This section provides guidance for workers and employers involved in providing emergency services such as emergency medical services (EMS) and medical transport, fire and rescue, and law enforcement. This guidance supplements the general interim guidance for workers and employers of workers at increased risk of occupational exposure to SARS-CoV-2.
Employers should remain alert of changing outbreak conditions, including as they relate to community spread of the virus and testing availability, and implement infection prevention measures accordingly. As states or regions satisfy the gating criteria to progress through the phases of the guidelines, employers will likely be able to adapt this guidance to better suit evolving risk levels and necessary control measures in their workplaces.
EMS and medical transportation providers, firefighters, and law enforcement officers are on the front lines for dealing with individuals with suspected or confirmed COVID-19.
Employers should assess the hazards to which their workers may be exposed; evaluate the risk of exposure; and select, implement, and ensure workers use controls to prevent exposure.
Typically, emergency response workers are already familiar with safe work practices, the utilization of PPE, and standard precautions in preventing the transmission of infectious diseases, including for body substance isolation.
However, given the ongoing spread of COVID-19, employers and workers should take additional precautions by employing a combination of engineering and administrative controls, safe work practices, and PPE. Workers and employers involved in EMS or other medical transport operations will likely need to adopt guidelines from the guidance for healthcare workers and employees to the mobile work environment. That may mean relying on PPE (e.g., respirators, gloves, eye protection) to protect workers when the use of Airborne Infection Isolation Rooms (AIIRs) or other isolation mechanisms are not practical and when a staff has close contact with suspected or confirmed COVID-19 patients in transit.
Safe Work Practices
Avoid unnecessary close (i.e., within 6 feet) or physical (i.e., touching) contact with members of the general public and especially those who are experiencing signs and/or symptoms consistent with COVID-19.
Perform as many tasks as possible in areas away from individuals with suspected or confirmed COVID-19 (e.g., do not remain in an ambulance, police car, or other vehicles with a potentially infectious person while performing administrative functions that could be done outside of the vehicle).
After transporting the patient, leave the rear doors of the transport vehicle open to allow for sufficient air changes to remove potentially infectious particles. The time to complete the transfer of the patient to the receiving facility and complete all documentation should provide sufficient air changes.
Follow safe work practices for cleaning and disinfection, including for vehicles, equipment, and other supplies:
- Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly, to include the provision of adequate ventilation when chemicals are in use. Doors should remain open when cleaning vehicles.
- Clean and disinfect the vehicle following standard operating procedures. 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, work surfaces) should be thoroughly cleaned and disinfected using an EPA-registered hospital-grade disinfectant in accordance with the product label.
- Clean and disinfect reusable patient-care equipment before use on another patient, according to the manufacturer’s instructions. Medical equipment (e.g., stethoscopes, blood pressure cuffs) making patient contact should be disposable or cleaned and disinfected before use on another patient.
- Although disposable flexible restraints (such as zip-ties) are preferable, restraints such as handcuffs and shackles should be disinfected before being used on another person. Clean and disinfect duty belt and gear before reuse using a household cleaning spray or wipe, according to the product label.
Follow standard operating procedures for containing and laundering used linen. Avoid shaking the linen.
Keep a complete change of clothes/uniform at the duty station, in case the clothes being worn become contaminated and need to be bagged for cleaning/disinfection. Avoid shaking the clothes. Follow standard operating procedures for laundering contaminated work clothing, including as described in the PPE Considerations section of the general guidance for workers and employers of workers at increased risk for occupational exposure.
Workers should avoid touching their faces, including their eyes, noses, and mouths, particularly until after they have thoroughly washed their hands upon completing work and/or removing PPE.
Personal Protective Equipment
Emergency responders must use proper PPE when exposed to a patient with suspected or confirmed COVID-19 or other sources of SARS-CoV-2 (See OSHA’s PPE standards at 29 CFR 1910 Subpart I).
Personal protective equipment ensembles may vary depending on workers’ job tasks, which may change frequently throughout the work shift. For many tasks, including those involving contact with the general public for whom there is no reason to suspect COVID-19, disposable gloves may be sufficient. When emergency responders have exposure to sick patients who are suspected of or known to have COVID-19, including individuals experiencing signs/symptoms consistent with COVID-19, they should wear, at a minimum:
- Eye/face protection (e.g., goggles, face shield)
- Face masks
Drivers, if providing direct patient care (e.g., moving suspected or confirmed COVID-19 patients onto stretchers), should wear all recommended PPE. After completing patient care and before entering an isolated driver’s compartment, the driver should remove and dispose of PPE and perform hand hygiene to avoid soiling the compartment. If the transport vehicle does not have an isolated driver’s compartment, the driver should remove the face shield or goggles, gown and gloves and perform hand hygiene (i.e., wash hands with soap and water for at least 20 seconds, if possible, or use an alcohol-based hand sanitizer with at least 60% alcohol). A respirator or facemask should continue to be used during transport.
On arrival, after releasing a transported person to the destination facility, emergency responders should remove and discard PPE and perform hand hygiene (i.e., wash hands with soap and water for at least 20 seconds, if possible, or use an alcohol-based hand sanitizer with at least 60% alcohol). Used PPE should be discarded in accordance with routine procedures.