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Coronavirus

Date Last Search Run: Nov 12, 2019
Table last updated: May 27, 2020
Data last added: Apr 23, 2020


Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)      
2 (fair evidence exists)      
3 (weak evidence exists)      


Interventions

Aerosolized/nebulized medication
Level Direction Primary Outcome Patient/Process Setting Reference
X Not Yet Graded (White) Supports: caution when performing AGMPs PH-Paramedic ASPR TRACIE. (2017). EMS Infectious Disease Playbook. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Medline
X Not Yet Graded (White) Increased risk for health care provider infection ED-MD Bischoff WE, Swett K, Leng I, Peters TR. Exposure to influenza virus aerosols during routine patient care. J Infect Dis 2013; 207(7):1037-46. Medline
X Not Yet Graded (White) Nebuliser delivery produced outcomes that were not significantly better than metered-dose inhalers delivered by spacer in adults or children ED-MD Cates CJ, Welsh EJ, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev. 2013 Sep 13;(9):CD000052. Medline
X Not Yet Graded (White) Use the appropriate PPE, including gloves, long-sleeved gowns, eye protection, and fit-tested particulate respirators (N95 or equivalent, or higher level of protection) Other Clinical management of severe acute respiratory infection when novel corona- virus (nCoV) infection is suspected [interim guidance]. Geneva: World Health Organization; 2020. Medline
X Not Yet Graded (White) Paramedics should consider alternatives to AGMPs PH-Paramedic COVID-19: What Paramedics Need to Know! Buick J Cheskes S Feldman M Richard Verbeek P Hillier M Chin Leong Y Drennan I Buick J 2020 Medline
X Not Yet Graded (White) Use HEPA filter, use VL when available, minimize attempts, consider SGA. ED-MD Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With the Guidelines®-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists: Supporting Organizations: American Association of Critical Care Nurses and National EMS Physicians [published online ahead of print, 2020 Apr 9]. Circulation. 2020;10.1161/CIRCULATIONAHA.120.047463. doi:10.1161/CIRCULATIONAHA.120.047463. Medline
X Not Yet Graded (White) Take PPE percautions Other Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. Updated March 10, 2020. Medline
X Not Yet Graded (White) Description of lit. gap on the subject Recommendations for future research SIM Judson SD, Munster VJ. Nosocomial Transmission of Emerging Viruses via Aerosol-Generating Medical Procedures. Viruses. 2019;11(10):940. Medline
X Not Yet Graded (White) Recommends usual management of viral pneumonia & PPE for aerosol generating procedures ICU Murthy S, Gomersall CD, Fowler RA. Care for Critically Ill Patients With COVID-19. JAMA 2020. Medline
X Not Yet Graded (White) All HCPs should wear, at minimum, surgical mask and eye protection, although using the precautionary principle, an N95 respirator would be preferred ED-MD Provincial Infection Control Network of British Columbia, PICNet. Respiratory Infection Outbreak Guidelines for Health Care Facilities. April 2018. Medline
X Not Yet Graded (White) Increased risk for health care provider infection at 1m In-Patient Simonds AK, Hanak A, Chatwin M, et al. Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections. Health Technol Assess 2010;14(46):131–172. Medline
X Not Yet Graded (White) Use caution Common masks create a plume of droplets SIM Somogyi R, Vesely AE, Azami T, et al. Dispersal of respiratory droplets with open vs closed oxygen delivery masks: implications for the transmission of severe acute respiratory syndrome. Chest. 2004;125(3):1155–1157. Medline
X Not Yet Graded (White) Increased risk for health care provider infection when using AGMPs ICU Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7(4):e35797. Medline

Air Medical Transport
Level Direction Primary Outcome Patient/Process Setting Reference
X Not Yet Graded (White) It is recommended that cases of suspected infectious disease, should not be transported by air, If there is a need for AMT, it is advisable to transport as early on as possible before the patient is extremely ill. PH-Paramedic & CCT Emerging infectious diseases including severe acute respiratory syndrome (SARS): guidelines for commercial air travel and air medical transport. Aviat Space Environ Med 2004; 75(1):85-6. Medline

