Coronavirus (COVID-19) - Tips

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First Responders

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Introduction

This tip sheet is for first responder employers and employees (e.g., paramedics, police officers, firefighters) who provide emergency medical services. This document provides an overview of recommended controls to help reduce the risk of exposure to COVID-19 in the workplace. Additional controls will also be required depending on the workplace and specific types of tasks performed by workers.

For general COVID-19 prevention practices, employers and employees can refer to the CCOHS resource “Protect Yourself and Others”.

Consider the Risks

  • The risk of contracting COVID-19 increases in situations where people are in closed spaces (with poor ventilation) and crowded places when with people from outside their immediate household. Risk is higher in settings where these factors overlap or involve activities such as close-range conversations, singing, shouting or heavy breathing (e.g., during exertion).
  • As a first responder, potential sources of exposure include:
    • providing medical treatment to an individual who has COVID-19 (the risk would be greater when performing aerosol-generating medical procedures).
    • touching surfaces or items that have been touched or handled by a person with COVID-19, and then touching your mouth, nose, or eyes.
    • having close contact with a co-worker who has COVID-19.
  • Each workplace is unique. Employers need to assess the risks of COVID-19 for their specific workplace and the activities conducted by their workers.
  • The employer must then implement appropriate hazard controls using the hierarchy of controls (i.e., elimination, substitution, engineering controls, administrative policies, and the use of personal protective equipment (PPE)). Use multiple personal preventive practices in a layered approach.
  • Consider implementing a written workplace safety plan that identifies potential exposures to COVID-19 and the controls implemented to protect employees.
  • Employers should consider the following:
    • How will employees be screened?
    • What will be done to promote the vaccine?
    • How will employees be trained?
    • Do employees have all the required supplies to protect themselves (e.g., personal protective equipment, hand hygiene products, cleaning, and disinfectant products)?
    • How will first responders be protected if they are providing emergency medical services to a person suspected of having COVID-19?
    • What precautions will be used to protect employees when patients are being transported in vehicles?

Vaccine

Communication and Training

  • Provide information and instruction to employees about the hazards of COVID-19 and what they need to do to protect themselves and others. Topics should include:
    • What COVID-19 is and the common symptoms
    • How the virus spreads
    • How layering multiple control measures helps to prevent the spread
    • Screening and what to do if employees feel sick or may have been exposed
    • Specific personal preventive practices that can be used to protect employees
    • Proper hand hygiene, as well as sneeze and cough etiquette
    • How to properly wear, handle, and care for personal protective equipment
    • Safe use of cleaning and disinfection chemicals
    • How to stay informed about COVID-19 (using reputable sources).
  • Encourage employees to report any COVID-19 concerns to their supervisor or employer. Employees can also report concerns to their health and safety committee or representative, or union if present.
  • Provide regular communications so that employees are informed of updates and have an opportunity to discuss their questions and concerns.
  • Post signs throughout the workplace, as a reminder about which precautions to follow (e.g., hand hygiene, physical distancing).
  • Provide mental health support resources for all employees, including access to an employee assistance program (EAP) if available.

Screening

  • Consider asking screening questions to employees, before each work shift, using a checklist from the Canadian Centre for Occupational Health and Safety (CCOHS) or your local public health authority.
  • Some jurisdictions require active screening of employees everyday before they come into work. Active screening steps may involve a self-assessment (e.g., using a web-based tool, having a person complete a questionnaire, or having a designated person asking direct questions). Consider the size of your workforce, the number of worksites, shifts, and activities when choosing your screening method.
  • Employees who have COVID-19 symptoms should return home immediately (preferably not by public transit) or stay home if already there. If they develop symptoms at work, they need to put on a medical mask, or if unavailable a well-constructed and well-fitting non-medical mask. They should also contact their health care provider and local public health authority.
  • Symptoms can vary from person to person and within different age groups.
  • Symptoms may take up to 14 days to appear after exposure to COVID-19. Some people have mild or no symptoms.
  • Older adults, people of any age with chronic medical conditions or who are immunocompromised, and those living with obesity are at risk for more severe disease and outcomes from COVID-19.
  • Develop procedures for contacting local public health authorities for further advice in the event of a positive COVID-19 case. If the case is work-related, additional notifications may be required (e.g., the jurisdictional health and safety regulator and worker compensation board).
  • To support contact tracing efforts, record the names and contact information of all workers and other persons who enter the workplace, as required by your local public health authority. Make sure that privacy is protected, and that the information is stored securely. Contact information must be destroyed in a timely manner according to privacy requirements.

