OG 4002 HRFE Medical PPE Guideline

Issued By: S. Ramey
Approved By:  Fire Chief Ken Stuebing 
Revision Date:  2022/07/08

Purpose
To provide guidance on proper medical PPE attire when attending to patients.

Operating Guidelines

Point of Care Risk Assessment
All responders should perform a point of care risk assessment for influenza like respiratory symptoms at a safe distance from the patient (~2m) and from other exposed bystanders when appropriate. 
Minimize Exposures: 
-    If the patient(s) show signs of respiratory illness, only the  minimum required number of responders should contact the patient or others already exposed.
-    When an assessment is not possible, the highest level of PPE should be used including a medical respirator.

Aerosol Generating Medical Procedures (AGMP)
Aerosol generating procedures include the use of Bag-Valve-Mask (BVM) Ventilations and being present with Paramedic crews performing endotracheal intubation. Medical PPE level RED (full PPE) should be worn in these instances. 
Risk Reduction Measures:
•    MFRs present should be limited to the minimum number required.
•    Good room ventilation should be established if possible.
•    Use a patient drape or barrier over the procedure area if possible.
•    Face shields are preferred choice for AGMP procedures and during procedures with risk of significant blood and body fluid splash.

HRFE Medical PPE Protection Levels (*Each level escalation includes the prior level PPE)

1

HRFE Approved Medical PPE
HRFE will provide all medical PPE required for medical calls, PPE includes :
-    Medical exam gloves
-    Gowns
-    Eye Protection (face shield or goggle style eye protection)
-    Masks
Responders are to follow instructions for on-scene decontamination of reusable PPE items between patient contacts and follow post call procedures for decontamination of reusable medical PPE.
A single-use face shield can be re-used by the Same user until it becomes cracked, or visibility is compromised when PPE is rationed.
PPE Risk Reduction:
•    MFRs should perform hand hygiene before donning and after doffing PPE.
•    Face or eye protection should be removed after leaving the room/area where the patient/procedure occurs and disposed of in a sealable receptacle/bag or decontaminated.
•    When wearing goggles and respirator, care should be taken while doffing as to not spread contaminants on skin outside of coverage area.
•    Follow HRFE instructions for on-scene and station decontamination of reusable PPE items.

 

 

Appendix – A [References]
1.    Nova Scotia Health Authority. COVID-19: Aerosol Generating Medical Procedures (AGMP) in Healthcare Settings. Retrieved from: http://policy.nshealth.ca/Site_Published/covid19/document_render.aspx?documentRender.IdType=6&documentRender.GenericField=&documentRender.Id=78461
2.    Canadian Agency for Drugs and Technologies in Health (CADTH). (2011). Rapid Response Report: Systematic Review Aerosol-Generating Procedures and Risk of Transmission of Acute Respiratory Infections: A Systematic Review. Retrieved from: https://www.cadth.ca/media/pdf/M0023__Aerosol_Generating_Procedures_e.pdf
3.    Center for Disease Control and Prevention. (2016). Prevention Strategies for Seasonal Influenza in Healthcare Settings: Guidelines and recommendations. Retrieved from: https://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm
4.    OSHA, CDC, NIOSH. (2015). Hospital Respiratory Protection Program Toolkit: Resources for Respiratory Program Administrators. Retrieved from: https://www.osha.gov/Publications/OSHA3767.pdf
5.    Provincial Infection Control Network. (2020). 2019 Novel Coronavirus: Aerosol Generating Medical Procedures in Healthcare Settings. Retrieved from: http://www.bccdc.ca/Health-Professionals-Site/Documents/2019-nCoV_AGMP_PICNet.pdf
6.    Provincial Infectious Diseases Advisory Committee (PIDAC). (2012). Routine Practices and Additional precautions in all healthcare Settings, 3rd edition. Retrieved from:  https://www.publichealthontario.ca/en/eRepository/RPAP_All_HealthCare_Settings_Eng2012.pdf
7.    Public Health Agency of Canada. (PHAC). (2013). Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health care Settings. Retrieved from: http://publications.gc.ca/collections/collection_2013/aspc-phac/HP40-83-2013-eng.pdf
8.    World Health Organization. (2009). Natural Ventilation for Infection Control in Health Care Settings. Retrieved from: 
9.    http://apps.who.int/iris/bitstream/10665/44167/1/9789241547857_eng.pdf
10.    World Health Organization. (2007). Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care. Retrieved from: http://apps.who.int/iris/bitstream/10665/112656/1/9789241507134_eng.pdf?ua=1
11.    Health Canada. Personal protective equipment against COVID-19: Medical gowns. Retrieved from: https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/medical-devices/personal-protective-equipment/medical-gowns.html
12.    Health Canada. Personal protective equipment against COVID-19: Medical gloves. Retrieved from: https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/medical-devices/personal-protective-equipment/medical-gloves.html
13.    Health Canada. Standards and Requirements for face shields. Retrieved from: https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/medical-devices/personal-protective-equipment/face-shields.html#a2
14.    Health Canada. COVID-19 medical masks and respirators: Information for health professionals. Retrieved from: https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/medical-devices/personal-protective-equipment/medical-masks-respirators/health-professionals.html