Clinician mental health/wellness during disaster
Level Direction Primary Outcome Patient/Process Setting Reference
X Not Yet Graded (White) Higher levels of psychological distress, post-traumatic stress and burnout among healthcare workers PH-Paramedic Assari S, Habibzadeh P. The COVID-19 Emergency Response Should Include a Mental Health Component. Arch Iran Med. 2020;23(4):281–282. Published 2020 Apr 1. doi:10.34172/aim.2020.12 Medline
X Not Yet Graded (White) Varied willingness to report in a pandemic PH-Paramedic Barnett DJ, Levine R, Thompson CB, Wijetunge GU, Oliver AL, Bentley MA, et al. Gauging U.S. Emergency Medical Services workers' willingness to respond to pandemic influenza using a threat- and efficacy-based assessment framework. PloS one 2010; 5(3):e9856. Medline
X Not Yet Graded (White) Some HCWs are at higher risk of mental health issues from pandemics Other Douglas PK, Douglas DB, Harrigan DC, Douglas KM. Preparing for pandemic influenza and its aftermath: mental health issues considered. Int J Emerg Ment Health 2009;11(3):137-44. Medline
X Not Yet Graded (White) training increased preparedness PH-Paramedic Elcin M, Onan A, Odabasi O, Saylam M, Ilhan H, Daylan Kockaya P, et al. Developing a Simulation-Based Training Program for the Prehospital Professionals and Students on the Management of Middle East Respiratory Syndrome. Simulation in healthcare 2016; 11(6):394-403. Medline
X Not Yet Graded (White) Training and mitigation strategies helped paramedics become psychologically prepared. PH-Paramedic Lateef F, Lim SH, Tan EH. New paradigm for protection: the emergency ambulance services in the time of severe acute respiratory syndrome. Prehospital emergency care 2004; 8(3):304-7. Medline
X Not Yet Graded (White) This study's finding that only 13.3% of states had complete plans delineating the role of 9-1-1 during a pandemic PH-Paramedic Oliver AL, Poplin GS, Kahn CA. Emergency Medical Services and 9-1-1 pandemic influenza preparedness: A national assessment. Am J Emerg Med 2012; 30(3):505-9. Medline
X Not Yet Graded (White) Most healthcare workers develop de novo PPE-associated headaches or exacerbation of their pre-existing headache disorders. PH-Paramedic Ong JJY., Bharatendu C., Goh Y., Tang JZY., Sooi KWX., Tan YL., et al. Headaches Associated With Personal Protective Equipment - A Cross-Sectional Study Among Frontline Healthcare Workers During COVID-19. Headache 2020. Medline
X Not Yet Graded (White) Predictors of willingness to work when requested included believing it is their responsibility to work, believing their coworkers were likely to work, receiving prophylaxis PH-Paramedic Rebmann T, Charney RL, Loux TM, Turner JA, Abbyad YS, Silvestros M. Emergency Medical Services Personnel's Pandemic Influenza Training Received and Willingness to Work during a Future Pandemic. Prehospital emergency care 2020:1-9. Medline
X Not Yet Graded (White) >200 paramedics had contact with patients with SARS and were quarantined. These events seriously affected EMS and their staff. PH-Paramedic Silverman A, Simor A, Loutfy MR. Toronto Emergency Medical Services and SARS. Emerging infectious diseases 2004; 10(9):1688-9. Medline
X Not Yet Graded (White) Confidence in the employer's capacity to respond appropriately to a pandemic significantly increased employee willingness to work (OR = 2.83; 95% CI = 1.9-4.1) PH-Paramedic Tippett VC, Watt K, Raven SG, Kelly HA, Coory M, Archer F, et al. Anticipated behaviors of emergency prehospital medical care providers during an influenza pandemic. Prehosp Disaster Med 2010; 25(1):20-5. Medline
X Not Yet Graded (White) The three most important variables that could account for the distress level were loss of control/vulnerability, fear for self-health and spread of the virus. ED-MD Wong TW, Yau JK, Chan CL, Kwong RS, Ho SM, Lau CC, et al. The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. European journal of emergency medicine 2005;12(1):13-8. Medline

