This tip sheet is for employers, workers, and volunteers who provide emergency medical services outside of a hospital setting including paramedics, recruits, workers providing emergency medical care, emergency medical technicians (EMTs), rescuers, etc. It provides an overview of potential hazards and risks due to COVID-19, and guidance regarding control measures.
COVID-19 is a contagious disease caused by the SARS-CoV-2 coronavirus. Infected individuals can spread the virus through respiratory particles when they cough, sneeze, breathe, etc. People can become infected when they inhale particles that contain the virus or by touching contaminated surfaces and then touching their face with unwashed hands.
Communicate to all workers and visitors that people with “flu-like” symptoms (that may be COVID-19) should not enter the workplace or report to work (e.g., in-person meetings, servicing vehicles or equipment, etc.).
Notify workers, visitors, patients, and the public that protective measures may be necessary for the safety of everyone.
Install sanitizer dispensers in high-traffic areas (e.g., main entrance, break rooms, administration offices, inside vehicles, etc.), keep them well stocked.
When community COVID-19 transmission rates change, consider assessing the degree of transmission risk that workers may be exposed to, modify procedures and protective equipment requirements (e.g., respirator or mask wearing, asking the public to wear masks, interacting with people at emergencies, limiting procedures), if required.
Encourage workers to do ongoing personal risk assessments and to respect the choices of others.
When responding to emergencies:
Provide first responders with adequate supplies of PPE and cleaning and disinfecting products.
Have dispatchers attempt to determine the COVID-19 status of any individuals present at the emergency site. Make sure that information is relayed to the first responders.
Avoid prolonged contact with members of the public unless providing life-saving care.
Implement procedures and processes that reduce the risk of being exposed to COVID-19 (e.g., assessing individuals for COVID-19 upon arrival if appropriate, requiring respirators when interacting with the public, requiring additional protective equipment when performing life-saving care, limiting the number of workers allowed in indoor spaces etc.)
Provide disposable masks to first responders, train workers to offer them to individuals who they interact with.
After providing care to a patient who was likely or confirmed to have COVID-19, clean and disinfect all equipment and surfaces (e.g., non-disposable personal protective equipment, medical devices and equipment, stretcher, etc.) touched by the person or the person’s body fluids.
If contact with illicit drugs is possible when responding to calls, train workers TO AVOID using hand sanitizer. Some hand sanitizers contain alcohol, which may increase the absorption of fentanyl and other hazardous substances through the skin. Make sure workers wear and remove protective gear safely and wash hands and exposed skin with soap and water.
When community COVID-19 transmission rates are high:
Consider requiring workers to wear a mask, installing physical barriers and, increasing physical distancing (e.g., at reception, service counters, inside vehicles, etc.),when able. Keep workers that spend most of their time outside the office or station (e.g., on emergency responses, at hospitals, etc.) with same partner or same small group of partners, if possible.
Responders who interact with others (e.g., paramedics) should perform a formal pre-shift COVID-19 assessment. If they report COVID-19 symptoms, have them take a laboratory COVID-19 test and isolate until the results are known.
Consider implementing a routine rapid testing program for workers to help prevent COVID-19 workplace outbreaks. Tailor the program according to local COVID-19 conditions.
Conduct training virtually, outdoors, or in well-ventilated indoor spaces, whenever possible.
It may be necessary to avoid performing aerosol-generating procedures (e.g., intubation, CPR) for patients known to have COVID-19, if possible. If those procedures must be performed, make sure that they are done with additional precautions in place to minimize the transmission of COVID-19:
Wearing additional protective gear such as respirator, face shield, gloves, and gown.
Thoroughly cleaning, disinfecting, and ventilating the equipment and space after the procedure.
Consider limiting the use of equipment (e.g., computers, tools, life-saving gear, etc.) to one worker, especially when it is difficult to clean and disinfect. If equipment must be shared, instruct users to clean and disinfect the equipment before and after use, especially when changing users.
Consider the Risks
The risk of COVID-19 transmission is increased when individuals are exposed to several risks at once, such as:
When person-to-person interactions are longer and more frequent.
In crowded spaces, especially when people cough, sneeze, or exhale forcefully.
In poorly ventilated spaces with other people.
When people have inadequate hand hygiene, respiratory etiquette, or do not have access to cleaning facilities and products.
When shared surfaces and objects are touched frequently.
When community COVID-19 hospitalizations or cases are high or increasing.
When sick individuals are allowed to stay in the workplace.
When individuals are exposed to several risks at once.
When other risks are high and workplace health measures are relaxed (e.g., dropping indoor mask wearing requirements, requiring all workers to return to the workplace, etc.).
Consider all possible COVID-19 exposure scenarios in your setting and perform COVID-19 risk assessments. Develop or use an existing risk assessment form to document and evaluate all work setting characteristics, activities, and job roles. It is good practice to review your assessment on a regular basis to make sure your control methods are effective.
Sample questions to ask during a COVID-19 risk assessment:
Are indoor spaces properly ventilated?
Where do individuals gather?
What activities require interactions, communication, or touching shared objects?
How long, frequent, and physically close are interactions between people?
Are people able to maintain adequate physical distance from each other?
Which workers are at higher risk?
What are the high-touch surfaces and shared objects?
Do individuals normally participate in activities that create respiratory droplets (e.g., singing, shouting, etc.).
Are people expected to stay in an enclosed space for an extended duration?
