelines. Below is an excerpt from the GMR guidelines which addresses this issue. If you have any further questions, please see an Operations Supervisor or RC in Health, Risk and Safety:

D. Respirator Re-Use:

1. Reuse of N95 respirators is permitted in the presence of controls that limit potential N95 respirator surface contamination (e.g., use of mask on patient or placing a cleanable face shield or procedure mask over the respirator to prevent droplet spray contamination). Additionally, unnecessary contact with the respirator surface must be minimized, strict adherence to hand hygiene and donning and doffing procedures must be practiced. Users must also physically inspect and perform a user seal check prior to each use. Respirators are used up to five times in a single shift and are discarded.

Safe N-95 respirator reuse is affected by a number of variables that impact respirator function and contamination over time. The guidelines below are designed to provide practical advice so that N-95 respirators are discarded before they become a potential risk for contact transmission or their functionality is reduced:

a) Discard N-95 respirators following use during aerosol generating procedures.

b) Discard N-95 respirators contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients.

c) Discard respirators that become damaged or wet.

d) Place your name on the strap of the respirator and place the used respirator that is clean, undamaged and in working order in a brown paper bag and place your name on the paper bag to ensure another person does not use your mask. Paper bags should be disposed of after each storage use..

e) Avoid touching any area of the respirator prior to hand hygiene. Clean hands with soap and water or an alcohol-based hand sanitizer before and after touching or adjusting the respirator (if necessary for comfort or to maintain fit).

f) Use a pair of clean (non-sterile) gloves when donning a used N-95 respirator and performing a user seal check. Discard gloves after the N-95 respirator is donned and any adjustments are made to ensure the respirator is sitting comfortably on your face with a good seal.

g) The KN-95 is not approved for re-use.

Truck Cleanliness and Inspections: Beginning Monday 18 January 2021 to address crew concerns with cleanliness, we will begin inspecting trucks at the end of the shift before crews are released at the end of shift. We need to gain control of ensuring our work environment is safe, clean and compliant with regulatory requirements. Unless specifically instructed to, vehicles should be washed, trash, linen and biohazards removed, and the cab area free of trash and/or debris.

Over the weekend of January 16-17 we will be going through the fleet as much as possible to get things back to a clean baseline, so we will be moving from a good starting point. At the end of your shift in addition to the MEDS Recon check, an OPS Lead or Supervisor needs to check your truck before leaving for your shift. Both crew members should be in attendance.

Mass gathering / Crowd / Protest Precautions. Let’s stay safe out there, please review the attached flyer in advance of possible unrest. This coming week may be challenging for all of us; please mentally prepare and have a “Go Bag” at the ready.

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