In response to the continued issues raised from our members, LAS UNISON Branch have worked with our management in the last few days to secure the following agreed guidance to our members that provides a more appropriate level of PPE for the risks we encounter.
We advise our members that, when faced with patient and public contact during the course of their work, that they make a risk assessment in each contact situation.
This should be in the form of an initial assessment, at a safe distance, utilising all the available information including that from EOC / 111 to assess whether the patient has symptoms consistent with Coronavirus.
Due to the nature of the environment and situations that we attend for patients requiring resuscitation, we believe that there is a high risk of aerosol contamination from chest compressions sufficient enough to warrant the available protection of FFP3 masks. We advise that our members use a minimum of FFP3 mask and gown or Tyvek suit to all patient resuscitations.
The first clinician on scene should don an FFP3 mask and gown to allow rapid attendance at the patients side to undertake defibrillation if needed and continue chest compressions.
If no gown and /or FFP3 is available an apron and / or surgical mask should be worn and then the clinician withdraw to don an FFP3 mask and Tyvek suit at an appropriate point.
It is felt that it will be far quicker to safely don an FFP3 mask and gown than it is to safely secure a surgical mask and apron or Tyvek to deliver early defibrillation and it also means all three clinicians will be able to work together throughout the resuscitation.
Given the Community spread of Coronavirus PPE needs to be used in line with the PHE guidance. This means, for every patient we have direct contact with, we should wear a surgical face mask, apron, double gloves and eye protection (risk assessed).
There is no requirement for the Tyvek suit to have a hood. However if the initial risk assessment suggests that the patient is at high risk of being infected with Covid-19 (eg confirmed cases
or symptoms of a high fever and / or cough) and the attending clinician will require contact with the patient within 1 meter for more than 15 minutes continuously, then consideration may be given to the attending clinician using a gown or Tyvek suit in place of the apron.
We advise a gown or Tyvek suit in place of the current poor quality apron as this is the only suitable bodily protection, available at this time, from the exposure and transmission of infected droplets in a pre-hospital environment until a time that a suitable alternative can be found and agreed for use with LAS UNISON.
Unless an APG is being undertaken, a surgical mask provides the necessary protection as per national guidance – a higher grade mask will only need to be worn, outside of a resuscitation or AGP, under exceptional circumstances.
We recognise the ongoing supply challenges of PPE nationally to ambulance NHS trusts and ask our members to consider, where safe, to use the minimum protection they deem necessary (if any) to best protect our resources.
However, if sufficient protection is not available at that time, then staff should withdraw from patient contact and request a suitably equipped resource to attend in their place.
By making this recommendation we are relying on the professionalism of our members to choose the correct PPE for each patient contact in order to protect our supplies for the weeks to come and ensure we maintain safety for our members throughout the Pandemic.
Staff that are not fit tested for the FFP3 masks, or who have failed fit testing, should not make close patient contact and request a suitable replacement resource if on scene.
Those staff who are not fit tested should ensure they attend to be fit tested as soon as possible or consider discussing alternative duties with their line manager.
Those staff who have failed fit testing should discuss options with their line manager.
Where staff reasonably believe their uniform to have been contaminated during close contact with a patient or person suspected to be infected with Covid-19 due to using insufficient PPE, should return to station as soon as safe to do so, decontaminate and replace the contaminated items with clean ones.
This may require staff to be prepared to attend work with an increased level of spare uniform and suitable toiletries.
Please contact your local UNISON representative should you have questions or further issues.