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Since December 2019, COVID-19 - a highly contagious viral infection which originated in China - has rapidly spread across the entire world. As of March 2020, 178 countries have been affected, with China, the US, Italy and Spain being some of the worst-hit nations. 

The rapid and unprecedented spread of the COVID-19 infection is putting a huge strain on healthcare providers all over the world. Not only do travellers and suspected patients need to be isolated, but confirmed patients need to be constantly monitored. Patients who are aged and/or have underlying conditions like diabetes, hypertension, heart disease, cancer, etc., are at an increased risk of complications due to COVID-19 infection, so these patients need added surveillance and care.

To be sure, home-based care for COVID-19 patients is recommended in most cases. However, where there is a need for hospitalization, ambulance services and emergency medical technicians (EMTs) have to stay on their toes, taking care of the transportation of suspected patients to the hospitals for much-needed care.

The proper transportation of suspected patients from their homes to the hospitals is an essential service, and the Indian Ministry of Health and Family Welfare (MoHFW) has issued guidelines for this transportation which need to be strictly followed by all healthcare providers. Here’s everything you need to know about these guidelines.

  1. Why is safe transportation of suspected COVID-19 patients important?
  2. Guidelines for emergency call centre employees
  3. Types of ambulances and uses
  4. Guidelines for EMTs, ambulance staff and driver
  5. On-board management of suspected COVID-19 patients
  6. Handing over suspected patient to the hospital
  7. Disinfection of ambulance after transportation
  8. Doctors for How to take a COVID-19 patient to hospital: government guidelines

Since COVID-19 is a highly infectious disease and is already rapidly spreading all over the world, dealing with suspected patients with utmost care towards hygiene and safety is vital. Anybody who comes in contact with a COVID-19 patient is at risk of getting infected, which not only puts the patient’s loved ones at risk but also healthcare providers.

This is the reason why the safe transportation of suspected COVID-19 patients is of the utmost importance while the pandemic is still raging. The MoHFW has issued precise guidelines to be followed by ambulance call centre employees, ambulance staff, EMTs and hospital staff.

If a person staying at home shows symptoms of COVID-19, they are supposed to call emergency services instead of showing up at the hospital themselves. The call centre employees are the bridge between the patient and the closest hospital prepared to deal with suspected COVID-19 patients. It’s their primary responsibility to dispatch appropriate ambulance services and medical professionals to the patient’s home, while also making sure that the hospital where the patient is being sent has proper and detailed information about the patient’s condition.

Hence, call centre employees need to get full details about the following before dispatching ambulance services:

  • The patient's name, age, gender, location, etc.
  • List of all the symptoms being experienced by the patient, including whether the patient has fever, cough and shortness of breath.
  • Whether the patient has recently returned from a foreign country.
  • Whether the patient was placed under home quarantine by airport or local authorities or by healthcare professionals.
  • Clinical condition of the patient; that is, whether he or she is stable or critical.

After ascertaining these details, the call centre employee is supposed to communicate with ambulance services and hospitals and relay these details.

Depending on the severity of the patient’s condition, call centre employees are supposed to dispatch appropriate ambulance services. There are three types of ambulances available for patient transportation currently:

  • Advanced life support or ALS ambulances with ventilators for severely ill patients.
  • Basic life support or BLS ambulances without ventilators for non-critical patients.
  • 102 ambulance or free ambulance services, for patients of other diseases and health issues like pregnant women, children, elderly patients. These ambulances are not meant to be used for COVID-19 patients.

Ambulance service providers can also convert other available ambulances for the transportation of suspected COVID-19 patients, but they have to make sure that these ambulances are properly disinfected before and after use to avoid the spread of COVID-19.

