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

Network Of practitioners For Emergency medicAl This project has received funding from the European Union ’ s systems and cRitical care Horizon 2020 programme, under grant agreement no. 786670 COVID EMS operations Lessons Learned NO-FEAR WP4 Webinar June 23 th 2020

A pan-European Challenge • Scattered and complex chain of 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 This project has received funding from the European Union ’ s Horizon 2020 programme, under grant agreement no. 786670

The network will be structured along 3 main pillars, with transversal expert groups  Care in hospital and pre-hospital setting Acute care of the  Continuity of care between EMS and receiving hospitals patient  Psychological support  Preparedness, planning and coordination with the authorities before the Acute care incident operations in security related  Calling, activation of system, scene management and on-site coordination incidents  Transportation and coordination with treatment facilities  Innovative curricula and training methodologies Training and  New simulation tools in pre- and in-hospital preparedness and response education of personnel and  Inclusion of pre-hospital care, disaster and emergency medicine in medical volunteers and nursing schools This project has received funding from the European Union ’ s Horizon 2020 programme, under grant agreement no. 786670

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 operations. • This webinar is being recorded and the presentations will be shared • The views presented are not formal communications from the organizations This project has received funding from the European Union ’ s Horizon 2020 programme, under grant agreement no. 786670

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 This project has received funding from the European Union ’ s Horizon 2020 programme, under grant agreement no. 786670

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

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

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

8 th March 2020 The other side of novel coronavirus outbreak: Fear of performing cardiopulmonary resuscitation Deakin et al 2018 Resuscitation

20 th March 2020 An integrated response to the impact of coronavirus outbreak on the EMS of Emilia Romagna Calls 3290 Calls 1141 Semeraro et al 2020 Resuscitation

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

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

24 th 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 Dr. Edison Montes M. Emergency Medicine Specialist EMS

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