Compressions/Defibrillation
Level Direction Primary Outcome Patient/Process Setting Reference
X Not Yet Graded (White) low/very low quality evidence: use PPE, consider defib “is reasonable” before donning more PPE, wear full PPE for AGMPs such as compressions/CPR. PH-Paramedic COVID-19 infection risk to rescuers from patients in cardiac arrest https://costr.ilcor.org/document/covid-19-infection-risk-to-rescuers-from-patients-in-cardiac-arrest Accessed: 2020-04-15 Medline
X Not Yet Graded (White) No evidence on outcomes or specific interventions for out-of-hospital cardiac arrests related to COVID-19. PH-Paramedic COVID-19: What Paramedics Need to Know! Buick J Cheskes S Feldman M Richard Verbeek P Hillier M Chin Leong Y Drennan I Buick J 2020 Medline
X Not Yet Graded (White) For COVID-19 positive pts: guide front-line providers in determining the appropriateness of starting and terminating CPR for patients with COVID-19, taking into account patient risk factors to estimate the likelihood of survival. ED-MD Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With the Guidelines®-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists: Supporting Organizations: American Association of Critical Care Nurses and National EMS Physicians [published online ahead of print, 2020 Apr 9]. Circulation. 2020;10.1161/CIRCULATIONAHA.120.047463. doi:10.1161/CIRCULATIONAHA.120.047463. Medline

CPAP/BiPAP
Level Direction Primary Outcome Patient/Process Setting Reference
X Not Yet Graded (White) Exercise caution when performing AGMPs PH-Paramedic ASPR TRACIE. (2017). EMS Infectious Disease Playbook. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Medline
X Not Yet Graded (White) consider alternatives to AGMPs PH-Paramedic COVID-19: What Paramedics Need to Know! Buick J Cheskes S Feldman M Richard Verbeek P Hillier M Chin Leong Y Drennan I Buick J 2020 Medline
X Not Yet Graded (White) Increased risk for of HCW infection ICU Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7(4):e35797. Medline

Epidemiology
Level Direction Primary Outcome Patient/Process Setting Reference
X Not Yet Graded (White) Have a low threshold to assess for shock in acute systolic HF associated with COVID . ECMO may be considered for those experiencing cardiogenic shock. Other Fried JA, Ramasubbu K, Bhatt R, et al. The Variety of Cardiovascular Presentations of COVID-19 [published online ahead of print, 2020 Apr 3]. Circulation. 2020;10.1161/CIRCULATIONAHA.120.047164. doi:10.1161/CIRCULATIONAHA.120.047164 Medline
X Not Yet Graded (White) Fatality rate of COVID-19 is approximately 4%, though sampling error may be large ED-MD Giwa A, Desai A. Novel coronavirus COVID-19: an overview for emergency clinicians. Emergency medicine practice 2020;22(2):1-21. Medline
X Not Yet Graded (White) This work provides additional evidence for a median incubation period for COVID-19 of approximately 5 days Other Lauer SA, Grantz KH, Bi Q, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med. 2020; [Epub ahead of print 10 March 2020]. doi: https://doi.org/10.7326/M20-0504 Medline
X Not Yet Graded (White) In the case of Meningitis/Encephalitis the specific SARS-CoV-2 RNA was not detected in the nasopharyngeal swab but was detected in a CSF. ED-MD Moriguchi T., Harii N., Goto J., Harada D., Sugawara H., Takamino J., et al. A first Case of Meningitis/Encephalitis associated with SARS-Coronavirus-2. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2020. Medline
X Not Yet Graded (White) Most cases were classified as mild (81%; ie, nonpneumonia and mild pneumonia). However, 14% were severe Other Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention [published online ahead of print, 2020 Feb 24]. JAMA. 2020;10.1001/jama.2020.2648. doi:10.1001/jama.2020.2648 Medline
X Not Yet Graded (White) Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Other Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published correction appears in Lancet. 2020 Mar 28;395(10229):1038] [published correction appears in Lancet. 2020 Mar 28;395(10229):1038]. Lancet. 2020;395(10229):1054–1062. doi:10.1016/S0140-6736(20)30566-3. Medline

