A COVID-19 positive patient in Italy is being lowered by ropes in a stretcher on the outside of an apartment building in order to avoid contamination of the stairwells. Photo by the Italian Fire & Rescue Services.
16 Mar 2020

New rescue procedures forced into place for pandemic stricken countries in lockdown

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During a pandemic like COVID-19, with national or regional quarantines being put in place, new procedures will have to be quickly put in place - and sometimes need to made up on the fly as first responders are thrown into unknown territory. Read how CTIF member Marco Aimo Boot operates in Piedmont, Italy during the current Corona-shutdown of his region:

"In an emergency situation, my personal purpose is to encourage and promote both the cooperation and the best practice sharing among firefighters and other rescue operators.

Key assumption: all the statements reported below are based on my personal experience, evidences and public media info that I have collected. They don’t represent official declarations from Italian Firefighter or other Italian Rescue Organizations.  (Marco Aimo Boot, Piedmont, Italy)

 

The key arrangements for all Firefighters at national level (due to the fact that in Italy we have a National Corp) are:

Interpersonal distance among each rescue team member of at least 1 m

If it’s not possible to guarantee 1 m of distance among the team members, it is necessary to wear the following personal protective equipment (PPE) during the rescue mission:

- Surgical mask and when it’s not available the balaclava on mouth (to prevent the droplets diffusion) + helmet with closed visor

- Disposable latex or nitrile gloves

- Allow a consistent ventilation of the rooms and rescue vehicles

- Enlarge the number of rescue vehicles for each mission to allow a wider distance among the team members inside the cab

 

- Any team member body temperature > 37,5 °C and difficulty breathing (dyspnoea) or shortness of breath must stay at home in isolation.

- Intensify the cleaning of the rescue vehicles

On the other hand, the EMS protocols are managed at Regional (and some cases adapted to local organization safety rules) accordingly to the following arrangements:

In case of suspected or declared positive COVID19 patient is the ambulance disinfection is necessary. This operation requires approx.. 30-40 minutes with a congestion in the ambulance depots and unavailability of crews for new rescue missions.

 

PPEs to wear in case of suspected positive (body temperature > 37,5 °C and difficulty breathing (dyspnoea) or shortness of breath or effective declared positive to CIVID19 infection:

- Disposable latex gloves ( 2 pairs)

-  Disposable long waterproof plastic medical surgeon gown

- Protective reusable glasses

- FFP2 or FFP3 (it’s preferable) mask

- Disposable medical shoe covers

- Disinfectants (mixture of sodium hypochlorite (0,1-0,5%), ethanol (62-71%), hydrogen peroxide (0,5%)

 

·PPEs to wear for any other rescue mission even if the patient is asymptomatic (the clinical investigation should be perform at a minimal distance of 2,5 m from the patient position. In case any suspect you should wear the PPEs report the previous item out the patient house/apartment :

-  Disposable latex gloves ( 1 pairs)

-  Surgical mask

-  Protective reusable glasses

 

·It’s fundamental to clean well your hands with soap and disinfectants (before, during if it possible and at the end of any rescue mission)

·The contaminated PPE disposal is only allowed in some hospitals declared by Crisis Management Dept. (it’s not so easy to manage)

 

Other considerations:

 

1.       The exponential epidemiological curve of new infection is the key issue to face. It requires a fast reaction of the medical treatment in term of resources and infrastructures (especially for intensive care areas).

2.       The confinement of the citizens it’s the only preventive measure to introduce as soon as possible.

3.       The road cleaning/disinfection seems not an effective measure.

4.       I haven’t numerical and official data, but the firefighters mission for road accidents and fires in general are declined due to the national shut down.

5.       The transfer of bariatric COVID19 patients require the common involvement of both CBRN and SAF (High Angel Rope Rescue) teams.

6.       In general the PPEs removal procedure is not so simple to perform for EMS teams due to a latch of practice in the ordinary rescue mission (it’s necessary an high level of attention and more time respect to a skilled CBRN team member from firefighters dept.)  out of the COVID19 emergency.

7.       The Italian Firefighter Corps helicopter fleet is sometime used to transfer positive COVID19 patients using aeronautical "Biobag" stretchers.

 

Italian rescue helicopter. Photo by the Italian Fire Service

 

Open issues:

1.       The available number surgical masks (even worst for FFP2 or FFP3) for each rescue team are not enough to replace them after any rescue missions. You need to spend many hours with the same mask. Personally, I don’t the effective performance degradation over the time. If you have any available data, please let me know.

2.       The National Health Dept. has placed to perform the oropharyngeal swabs also to the symptomatic patient (due to a limited number of swabs and saturation of the clinical labs)

3.       The COVID19 patient symptoms are common to the seasonal flu. Therefore it’s very hard to identify a positive patient out of the hospital! You are called to use the limited disposable PPEs sparingly.

4.       We haven’t a clear scientific evidence of the virus lifetime of metallic, plastic and other materials. After any mission, we clean and disinfect with attention all the surfaces on the rescue vehicle but it’s not 100% proven.  It’s a very stressful situation when you remove the PPE… The invisible threat is around the corner!!

5.       The same situation you need to manage with the ordinary PPEs after the shift when you return at home…

 

Italian firefighter Marco Aimo Boot in a hazmat suit during the Corona outbreak in Italy. Photo: Marco Aimo Boot.

To give you a tangible real feeling of the situation, I have attached a photo of mine at the end of the last EMS shift." Photo left of the author, Italian firefighter Marco Aimo Boot in a surgical mask during the Corona outbreak in Italy. Photo: Marco Aimo Boot.

Marco Aimo Boot

Piedmont, Italy

 

 

 

Firefighers in Hazmat suits during the Corona-lockdown in Piedmont, Italy. Photo: Marco Aimo Boot

Fire fighers in Hazmat suits during the Corona-lockdown in Piedmont, Italy. Photo: Marco Aimo Boot