[Source: Standard Operating Procedure (SOP) for Transporting A Suspect / Confirmed Case of COVID-19, Ministry of Health & Family Welfare, Government of India.]
Ideally, there should be ambulances identified specifically for transporting COVID suspect patients or those who have developed complications, to the health facilities. Currently, there are two types of ambulances – ALS (with ventilators) and BLS (without ventilators). States may empanel other ambulances having basic equipment like that of BLS and use it for COVID patients. However, this must be ensured that strict adherence to cleaning and decontamination protocols given here in the guidance note need to be followed.
Call centres after receiving the call will try to triage the condition of the patient and accordingly dispatch either ALS, BLS or other registered ambulances.
|However, please ensure that 102 ambulances should not be used for corona patients and should only be used for transporting pregnant women and sick infants.|
- Ambulance staff (technicians as well as drivers) should be trained and oriented about common signs and symptoms of COVID-19 (fever, cough and difficulty in breathing). They should also be aware about common infection, prevention and control practices including use of Personal Protective Equipment (PPE).
- Both the EMT and driver of ambulance will wear PPE while handling, managing and transporting the COVID identified/ suspect patients.
- Similar use of PPE is to be ensured by the health personnel at receiving health facility.
- Patient and attendant should be provided with triple layer mask and gloves.
- Simple public health measures like hand hygiene, respiratory etiquettes, etc. need to be adhered by all.
Call Centre: On receiving the call, the call centre needs to enquire following details:
- Demographic details of the patient i.e. name, age, gender etc.
- To ascertain whether the patient is suspect case of COVID-19
- Symptoms of patient: Ask whether the patient is suffering from fever, cough and difficulty in breathing
- Whether patient has recently returned from a foreign country
- Whether the patient was under home quarantine as directed by local health administration
- Clinical condition of patient to be transported: whether stable or critical.
In case of an inter-facility transfer, the casualty medical officer of the referring hospital has to ensure that bed is available in referral hospital with supporting equipment and needs to convey the same while making the call.
Assign the job to nearest ambulance
Check for state of preparedness of ambulance.
Ensure PPE for ambulance staff.
Both call centre and ambulances should always keep the updated list of available hospitals and beds.
- On receiving the call, from the call centre and prior to shifting the patient, EMT will perform following:
- The EMT will seek the above mentioned details again to ensure whether the patient is a suspect case of COVID-19.
- The EMT will wear the appropriate PPE.
- The EMT shall assess the condition of the patient
- If the patient is ambulatory and stable, he/she may be asked to board the ambulance otherwise the EMT (while using the prescribed PPE) may assist loading of patient.
- Only one caregiver should be allowed to accompany the patient (while using the prescribed PPE).
- EMT should also ensure availability and provision of adequate triple layered mask and gloves for patient and/or attendant.
- The patient and the care giver will be provided with a triple layer medical mask.
- EMT will contact the identified health facility for facility preparedness and readiness.
Management on board
- Measure vitals of patient and ensure patient is stable.
- If required, give supplementary O2 therapy at 5 L/min and titrate flow rates to reach target SpO2 ≥90%.
- If patient is being transported on ventilator to a higher center, follow ventilator management protocols, provided the EMT is either trained or assisted by a doctor well versed in ventilator management.
Handing over the patient
- On reaching the receiving hospital, the EMT will hand over the patient and details of medical interventions if any during transport.
- After handing over the patient, the PPEs will be taken off as per protocol followed by
- hand washing. Use Alcohol based rub /soap water for hand hygiene.
- The biomedical waste generated (including PPE) to be disposed off in a bio-hazard bag (yellow bag). Inside would be sprayed with Sodium Hypochlorite (1%) and after tying the exterior will also be sprayed with the same. It would be disposed off at their destination hospital. This shall again be followed by hand washing.
Disinfection of ambulance
- 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 and work surfaces) should be thoroughly cleaned and disinfected using 1% Sodium Hypochlorite solution.
- Clean and disinfect reusable patient-care equipment before use on another patient with alcohol based rub.
- Cleaning of all surfaces and equipment should be done morning, evening and after every use with soap/detergent and water.
Rational use of PPE by ambulance staff
|Transporting patients not on any assisted ventilation||Moderate
|N-95 mask Gloves|
|Management of SARI patient while transporting
|High risk||Full complement of PPE||When
generating aerosol procedures are
|Low risk||Triple layer medical mask Gloves|