Field assessment units / ED avoidance
Level Direction Primary Outcome Patient/Process Setting Reference
X Not Yet Graded (White) The risk attributable to visiting the emergency department risk was 70.5%, whereas risk attributable to community exposure was 2%. ED-MD Esteve-Esteve M, Bautista-Rentero D, Zanón-Viguer V. Risk of influenza transmission in a hospital emergency department during the week of highest incidence. Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias 2018; 30(1):7-13. Medline
X Not Yet Graded (White) Supports: EMS initiated non-transport with home supports. PH-Paramedic Glauser W. Proposed protocol to keep COVID-19 out of hospitals. CMAJ 2020;192(10):E264-E265. Medline
X Not Yet Graded (White) Supports commmunity based acute care pre and post DC Other Nacoti M., Ciocca A., Giuppoini A., Brambillasca P., Lussana F., Pisano M et al. At the Epicenter of the Covid-19 Pandemic and Humanitarian Crises in Italy: Changing Perspectives on Preparation and Mitigation. New England Journal of Emergency Medicine 2020 march 21 ahead of print Medline
X Not Yet Graded (White) Specific algorithms, detailed protocols, and specialised teams must be fostered within each EMS department to allocate the right resources to the right individuals when cases of COVID-19 present. PH-Paramedic Spina S., Marrazzo F., Migliari M., Stucchi R., Sforza A., Fumagalli R. The response of Milan's Emergency Medical System to the COVID-19 outbreak in Italy. Lancet (London, England) 2020;395(10227):e49-e50. Medline

High flow NRB Mask
Level Direction Primary Outcome Patient/Process Setting Reference
X Not Yet Graded (White) Avoid AGMPs, consider MDI PH-Paramedic COVID-19: What Paramedics Need to Know! Buick J Cheskes S Feldman M Richard Verbeek P Hillier M Chin Leong Y Drennan I Buick J 2020 Medline
X Not Yet Graded (White) These findings suggest that health-care workers providing NIV working within 1 m of an infected patient should have a higher level of respiratory protection, but that infection control measures may have less relevance for these procedures. ED-MD Simonds AK, Hanak A, Chatwin M, et al. Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections. Health Technol Assess 2010;14(46):131–172. Medline
X Not Yet Graded (White) Use caution Common masks create a plume of droplets SIM Somogyi R, Vesely AE, Azami T, et al. Dispersal of respiratory droplets with open vs closed oxygen delivery masks: implications for the transmission of severe acute respiratory syndrome. Chest. 2004;125(3):1155–1157. Medline
X Not Yet Graded (White) Significant risk of HCW infection ICU Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7(4):e35797. Medline

