COVID EMS operations Lessons Learned NO-FEAR WP4 Webinar June 23 - - PowerPoint PPT Presentation

Network Of practitioners For Emergency medicAl systems and cRitical care This project has received funding from the European Union’s Horizon 2020 programme, under grant agreement no. 786670

COVID EMS operations Lessons Learned

NO-FEAR WP4 Webinar June 23th 2020

A pan-European Challenge

• Scattered

and complex chain

• f

actors in security-related incidents: EMS, hospital staff, police, firemen, citizens

• Fear of new threats: terrorism, armed conflicts, dirty weapons, new

infectious diseases

• Lack of communication between practitioners and suppliers:

suppliers are not aware of the specific needs of practitioners, practitioners are not aware of new products and innovation

• No common methodologies and standardized actions

The network will be structured along 3 main pillars, with transversal expert groups

Acute care of the patient

Acute care

• perations

in security related incidents Training and education of personnel and volunteers

• Care in hospital and pre-hospital setting
• Continuity of care between EMS and receiving hospitals
• Psychological support
• Preparedness, planning and coordination with the authorities before the

incident

• Calling, activation of system, scene management and on-site coordination
• Transportation and coordination with treatment facilities
• Innovative curricula and training methodologies
• New simulation tools in pre- and in-hospital preparedness and response
• Inclusion of pre-hospital care, disaster and emergency medicine in medical

and nursing schools

Objectives of the meeting

Share experiences and lessons learned of EMS providers globally, on their COVID 19 response, in order to improve our current and future

• perations.
• This webinar is being recorded and the presentations will be shared
• The views presented are not formal communications from the
• rganizations

Agenda

• Iprocure Security Project
• International Association of Fire Chiefs Fire Chiefs
• SAMU RN – Santiago, Chile
• London Ambulance Service
• SAMUR P.C, Madrid
• University Hospital Brussels – Universitair Ziekenhuis Brussel
• Bavarian Red Cross
• Magen David Adom Israel

Memories from the past One fear for the future

Federico Semeraro, MD, FERC Consultant in Anaesthesia and Intensive Care, Maggiore Hospital, Bologna, Italy European Resuscitation Council co-chair BLS Science and Education Committee Italian Resuscitation Council Scientific Committee Member

8th March 2020 Italy Lockdown 8th March 2020 Letter to Editor Resuscitation The other side of novel coronavirus outbreak: Fear of performing cardiopulmonary resuscitation 16th March 2020 – New Covid19 ICU Until 19th April 2020 – Covid19 ICU 20th March 2020 Letter to Editor Resuscitation An integrated response to the impact of coronavirus outbreak

• n the Emergency Medical Services of Emilia Romagna

Memories from the past

7th March 2020 Italian Resuscitation Council CPR SARS-COV-2 Recommendation

8th March 2020 The other side of novel coronavirus outbreak: Fear of performing cardiopulmonary resuscitation

Deakin et al 2018 Resuscitation

20th March 2020 An integrated response to the impact of coronavirus outbreak

• n the EMS of Emilia Romagna

Calls 3290 Calls 1141

Semeraro et al 2020 Resuscitation

30th March 2020 ILCOR Covid-19 infection risk to rescuers from patients in cardiac arrest

15th April 2020 New Early Warning Score: off-label approach for Covid-19

• utbreak patient deterioration in the community

“The hypothes is of early interception of deterioration could be useful to prevent potential increase in mortality that unfortunately did happen last month in Italy. We created a free open source platform called CovidUP19 ad hoc for citizens to increase awareness about potential deterioration in case of covid-19 infection. We invited all the international health system researchers to allocate time and resources on this innovative approach for potential“off label” application of NEWS in Covid-19 patients.”

Semeraro et al 2020 Resuscitation

24th April European Resuscitation Council COVID-19 Guidelines

Kids Save Lives Covid-19

As a specific campaign, the authors propose a renovated KSL logo for use during the COVID-19 pandemic and, in agreement with the European Resuscitation Council, calls the international community for specific initiatives to reinforce and adapt the KSL campaign to the current context. Far too many people are still dying following OHCA worldwide, and hundreds of thousands of deaths could be avoided. All the communities must overcome the fear of COVID-19 to help KIDS to learn to save lives.

One concern for the future

Bystander CPR Cardiac arrest in the schools How we can manage ? How we can protect bystander ? Howe we can convince bystander to intervene? How we can reduce the fear ?

Centro Metropolitano de Atención Prehospitalaria / SAMU Metropolitano

COVID-19 MEDEVAC Experience at Chilean EMS

• Dr. Edison Montes M.

Emergency Medicine Specialist

Chilean demographics

• 2017 Census - 17.6M

inhabitants

• 2019 Estimation - 19.1M

inhabitants

• Metropolitan Region - 7.1M

inhabitants (2017) - 40,3%

• 4270 Km from north to south
• 445 Km from east to west

COVID-19 statistics until June 22

• Total confirmed - 246963
• Active cases - 37064
• 80.3% Metropolitan Region
• Average daily cases - 5500
• Total deaths - 4502
• Total recovered - 205397

Health System Infrastructure Resources (SOCHIMI)

• ICU beds April 2 - 726
• ICU beds June 21 -

2688 (3,7 fold increase)

• ICU occupation
• 90% national
• 95% Metropolitan

region

SAMU Metropolitano Infrastructure

• March 01
• 22 Basic ambulances
• 18 Advanced ambulances
• 1 Medical ambulance
• June 22
• 19 Basic ambulances
• 21 Advanced ambulances
• 1 Medical ambulance

