Abstract
Patients with COVID-19 who require aerosol-generating medical procedures (such as endotracheal intubation) are challenging for paramedic services. Although potentially lifesaving for patients, aerosolizing procedures carry an increased risk of infection for paramedics, owing to the resource limitations and complexities of the pre-hospital setting. In this paper, we describe the development, implementation, and evaluation of a novel pre-hospital COVID-19 High-Risk Response Team (HRRT) in Peel Region in Ontario, Canada. The mandate of the HRRT was to attend calls for patients likely to require aerosolizing procedures, with the twofold goal of mitigating against COVID-19 infections in the service while continuing to provide skilled resuscitative care to patients. Modelled after in-hospital ‘protected code blue’ teams, operationalizing the HRRT required several significant changes to standard paramedic practice, including the use of a three-person crew configuration, dedicated safety officer, call–response checklists, multiple redundant safety procedures, and enhanced personal protective equipment. Less than three weeks after the mandate was given, the HRRT was operational for a 12-week period during the first wave of COVID-19 in Ontario. HRRT members attended ~70% of calls requiring high risk procedures and were associated with improved quality of care indicators. No paramedics in the service contracted COVID-19 during the program.
Highlights
In the early months of the coronavirus disease 2019 (COVID-19) pandemic, uncertainty surrounding the clinical course of patients and, importantly, the transmissibility of the pathogen presented significant operational challenges for paramedic services
High-Risk Response Team (HRRT) crews attended a total of 1244 calls potentially meeting the mandate of the team based on dispatch information, of which 735 patients (59%) did not require Aerosol-Generating Medical Procedures (AGMPs), leaving a final sample of 509 patients for which the HRRT crew assumed care
One of the key recommendations to come out of the Severe Acute Respiratory Syndrome (SARS) Commission Report of 2007 was that, in the absence of scientific certainty regarding the risk of infection to healthcare providers, the ‘precautionary principle’ should guide decisions around provider safety [32]
Summary
In the early months of the coronavirus disease 2019 (COVID-19) pandemic, uncertainty surrounding the clinical course of patients and, importantly, the transmissibility of the pathogen presented significant operational challenges for paramedic services. Initial reports suggested that more than 40% of hospitalized patients would require supplemental oxygen and as many as 15% may require mechanical ventilation [1–3]—procedures for which there is an established risk of disease transmission to healthcare providers through infectious aerosols [4]. The initial weeks of the pandemic saw shocking rates of infections and deaths among healthcare workers caring for patients with COVID-19 [5,6]. This risk of infection was potentially even more pronounced for paramedics, owing to the complexities of providing care in a prehospital setting, where environments are difficult to control, patients are undifferentiated, resources are limited, and logistical issues
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