Intubation/Advanced Airway
Level Direction Primary Outcome Patient/Process Setting Reference
X Not Yet Graded (White) Supports caution, use RSI where possible, have exhaust on PH-Paramedic ASPR TRACIE. (2017). EMS Infectious Disease Playbook. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Medline
X Not Yet Graded (White) ETI significantly increases risk to HCW Other Chen WQ, Ling WH, Lu CY, Hao YT, Lin ZN, Ling L, et al. Which preventive measures might protect health care workers from SARS? BMC Public Health 2009; 9:81. Medline
X Not Yet Graded (White) Endotracheal intubation is done by an expert ED-MD Cheung JC., Ho LT., Cheng JV., Cham EYK., Lam KN. Staff safety during emergency airway management for COVID-19 in Hong Kong. The Lancet Respiratory medicine 2020;8(4):e19. Medline
X Not Yet Graded (White) Performed by a trained and experienced provider using airborne precautions ED-MD Clinical management of severe acute respiratory infection when novel corona- virus (nCoV) infection is suspected [interim guidance]. Geneva: World Health Organization; 2020. Medline
X Not Yet Graded (White) low/very low quality evidence: wear full PPE for AGMPs such as ETI/compressions/CPR. PH-Paramedic COVID-19 infection risk to rescuers from patients in cardiac arrest https://costr.ilcor.org/document/covid-19-infection-risk-to-rescuers-from-patients-in-cardiac-arrest Accessed: 2020-04-15 Medline
X Not Yet Graded (White) Paramedics should consider early placement of an advanced airway/SGA. PH-Paramedic COVID-19: What Paramedics Need to Know! Buick J Cheskes S Feldman M Richard Verbeek P Hillier M Chin Leong Y Drennan I Buick J 2020 Medline
X Not Yet Graded (White) risk of developing SARS for HCWs performing endotracheal intubation (relative risk [RR], 13.29; 95% confidence interval [CI], 2.99 to 59.04; p = 0.003). Other Fowler RA, Guest CB, Lapinsky SE, Sibbald WJ, Louie M, Tang P, et al. Transmission of severe acute respiratory syndrome during intubation and mechanical ventilation. Am J Respir Crit Care Med 2004; 169(11):1198-202. Medline
X Not Yet Graded (White) Supports Airbonre precautions during procedure ICU Murthy S, Gomersall CD, Fowler RA. Care for Critically Ill Patients With COVID-19. JAMA 2020. Medline
X Not Yet Graded (White) Increased risk for health care provider and patient infection Increased risk for patient health Support room air ventilation hands sterilized by iodine gloves education double exposure suits In-Patient Pei LY, Gao ZC, Yang Z, Wei DG, Wang SX, Ji JM, et al. Investigation of the influencing factors on severe acute respiratory syndrome among health care workers. Beijing da xue xue bao Yi xue ban = Journal of Peking University Health sciences 2006; 38(3):271-5. Medline
X Not Yet Graded (White) Use caution ED-MD Provincial Infection Control Network of British Columbia, PICNet. Respiratory Infection Outbreak Guidelines for Health Care Facilities. April 2018. Medline
X Not Yet Graded (White) Increased risk for health care provider infection: close contact with the airway and failure of infection control practices to prevent exposure to respiratory secretions In-Patient Raboud J, Shigayeva A, McGeer A, Bontovics E, Chapman M, Gravel D, et al. Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto, Canada. PLoS ONE 2010; 5(5):e10717, 2010. Medline
X Not Yet Graded (White) Significant risk of HCW infection ICU Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7(4):e35797. Medline
X Not Yet Graded (White) Increased risk for health care provider and patient infection Increased risk ambulance vehicle contamination PH-Paramedic Verbeek PR, McClelland IW, Silverman AC, Burgess RJ. Loss of paramedic availability in an urban emergency medical services system during a severe acute respiratory syndrome outbreak. Academic emergency medicine 2004; 11(9):973-8. Medline
X Not Yet Graded (White) Support: PPE Donning and Doffing; one provider along procedure ICU Wei WI, Tuen HH, Ng RW, Lam LK. Safe tracheostomy for patients with severe acute respiratory syndrome. Laryngoscope 2003; 113(10):1777-9. Medline

Manual BVM (no advanced airway)
Level Direction Primary Outcome Patient/Process Setting Reference
X Not Yet Graded (White) We recommend avoiding bag mask ventilation for as long as possible; ED-MD Cheung JC., Ho LT., Cheng JV., Cham EYK., Lam KN. Staff safety during emergency airway management for COVID-19 in Hong Kong. The Lancet Respiratory medicine 2020;8(4):e19. Medline
X Not Yet Graded (White) Use 2 handed technique with a good seal. PH-Paramedic COVID-19 infection risk to rescuers from patients in cardiac arrest https://costr.ilcor.org/document/covid-19-infection-risk-to-rescuers-from-patients-in-cardiac-arrest Accessed: 2020-04-15 Medline
X Not Yet Graded (White) Sig risk for HCW infection ICU Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7(4):e35797. Medline

