Central Mass EMS Corp.    CMEMSC OFFICE: (508) 854-0111   |   CMED 24/7 Phone: 508-854-0100

Dear EMS Colleagues,

As this current wave of COVID is battering the healthcare system, I applaud you for your efforts and the diligent care you have continued to provide your patients. It is certainly a challenging time for all of us. Because of a few recent events that have been brought to the Region I want to take a moment to remind you of some important considerations to keep in mind as we look at the big, COVID-painted picture.

Because every patient must be treated as if they have COVID until proven otherwise, OEMS recently updated STP 1.2 Patient at Risk for COVID-19 to reflect that. I specifically want to remind you of section d. EMS may defer CPAP or other respiratory therapies (such as nebulizer or inhaler therapies) to the receiving hospital, to reduce aerosol-generation risk. Keep in mind that the Protocols permit MDI use in place of nebulizers anyway, even for patients not specifically noted to be at risk for COVID-19, and it is acceptable to do so for all patients during this period. Parenteral therapy (e.g. intramuscular epinephrine) may be necessary for the safer treatment of severe bronchospasm. When in doubt, please discuss individual cases with on-line medical control (emphasis added).

As conscientious and caring providers, it is understandable that you want to do the best for your patients but consideration must be given to the protection of others as well. If you choose an aerosolizing procedure for your patient you must discontinue it’s use before entering the emergency department. Inform the hospital staff of the severity of your patient in the CMED entry note so they can prepare appropriately. Ensure the staff is ready for your patient before entering if needed. This is also advisable when you have a patient that is being ventilated manually or mechanically. 

Again, your patient care and compassion are greatly appreciated. Remember to take the initiatives to keep yourself, your crew, your patient and your fellow healthcare workers as safe as possible during this unprecedented pandemic. Do this by wearing your PPE. Upgrade to an N95 for any aerosolizing procedures. Consider alternative treatments when you can. Add inline HEPA filters when appropriate. Communicate with the receiving facility early. Remember we are all in this fight together.

All the best,

John Broach, MD, MPH, MBA, FACEP

Region II Medical Director