Transporting a Suspect/ Confirmed Case of COVID-19

[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.

• 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