Medical Communication Centre triage/screening
Level Direction Primary Outcome Patient/Process Setting Reference
X Not Yet Graded (White) Feasible but needed to improve its specificity without compromising patient safety. Other Anhang Price R, Fagbuyi D, Harris R, Hanfling D, Place F, Taylor TB, et al. Feasibility of web-based self-triage by parents of children with influenza-like illness: a cautionary tale. JAMA pediatrics 2013; 167(2):112-8. Medline
X Not Yet Graded (White) Supports dispatch screening PH-Paramedic ASPR TRACIE. (2017). EMS Infectious Disease Playbook. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Medline
X Not Yet Graded (White) method did not reliably discriminate between patients with good and poor outcomes. ED-MD Challen K, Goodacre SW, Wilson R, Bentley A, Campbell M, Fitzsimmons C, et al. Evaluation of triage methods used to select patients with suspected pandemic influenza for hospital admission. EMJ 2012; 29(5):383-8. Medline
X Not Yet Graded (White) Feasible Other Clancy T, Neuwirth C, Bukowski G. Lessons learned in implementing a 24/7 public health call center in response to H1N1 in the state of New Jersey. American journal of disaster medicine 2009; 4(5):253-60. Medline
X Not Yet Graded (White) Supports screening Other Clinical management of severe acute respiratory infection when novel corona- virus (nCoV) infection is suspected [interim guidance]. Geneva: World Health Organization; 2020. Medline
X Not Yet Graded (White) Supports comms pre-screen PH-Paramedic COVID-19: What Paramedics Need to Know! Buick J Cheskes S Feldman M Richard Verbeek P Hillier M Chin Leong Y Drennan I Buick J 2020 Medline
X Not Yet Graded (White) For EMS, telecommunicators should alert dispatched EMS teams to don PPE if there is any suspicion for COVID-19 infection. ED-MD Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With the Guidelines®-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists: Supporting Organizations: American Association of Critical Care Nurses and National EMS Physicians [published online ahead of print, 2020 Apr 9]. Circulation. 2020;10.1161/CIRCULATIONAHA.120.047463. doi:10.1161/CIRCULATIONAHA.120.047463. Medline
X Not Yet Graded (White) This triage system improved efficiency of resource utilization without incurring apparent influenza-like illness morbidity. Other Eppes CS, Garcia PM, Grobman WA. Telephone triage of influenza-like illness during pandemic 2009 H1N1 in an obstetric population. Obstet Gynecol 2012; 207(1):3-8. Medline
X Not Yet Graded (White) Emergency room TT calls are one to five weeks ahead of surveillance data collected by the CDC. ED-MD Espino JU, Hogan WR, Wagner MM. Telephone triage: a timely data source for surveillance of influenza-like diseases. AMIA Annual Symposium proceedings AMIA Symposium 2003:215-9. Medline
X Not Yet Graded (White) Associated with improved patient flow without affecting rates of return to the ED within 48 hours or 7 days ED-MD Fagbuyi DB, Brown KM, Mathison DJ, Kingsnorth J, Morrison S, Saidinejad M, et al. A rapid medical screening process improves emergency department patient flow during surge associated with novel H1N1 influenza virus. Ann Emerg Med 2011; 57(1):52-9. Medline
X Not Yet Graded (White) Keeping it relatively simple, user-friendly, and regularly updated, nurses were able to screen patients rapidly ED-MD Foo CL, Tham KY, Seow E. Evolution of an emergency department screening questionnaire for severe acute respiratory syndrome. Academic emergency medicine 2004;11(2):156-61. Medline
X Not Yet Graded (White) A standardised assessment form is acceptable to clinicians and could be used to collect research data in an influenza pandemic, but analysis may be limited by missing data. ED-MD Goodacre S, Irving A, Wilson R, Beever D, Challen K. The PAndemic INfluenza Triage in the Emergency Department (PAINTED) pilot cohort study. Health Technol Assess 2015; 19(3):v-xxi, 1. Medline
X Not Yet Graded (White) Discusses planning Other Kaposy C, Bandrauk N, Pullman D, Singleton R, Brunger F. Adapting the Hamilton Health Sciences critical care pandemic triage protocol. Healthc Q. 2010;13(2):60–63. doi:10.12927/hcq.2013.21671 Medline
X Not Yet Graded (White) Feasible PH-Paramedic Koenig KL, Beÿ CK, McDonald EC. 2019-nCoV: The Identify-Isolate-Inform (3I) Tool Applied to a Novel Emerging Coronavirus. The western journal of emergency medicine 2020; 21(2):184-190. Medline
X Not Yet Graded (White) Current guidelines regarding PPE use are adequate. Compliance with PPE needs to be addressed through the use of intra-agency communications and regular information updates PH-Paramedic Smith EC, Burkle FM, Holman PF, Dunlop JM, Archer FL. Lessons from the front lines: the prehospital experience of the 2009 novel H1N1 outbreak in Victoria, Australia. Disaster medicine and public health preparedness 2009; 3(S2):S154-9. Medline
X Not Yet Graded (White) Supports: triaging using fever status OR Zhang J, Zhou L, Yang Y, Peng W, Wang W, Chen X. Therapeutic and triage strategies for 2019 novel coronavirus disease in fever clinics. Lancet Respir Med 2020; 8(3):e11–e12. Medline