Screening the Public

  • Update procedures for emergency dispatchers to include COVID-19 related screening questions when gathering information from callers.
  • Dispatchers should ask questions to determine if anyone at the incident location has COVID-19 related symptoms, has travelled outside the country, had close contact with someone who has COVID-19, or is currently under quarantine/isolation as directed by Public Health. Dispatchers should relay this information to the first responders.
  • Educate the public on screening and why it is important to provide honest answers to ensure safe service delivery.

Treating Individuals

Always follow current work practices and prevention measures when treating individuals, including:

  • During calls, limit the number of personnel that enter a building, if the situation can be handled safely by a smaller crew.
  • Individual’s assessment – Only the required responders needed for care work should be within 2 metres of the individual. Other responders should remain at least 2 metres away from the patient or their family members. Ask the individual to wear a medical mask. If this is not possible or not tolerated, ask the individual to cough or sneeze in their arm and to perform hand hygiene.
  • When you are within 2 metres of an individual under investigation, wear gloves, a face shield, a gown, and an N95 respirator.
  • When removing PPE always perform hand hygiene. N95 respirators should only be removed using the straps.
  • Vulnerable community care – Be vigilant when entering facilities (e.g., nursing or retirement homes) associated with people who may have pre-existing conditions.

Transporting Individuals

  • Limit the number of people in the individual’s transportation compartment. Discourage family members from accompanying the patient. Ask others to follow in a separate vehicle, unless necessary (e.g., pediatric patient). Offer a medical mask and ask them to perform hand hygiene before entering the vehicle.
  • Transport with full ventilation (see ventilation section for further information).
  • Wear full PPE during transport, and do not perform aerosol-generating medical procedures, if possible.
  • Isolate the driver. The driver should remove PPE and perform hand hygiene before entering the cab. The driver should still wear a medical mask. However, if it is not possible to isolate the driver’s compartment, conduct a hazard assessment and make sure that precautions are in place to protect the driver (e.g., if an aerosol generating medical procedure is performed the driver should wear an N95 respirator).
  • Notify the receiving facility that a suspected COVID-19 individual is arriving. Driver should re-apply necessary PPE upon arrival to the destination if contact with the individual is necessary.
  • Put on appropriate PPE and perform routine vehicle and equipment cleaning and disinfection after the call. If an aerosol generating medical procedure was performed, put on the necessary PPE, perform post-transport ventilation (e.g., open all doors and windows, turn exhaust fans on high) for 20 minutes, then clean and disinfect equipment.

Reducing Potential Exposures

  • Keep crews together if possible. Each crew should stay physically distant from other crews and should not socialize with other crews.
  • Determine if any employees can work remotely (e.g., roles that perform administrative functions). Provide ergonomic support and resources for employees setting up home offices.
  • Eliminate non-essential work travel for all employees.
  • Discourage unnecessary physical contact such as handshakes.
  • Avoid in-person meetings where possible. Use remote communications methods instead (e.g., teleconferencing, videoconferencing). When in-person meetings are required, use a large well-ventilated space, instruct participants to stay the greatest physical distance (at least 2 meters) apart, and wear non-medical masks.
  • Reduce the amount of paper documentation being exchanged between employees. Consider using digital or electronic methods to exchange documents. If this can’t be avoided, wash or sanitize hands after exchanging documents.
  • Consider cancelling or postponing non-urgent community events.