Meet your legal occupational health and safety obligations by doing everything reasonably possible in the circumstances to protect the workers and ensure the health and safety the workplace.
To provide the highest level of protection to workers, use multiple public health measures and workplace controls in a layered approach. No single measure is completely effective alone. Be careful not to create new hazards or negatively impact existing safety controls. Review and adjust measures as necessary in consultation with the health and safety committee or representative.
Create and implement a written workplace COVID-19 safety plan supported by the risk assessment. A written plan may be legally required by the jurisdiction in which you operate. Refer to local authorities for details on what must be included in the plan, if it needs to be posted, etc.
Implement policies and programs to accommodate workers, particularly those who are at high risk of severe disease or outcomes (i.e., immunocompromised, have chronic medical conditions, or are older) from a COVID-19 infection.
Communication and Training
Communicate new and updated workplace controls and applicable public health measures to all workers in languages they understand. Specific training requirements and recommendations may vary depending on your jurisdiction. Allow workers the opportunity to ask questions and share concerns. Respond to questions and provide feedback within a reasonable time.
Train workers on COVID-19 specific topics such as:
Screening: keeping individuals who may be infected with COVID-19 out of the workplace.
Contact tracing: identifying and notifying people exposed to the virus and offering advice.
Screen individuals who enter the workplace, if required by your local jurisdiction. Consider having a screening program even when it is not required as an additional measure to protect your workers.
Determine which type of screening your worksite requires: passive or active.
Passive screening requires individuals to self-monitor and self-report possible illness or exposure to COVID-19.
Active screening requires individuals to respond to questions about signs or symptoms of infection, recent possible
COVID-19 exposures, or recent travel outside of Canada.
Allow individuals that pass the screening to access the workplace. Deny access to anyone who does not pass the screening.
Have workers who do not pass the screening contact their supervisor. The supervisor should instruct them to return (or stay) home and follow local public health guidance which may include isolation, testing for COVID-19, or contacting their healthcare provider or public health authority.
Determine if you are required to implement contact tracing. If so, maintain a list of all individuals (for which contact tracing applies) entering the workplace, including their names, contact information, and time spent in the workplace. This information should be provided to the local public health authority if requested for the purpose of contact tracing. All information must be safely stored and destroyed as required by privacy legislation.
For additional information on screening and contact tracing, refer to:
Ventilate indoor spaces appropriately according to the number of occupants and types of activities.
Open windows and doors to the outside, if possible.
Maintain ventilation systems and seek advice from a ventilation specialist on possible improvements (e.g., increasing air exchanges per hour, reducing or eliminating recirculated air, or upgrading to air filtration and disinfection).
If possible, run ventilation systems continuously or for two hours before and after buildings are occupied.
Run local exhaust fans that vent to the outside to help remove contaminated air.
Make sure that air circulation or cooling fans do not direct air flow from person to person.
If ventilation cannot be improved, consider using portable air filtration units with high-efficiency particulate (HEPA) filters.
Keep indoor humidity between 30% and 50%.
For additional information on indoor ventilation, refer to:
PPE includes such items as respirators, medical masks, eye protection, gloves, and safety footwear.
Eye protection (safety glasses, goggles, or face shields) may be worn in addition to a mask when in close physical contact with others. Note: face shields do not provide respiratory protection and cannot replace masks.
COVID-19 PPE policies must not interfere when a higher level of protection is needed for a task.
Workers may need PPE for COVID-19 protection if they are:
Performing tasks that require them to be less than 2 metres from another person.
Using cleaning and disinfecting products (refer to the manufacturers’ safe handling instructions).
Follow the mask wearing requirements of your local jurisdiction. If not required, mask wearing should be encouraged as an additional measure when there is a high risk for COVID-19 spread, or when physical distancing is not possible.
Masks should be comfortable, well-constructed and well-fitting, covering the nose, mouth, and chin.
Consider using masks with a transparent window when communicating with people who are deaf or hard of hearing.
Masks should not be worn by anyone who is unable to remove it without assistance (e.g., due to their age, ability, or developmental status).
Allow workers to wear masks, even if not required, based on their discretion (e.g., being at risk of more severe disease, working in crowded setting, etc.).
Immediately have them wear a mask (preferably a respirator or medical mask, or if neither is available, a well-constructed and well-fitting non-medical mask). A respirator used in this way (i.e., as source control) may not need to be fit tested.
Have them leave as soon as possible.
If they cannot immediately leave, have them isolate in a designated area, away from others, until they can leave.
Call 911 for medical assistance if symptoms are life threatening. If it is a worker, notify their emergency contact.
Complete an incident report and begin an investigation.
Refer to guidance from your local public health authority to determine when the worker can return to work.
Consider updating your sick leave policy to provide support to workers who are or may be sick. Support may include paid or unpaid sick leave, long-term disability, and information on government programs, if available.
Note that this guidance is just some of the adjustments organizations can make during a pandemic. Adapt this list by adding your own good practices and policies to meet your organization’s specific needs.
Disclaimer: As public and occupational health and safety information is changing rapidly, local public health authorities should be consulted for specific, regional guidance. This information is not intended to replace medical advice or legislated health and safety obligations. Although every effort is made to ensure the accuracy, currency and completeness of the information, CCOHS does not guarantee, warrant, represent or undertake that the information provided is correct, accurate or current. CCOHS is not liable for any loss, claim, or demand arising directly or indirectly from any use or reliance upon the information.