PPE/Clinician Safety
Level Direction Primary Outcome Patient/Process Setting Reference
X Not Yet Graded (White) Supports mask, glives, gown, eye protection PH-Paramedic ASPR TRACIE. (2017). EMS Infectious Disease Playbook. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Medline
X Not Yet Graded (White) low certainty: N-95 for high risk or AGMPs, otherwise surg msk is no worse. Other Bartoszko JJ, Farooqi MAM, Alhazzani W, Loeb M. Medical Masks vs N95 Respirators for Preventing COVID-19 in Health Care Workers A Systematic Review and Meta-Analysis of Randomized Trials [published online ahead of print, 2020 Apr 4]. Influenza Other Respir Viruses. 2020;10.1111/irv.12745. doi:10.1111/irv.12745. Medline
X Not Yet Graded (White) Supports PPE and avoiding face to face contact with confirmed cases. Other Chen WQ, Ling WH, Lu CY, Hao YT, Lin ZN, Ling L, et al. Which preventive measures might protect health care workers from SARS? BMC Public Health 2009; 9:81. Medline
X Not Yet Graded (White) Use PPE (medical mask, eye protection, gloves and gown) In-Patient Clinical management of severe acute respiratory infection when novel corona- virus (nCoV) infection is suspected [interim guidance]. Geneva: World Health Organization; 2020. Medline
X Not Yet Graded (White) Fitted high filtration mask for AGMPs. Uncertainty remains around certain details of personal protective equipment including use of hoods, mask type and the potential for re-use of equipment. Other Cook TM. Personal protective equipment during the COVID-19 pandemic - a narrative review [published online ahead of print, 2020 Apr 4]. Anaesthesia. 2020;10.1111/anae.15071. doi:10.1111/anae.15071. Medline
X Not Yet Graded (White) low/very low quality evidence: use PPE, consider defib “is reasonable” before donning more PPE, wear full PPE for AGMPs such as compressions/CPR. PH-Paramedic COVID-19 infection risk to rescuers from patients in cardiac arrest https://costr.ilcor.org/document/covid-19-infection-risk-to-rescuers-from-patients-in-cardiac-arrest Accessed: 2020-04-15 Medline
X Not Yet Graded (White) When no interventions are performed, paramedics providing care or who are in close proximity to the patient should wear a surgical type mask, gown, gloves and eye protection, either goggles or a face shield. PH-Paramedic COVID-19: What Paramedics Need to Know! Buick J Cheskes S Feldman M Richard Verbeek P Hillier M Chin Leong Y Drennan I Buick J 2020 Medline
X Not Yet Graded (White) PPE to guard against contact with both airborne and droplet particles, Limit personnel. ED-MD Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With the Guidelines®-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists: Supporting Organizations: American Association of Critical Care Nurses and National EMS Physicians [published online ahead of print, 2020 Apr 9]. Circulation. 2020;10.1161/CIRCULATIONAHA.120.047463. doi:10.1161/CIRCULATIONAHA.120.047463. Medline
X Not Yet Graded (White) Supports isolation of positive patients ICU Grasselli G, Pesenti A, Cecconi M. Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. JAMA 2020. Medline
X Not Yet Graded (White) HCP in the room should wear an N95 or higher-level respirator such as disposable filtering facepiece respirators, PAPRs, and elastomeric respirators, eye protection, gloves, and a gown ED-MD Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. Updated March 10, 2020. Medline
X Not Yet Graded (White) Despite use of PPE the incidence of P-SARS among all 322 EMTs was 0.6% (2/322; 95% CI = 0.2% to 2.2%) and the mortality rate was 0.3% (1/322; 95% CI = 0.1% to 1.7%). PH-Paramedic Ko PC, Chen WJ, Ma MH, Chiang WC, Su CP, Huang CH, et al. Emergency medical services utilization during an outbreak of severe acute respiratory syndrome (SARS) and the incidence of SARS-associated coronavirus infection among emergency medical technicians. Academic emergency medicine 2004; 11(9):903-11. Medline