Physical Distancing

  • Keep the greatest physical distance possible (at least 2 metres) from people outside your immediate household, where possible.
  • Make sure there are procedures for any work that requires employees to work within two metres of another person and include precautions such as the use of personal protective equipment.
  • Review training programs and determine if any training can be conducted virtually. Identify which training is essential and can only be conducted in person (e.g., those with a practical component that are considered critical to the department’s operations). Consider:
    • Establishing a maximum number of participants
    • Having participants wear a well-fitted and well-constructed non-medical mask
    • Determining if training can take place outdoors. If taking place indoors, make sure the training is conducted in a large, well ventilated space
    • Having participants maintain the greatest distance possible (at least 2 metres) away from others.
  • Post capacity limits at entrances to shared employee areas (e.g., kitchens, washrooms, conference rooms).
  • Remove chairs and post reminders to maintain physical distancing in common meeting spaces (e.g., kitchen, offices, etc.).

Ventilation

Below are tips related to vehicles (e.g., ambulances) used to transport patients to healthcare facilities:

  • When travelling with others always try to increase the amount of fresh air entering the vehicle. Make sure that all climate controls are set to fresh (not recirculating) air.
  • Where possible, when transporting patients, use vehicles that have separate driver and patient compartments. If applicable, close any pass-through doors and windows between the two compartments, before bringing the patient on board. Make sure the ventilation system is using the maximum amount of outside air possible.
  • If a vehicle without an isolated driver compartment must be used, turn on the outside air vents in the driver area to the highest setting and (if equipped) turn on the rear exhaust ventilation fans. These settings will help direct air flow away from the driver and towards the back of the vehicle.
  • Some vehicles may be equipped with a supplemental recirculating ventilation unit that passes air through HEPA (high efficiency particulate air) filters before returning it to the vehicle. Using this system can help reduce potential infectious particles in the air.
  • After transporting the patient to the healthcare facility, leave the rear doors of the transport vehicle open. This will help remove any potentially infectious particles prior to cleaning and disinfecting the vehicle. Make sure that appropriate security precautions are in place when the doors are open to prevent theft. (Note: If an aerosol generating medical procedure was used, follow the post-transport ventilation recommendations in the ‘Transporting Individuals’ section).

Below are tips related to buildings (e.g. paramedic stations police stations, fire halls):

  • Verify that the heating, ventilation, and air conditioning (HVAC) system(s) for the building is working properly.
  • Ensure preventative maintenance for HVAC system(s) is conducted according to manufacturer's instructions (e.g., regular filter changes and inspection of critical components).
  • If possible, consult a HVAC professional to determine whether your HVAC system:
    • can be adjusted to increase air exchange rates
    • is using filters of the highest Minimum Efficiency Reporting Value (MERV) rating compatible with the system.
  • For additional information on indoor ventilation, please refer to:

Personal Hygiene

  • Encourage frequent and proper hand washing with soap and water, for at least 20 seconds. If soap and water aren't available, use hand sanitizer.
  • Provide hand sanitizer to all employees and make sure that hand sanitizer is available in each vehicle. Make sure that all provided hand sanitizer has at least 60% alcohol.
  • Follow the World Health Organization’s “My five moments for hand hygiene” approach to cleaning their hands:
              (1) before touching a patient
              (2) before any clean or aseptic procedure is performed
              (3) after exposure to body fluid
              (4) after touching a patient
              (5) after touching a patient’s surrounding
  • Also wash hands at the start of shift, before eating or drinking, after touching shared items, after using the washroom, after removing PPE, after cleaning and disinfecting objects, after each call, after refuelling vehicles, after being in public, and at the end of the shift.
  • Patients should be offered hand hygiene prior to entering the vehicle and should wear a surgical procedure mask, if tolerated, during transport.
  • Discourage individuals from touching their eyes, nose, or mouth with unwashed hands and from touching the outer surface of their mask while wearing or handling it, as it may be contaminated. Promote hand washing or use of hand sanitizer after putting on, touching, or removing masks.
  • Promote good respiratory hygiene. Provide disposable tissues and remind individuals to cough or sneeze into the bend of your arm or a tissue and to dispose of tissues immediately, followed up with hand washing or use of hand sanitizer.
  • Verify that all necessary materials are readily available in the workplace (e.g., hand sanitizer, garbage disposal, disposable tissues).