MEDEVAC Statistics

• 36 missions (May 15 to June

21)

• 93 patients (mechanical

ventilation)

• Isoark N36.6 capsule
• Fixed and rotary wing
• Hercules C-130
• Apache UH-60
• Beechraft Super King Air

Positive lessons learned

❖ Team work with other institutions ❖ Planning & organization ❖ Work under extreme stress ❖ Leadership of regional EMS

Issues to be improved

❖ Develop EVACRIT resources check list ❖ Electromedical equipment availability was

most important limitation

❖ Need of dedicated staff, with proper

training

Challenges

❖ Develop a specific unit for EVACRIT ❖ Defined budget ❖ Ultra specialized staff ❖ Exclusive staff permanently trained ❖ Exclusiveness of electromedical

equipment

Fire Chief Gary Ludwig

President and Chairman of the Board International Association of Fire Chiefs

Current Situation

• Total Cases: 2,289,168
• Deaths: 120,044
• Fire/EMS Deaths: 55+
• Phase I and II re-opening in all 50 states
• Restaurants at 50% capacity, gyms at 30% capacity, religious services at 25% capacity
• Hot spots occurring in many states – mostly in the South and Southwest
• Some cities considering re-issuing stay-at-home orders
• Protests and riots could lead to increase in cases

IAFC Response

• IAFC is not a response agency, but directly supports fire departments
• Provided resources to fire/EMS chiefs
• Compilation of best practices
• Guidance
• Webinars
• Partnership with Amazon to purchase PPE
• Resources available at www.iafc.org/covid19
• Represented fire departments before the US federal government to request

funding, PPE, and other resources

What Worked

• Call screening
• Important to ask callers about their symptoms and warn responders
• Minimizing shift trades and re-assignments
• Prevents virus spread if a firefighter/paramedic is asymptomatic
• Minimizing number of personnel contacting patients
• Prevent potential exposures by limiting who comes into close contact with a patient
• Medical Line for Fire/EMS Personnel
• Some agencies created a phone line for personnel to call to review their symptoms and

assess whether they should quarantine or stay home from work

What to Improve

• PPE Availability
• Fire departments need to prepare for future COVID waves
• Need to prevent competition for PPE between EMS, hospitals, and nursing homes
• Public Education
• It’s still safe to call 911 – “Don’t Die from Doubt” Campaign
• Communicable Disease Reporting
• Inform EMS personnel when they have been exposed to patients with serious diseases
• EMS Financing in the US
• Need to support treatment without transportation

Future R&D Needs

• PPE
• Need for better reusable PPE
• Need for PPE disinfection – especially for respirators
• Improve ability to identify counterfeit PPE
• Improved testing
• Need for faster and more accurate testing
• Viral testing
• Antibody testing
• Need rapid testing to distinguish COVID vs. Influenza vs. RSV
• Likely to see challenges in the fall due to convergence of flu season

and COVID

• Vaccines
• Need distribution strategy

Daniel Barnwall

Emergency Planning & Resilience Officer Department for Resilience & Specialist Assets

COVID-19 ‘Lessons Learned’ Webinar

23rd June 2020

London Ambulance Service NHS Trust

Current Situation in the UK

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London Ambulance Service NHS Trust

Current Situation in London Ambulance

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• Overall, positive response time performance across all

metrics

• Sustained positive position (since first week in April)
• Continue to ensure ‘restart’ of NHS services and encouraging

the population to seek help as required

• Debriefing / After Action Reviewing of ‘Pre-Peak’ and ‘Peak’

activities ongoing

• Maintenance of peak response capacities

London Ambulance Service NHS Trust

• Increased ‘COVID’ capacity in 999 and 111 call

answering – in reserve

• Maintain ‘larger’ reserve response capacity – e.g. bank

paramedics / fire-fighters / volunteer ambulance drivers

• Regular senior organisational, clinical and operational

leadership video and web briefings

• Enhanced logistics support in to ambulance operations

– PPE supply chain, vehicle cleaning, ambulance station capabilities

• Focus on staff welfare, testing, accommodation and

travel requirements

COVID-19 Operations Positive Lessons – ‘To Keep’

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London Ambulance Service NHS Trust

• Challenge of ‘keeping up’ with latest guidance

from the NHS, Public Health England and Central Government

• Real challenges for organisation-wide

communication / briefing / understanding of the current situation – use of all media channels – TV / Social Media / Email / Intranet / Bulletin

• Regularly updated ‘patient facing’ guidance

from the medical directorate

COVID-19 Operations Considerations for improvement

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London Ambulance Service NHS Trust

• Ensure understanding of pre-peak and peak debrief,

prepare for further outbreaks or further peak(s)

• Central Government next steps and impact on EMS?
• Quarantines, NHS Test and Trace, economic restart
• Maintain momentum of response activity
• Maintain support of volunteers and the public
• Prepare for increased demand
• Summer, warm weather, ‘normal’ increased demand
• Resume NHS ‘normal’ activity across routine and urgent

care

• Re-start of sporting and cultural events within London
• COVID-19 second peak?

Future challenges

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London Ambulance Service NHS Trust

Thank you

daniel.barnwall@lond-amb.nhs.uk www.londonambulance.nhs.uk

@ldn_ambulance ldn_ambulance

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