X Not Yet Graded (White) Risk was lower with consistent use of a N95 mask than with consistent use of a surgical mask. ICU Loeb M, McGeer A, Henry B, Ofner M, Rose D, Hlywka T, et al. SARS among critical care nurses, Toronto. Emerg Infect Dis. 2004; 10(2):251-5. Medline
X Not Yet Graded (White) Supports isolating postive patients ICU Murthy S, Gomersall CD, Fowler RA. Care for Critically Ill Patients With COVID-19. JAMA 2020. Medline
X Not Yet Graded (White) gloves (OR=0.102), hands sterilized by iodine (OR=0.231), room air ventilation (OR=0.32), were significantly protective; conversely, tracheal intubation (OR=30.793) was a significant risk factor. In-Patient Pei LY, Gao ZC, Yang Z, Wei DG, Wang SX, Ji JM, et al. Investigation of the influencing factors on severe acute respiratory syndrome among health care workers. Beijing da xue xue bao Yi xue ban = Journal of Peking University Health sciences 2006; 38(3):271-5. Medline
X Not Yet Graded (White) Facial protection (i.e., masks and eye protection, or face shields, or masks with visor attachment) PH-Paramedic PHAC. Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care Settings, 2017. Medline
X Not Yet Graded (White) Ensure that staff members have quick and easy access to the PPE and cleaning products required when providing care ED-MD Provincial Infection Control Network of British Columbia, PICNet. Respiratory Infection Outbreak Guidelines for Health Care Facilities. April 2018. Medline
X Not Yet Graded (White) Current guidelines regarding PPE use are adequate for use during an outbreak of infectious disease. PH-Paramedic Smith EC, Burkle FM, Holman PF, Dunlop JM, Archer FL. Lessons from the front lines: the prehospital experience of the 2009 novel H1N1 outbreak in Victoria, Australia. Disaster medicine and public health preparedness 2009; 3(S2):S154-9. Medline
X Not Yet Graded (White) Both hand washing (adjusted OR 0.07, 95 % CI 0.008-0.66, P=0.02) and wearing of N95 masks (adjusted OR 0.1, 95% CI 0.02-0.86, P=0.04) remained strongly protective but gowns and gloves had no effect. In-Patient Teleman MD, Boudville IC, Heng BH, Zhu D, Leo YS. Factors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore. Epidemiology & Infection 2004; 132(5):797-803. Medline
X Not Yet Graded (White) The primary reason for quarantine was unprotected exposure to a health care institution experiencing a SARS outbreak. suggests a dedicated paramedic surveillance and quarantine program. PH-Paramedic Verbeek PR, McClelland IW, Silverman AC, Burgess RJ. Loss of paramedic availability in an urban emergency medical services system during a severe acute respiratory syndrome outbreak. Academic emergency medicine 2004; 11(9):973-8. Medline
X Not Yet Graded (White) Personal protective equipment is not consistently employed as per medical directives. Reasons given for non-use included non-availability, judgment of non-necessity or technical difficulties. PH-Paramedic Visentin LM, Bondy SJ, Schwartz B, Morrison LJ. Use of personal protective equipment during infectious disease outbreak and nonoutbreak conditions: a survey of emergency medical technicians. CJEM 2009; 11(1):44-56. Medline

Suction
Level Direction Primary Outcome Patient/Process Setting Reference
X Not Yet Graded (White) very low quality evidence: suctioning is aerosol generating PH-Paramedic COVID-19 infection risk to rescuers from patients in cardiac arrest https://costr.ilcor.org/document/covid-19-infection-risk-to-rescuers-from-patients-in-cardiac-arrest Accessed: 2020-04-15 Medline


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