Ambulance staff (technicians as well as drivers) should be trained and oriented about common signs and symptoms of COVID-19 (fever, cough and difficulty in breathing). They should also be aware about common infection, prevention and control practices including the use of Personal Protective Equipment (PPE). (Read more: 10 steps to put on and take off PPE for medical professionals)

On receiving the call for the ambulance, EMTs, ambulance staff and the driver have to take ample precautions before departing to collect the patient. The EMTs and ambulance staff must ensure the following:

  • Check the call transcript and details collected to ensure whether the patient is a suspect case of COVID-19.
  • All staff should wear the appropriate PPE.
  • On reaching the patient, the EMT or ambulance staff must assess the condition of the patient and assist in loading the patient.
  • Only one caregiver from the patient’s family should be allowed to accompany the patient, and this caregiver should also wear the appropriate PPE.
  • The EMT or ambulance staff must provide the patient and caregiver with a triple layer medical mask, gloves, etc.
  • The EMT or ambulance staff should contact the identified healthcare facility or hospital and confirm their preparedness and readiness.

Once the patient and his or her caregiver are given PPEs and placed in the ambulance, the EMTs and ambulance staff must make sure that the following are done while en route to the hospital or healthcare facility:

  • Measure the vitals of the patient, and ensure that the patient is stable. 
  • If required, give supplemental oxygen or O2 therapy at 5 L/min and titrate flow rates to reach target SpO2 ≥90%. SpO2 stands for blood oxygen saturation levels or the percentage of haemoglobin that is actually linked to oxygen in the blood. These levels are between 94% and 99% in healthy individuals and can be around 90% in those with mild respiratory illnesses.
  • If the patient is being transported on ventilator to an advanced healthcare facility, follow ventilator management protocols, provided the EMT is either trained or assisted by a doctor well versed in ventilator management.

The moment the ambulance reaches the designated hospital, the ambulance staff and EMTs are supposed to hand over the patient to the hospital staff via due process. These are the protocols that must be followed at this stage:

  • The EMT and ambulance staff will hand over the patient while providing all details of the patient’s condition, including any medical interventions which may have been performed during transport.
  • Once the patient is handed over, the EMTs and ambulance staff will take off the PPEs as per protocol and wash their hands with soap and water. An alcohol-based hand sanitizer can also be used. 
  • Biomedical wastes from the ambulance, including the PPEs, should be disposed of in a biohazard bag. The inside of the bag must be sprayed with sodium hypochlorite, the bag must then be tied, and the outside should be sprayed as well. The bag should be disposed of with other biohazard wastes at the hospital itself.
  • This disposal of biohazard wastes should be followed by another round of handwashing.

It’s not just the ambulance staff, EMTs, etc., who must go through a proper disinfection protocol after transporting a suspected COVID-19 patient. The ambulance itself needs to be strictly disinfected and made ready for the next patient. The following things must be done to disinfect the ambulance:

  • All surfaces that may have come in contact with the patient or materials contaminated during patient care (e.g., stretcher, rails, control panels, floors, walls and work surfaces) should be thoroughly cleaned and disinfected using 1% sodium hypochlorite solution. 
  • Clean and disinfect reusable patient-care equipment with an alcohol-based rub before use on another patient. 
  • Cleaning of all surfaces and equipment should be done every morning and evening as well as after every use with soap/detergent and water.
Dr. Sunil Sharma

Dr. Sunil Sharma

General Physician
5 Years of Experience

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Dr. Komal Poswal

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References

  1. Ministry of Health and Family Welfare [Internet]. Government of India. New Delhi. India; Coronavirus Disease 2019 (COVID-19): Standard Operating Procedure (SOP) for transporting a suspect/confirmed case of COVID-19.
  2. Ministry of Health and Family Welfare [Internet]. Government of India. New Delhi. India; Guidelines of Clinical Management of COVID-19.
  3. National Centre for Disease Control [Internet]. Civil Lines. New Delhi. India; COVID-19 Outbreak: Guidelines for Setting Up Isolation Ward.
  4. Liew, Mei Fong. et al. Safe patient transport for COVID-19. Critical Care volume 24, Article number: 94 (2020)
  5. Centers for Disease Control and Prevention [Internet], Atlanta (GA): US Department of Health and Human Services; Healthcare Infection Prevention and Control FAQs for COVID-19
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