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Living the Pandemic on the Front Lines & Lessons Learned From a Pre-Hospital Care Perspective.

No part of the healthcare system in NYC has been hit harder than the 911 system and the first responders who work in the pre-hospital setting. Chris Root @gueromedico and I talk about the experience, PPE, personal safety, cardiac arrest protocols, airway and how to stay sane during the COVID19 crisis. This one went a little long, but lots of great stuff here.

Summary Take Home Points

  • PPE is your first and most important line of defense. It works when utilized properly. N95 mask, face shield, gown, bouffant cap and double gloves.
  • Hypoxia alone cannot be a trigger to intubate. Many of these patients really need oxygen flow more than positive pressure. Nasal cannula or non-rebreather can temporize them until you can get them to a setting where treatments like high-flow nasal cannula or CPAP can be safely administered in a negative pressure environment.
  • Use a HEPA filter any time mechanical ventilation is being provided. If you takeover care and the first responding unit is providing ventilations without a HEPA filter, attach one to the BVM before continuing with the resuscitation.
  • Early airway management in a COVID cardiac arrest. This is an issue of provider safety. Intubation or placement of a supraglottic device with a HEPA filter attached will mitigate the biggest source of aerosols and droplets during the resuscitation.
  • We can’t maintain social distancing from our partners on the ambulance. Wear a mask at all times while on duty, wipe down surfaces in the cab regularly, step out of the cab to eat or drink, Purell constantly.
  • Working EMS during a pandemic is traumatic. It’s important to be able to vent to people who get what you’re going through. Reach out to your colleagues and avail yourself of any peer support available through your organization.

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