Cleaning and Disinfecting

  • Viruses can remain on objects for a few hours to days depending on the type of surface and environmental conditions.
  • To promote consistent disinfecting practices, create and provide a routine cleaning and disinfecting procedure, schedule and checklist.
  • Use household or commercial disinfectants to destroy or inactivate viruses and bacteria.   The disinfectant used should have a drug identification number (DIN), meaning that it has been approved for use in Canada.
  • Employees should be trained on the safe use of the cleaning and disinfecting products. Always follow the manufacturer’s instructions when using, handling, or storing the product. Review the product’s label, and (if applicable) safety data sheet to determine what precautions to follow.
  • Select PPE that will protect workers from both the hazard of COVID-19 and the hazard of potential chemical exposure from the cleaning and disinfectant products used.
  • Clean and disinfect all high contact surfaces. For example, with vehicles:
    • Make sure that PPE is worn and there is appropriate ventilation (e.g., keep windows and doors open to allow outside air to enter the vehicle).
    • All visible surfaces should be cleaned first and then disinfected starting from the ceiling of the vehicle and working down to the floor in a systematic process (e.g., ceiling, walls, cupboards, windows, work surfaces, chairs, and floor).
    • All surfaces that may have had contact with the patient or materials that were contaminated during patient care must be thoroughly cleaned and disinfected including tools and equipment (e.g., blood pressure cuffs, stethoscopes, defibrillators, etc.) and the stretcher.
    • Stretcher linens should be removed and placed in a bag. Do not shake dirty laundry. Launder items according to the manufacturer’s instructions. Machine wash using the warmest appropriate water setting (preferably hot water), use laundry detergent, and dry thoroughly.
  • Change out of work clothing at the end of each shift and wash them (see laundry tips mentioned above). Do not store street clothes and work clothing in the same space unless both are clean.

Personal Protective Equipment (PPE)

  • Review and update procedures to include the PPE that will be used to protect first responders from COVID-19. Follow any specific PPE requirements for your jurisdiction (if applicable).
  • See ‘Treating Individuals’ section for PPE recommendations.
  • Consider having all responders and those associated with the call wear a medical mask. If in close contact (within 2 metres) of a positive or suspected COVID-19 individual, use an N95 respirator.
  • Ensure that workers are trained on the proper use of PPE including donning and doffing procedures. Make sure that employees understand the limitations of PPE.
  • Training on the care, use and storage of respirators should include:
    • Limitations of the respirator.
    • Inspection and maintenance of the respirator.
    • Proper fitting of the respirator.
    • Cleaning and disinfecting the respirator (if applicable).
  • Make sure that first responders are fit tested before they are required to wear a tight-fitting respirator (e.g., N95). Fit testing verifies that there is an effective seal between the respirator and the worker's face.
  • Consider fit testing responders to a minimum of two N95 styles should PPE availability be challenged.
  • Remind employees that they cannot have facial hair that comes between the sealing surface of the respirator facepiece and the face. Facial hair can cause respirators to leak around the face seal.
  • Ensure that there are written measures and procedures regarding the selection, care and use of respirators.
  • Verify that appropriate supplies of PPE are available. Extra supplies are recommended to be carried on each vehicle.
  • Ensure there is a safe area with disposal and decontamination supplies for first responders to doff their PPE.
  • Develop procedures for the proper disposal of any single-use PPE. Waste should be bagged and deposited in an appropriate garbage container.
  • Ensure re-usable PPE is cleaned and disinfected after use according to manufacturer’s instructions. See cleaning and disinfecting section for additional information.

Evaluate Controls

  • Regularly review the adequacy of the controls implemented and make improvements as necessary.
  • Determine if there are any new hazards created by any of the changes implemented at the workplace. For example, if workers are issued N95 respirators have they been fit tested? Review and adjust programs as necessary.

Business Continuity Plans

  • Review and adjust business continuity plans to address issues related to COVID-19 such as: what to do if there is a staff shortage, what to do in the event of an outbreak, and how communication will be coordinated with stakeholders such as the jurisdiction’s Ministry of Health and local public health authorities.

It is important that mental health resources and support are provided to all workers, including access to an employee assistance program, if available.

For further information on COVID-19, refer to the Public Health Agency of Canada.

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.

Document last updated April 14, 2020