Health & Safety Concerns Regarding Coronavirus Preparedness
I have been giving much thought to the current Coronavirus (C-19 for short) situation and have been collating issues and concerns about the lack of preparation, training and organisation in respect of it.
The following covers all the bases where there are issues and it is no secret that as UNISONs Health and Safety Officer I am deeply disappointed that there has been minimal consultation with me personally over the C-19 situation especially since I have made it known that I was available to attend Trust meetings.
The current state of play is far from acceptable and this will be discussed with the branch incoming branch secretary and branch chair this week.
After receiving a draft copy of the SOP relating to C-19 and the use of the “3M Versaflo TR-300” respirator on 27 February 2020 from Jason Gillingham, I added my concerns and returned the said amended document in the anticipation that I would receive a reply to the issues and concerns that I had raised. This has not happened.
I feel that my genuine concerns about staff health, safety and welfare have been ignored, intentionally or otherwise and I am disappointed that the Trust has not invited me (Unison Health and Safety Officer) to any meetings to discuss these issues in order to achieve a satisfactory outcome. In the interim I have been keeping abreast of the of the increase and spread of C-19 and have become even more concerned about the lack of realistic and robust support to our members. These same concerns were raised when Ebola became an issue and I did not receive acceptable answers to the concerns raised at that time either.
- There has been a total lack of adequate and suitable training and in respect of contagious diseases and the use of full body PPE by our members apart from HART Teams.
- There has been a limited amount of successful FFP3 Fit Testing, but the Trust has been very slow to provide adequate and suitable PPE to the members of staff that have failed the FFP3 Fit Test.
- There has been no active training in the correct donning / doffing of full PPE including the full body suit, gloves and masks to ensure that members are properly trained in the correct procedures including Buddy-checking whilst donning or following correct sequences during doffing which can pose an increased risk of contamination if not carried out correctly. Donning and doffing should be supervised by a trained member of staff qualified to identify if any errors or omissions take place which could place the wearers at risk.
- The 3M on line video instructions on how to assemble and the 3M respirator reflects its usage by tradesmen and general workers. The decontamination instructions given by 3M state that the hood should be removed from the head assembly and disposed of, retaining the inner head assembly which can then be cleaned. There is no mention of this 3M respirator being used by emergency medical staff or that it can SAFELY be decontaminated after coming into contact with C-19 or other such contagious diseases.
- The Trust SOP states that the 3M respirator can be decontaminated by using 1:5000 active chlorine however we believe that this has not been approved by 3M the manufacturers because parts of the hood material are porous and these therefore should be disposed of.
- The current system of call taking is letting our members down because I am receiving calls from reps and members who inform me that crews have been sent to patients who had telephoned 111 because they were suffering the signs and symptoms of C-19, but this crucial information is NOT apparently being passed to the crews. This fails to comply with the NHS England advice that “Where possible cases are identified, this information MUST be passed to the responding resources (ambulance or response car) prior to arrival on scene”.
This failure results in ambulance crews entering the “hazardous area” inside the patient’s accommodation, handling doors, furniture and the patient, without PPE because they were not pre-warned in the MDT messages that assigned them to the patient. I have reiterated to reps that they must actively encourage members to raise a Datix for any such incident, particularly in respect of C-19 to prevent the same happening to other crews.
- I am being informed by reps of a crew who had completed their clinical assessment and believed the patient to be a suspected C-19 patient who had recently returned from Italy. They were concerned that they had been within the hazardous zone in excess of 50 minutes, potentially handling and breathing in the aerosol droplets. The crew then informed 111 who instructed the crew that the patient must be swabbed to establish if they actually were infected. With this in mind, the crew asked their manager if they too should self -isolate, because of the given circumstances, but their manager said they need NOT self-isolate unless the patient’s swab was positive (how and when would the crew know of the result?)… or the crew developed symptoms… A case of Horse, Gate, Bolted…
- This raises a whole bucket load of issues, because the crew who are potentially infected are expected to attend to other patients, before then going home and potentially infecting their own family members… up to the point where that patient’s swab is positive AND by now they have potentially spread it further… at which point they would be expected to self-isolate… Unfortunatley this may be TOO LATE.
- The UK Government has advised that residents in the UK should self-isolate if they have been in contact with anyone that has returned from certain foreign countries or been in contact with persons that are suspected or confirmed to have C-19, even recommending that where possible they should consider working from home. This does not appear to apply to ambulance crews who are in the thick of it. The WHO organisation advises that it is still possible to catch C-19 from a patient that who has just a mild cough and does not feel ill.
- Our Clinical members cannot work from home; the very nature of their work requires them to go into the personal spaces of patients, and this means they are exposed to potential bacteria, viruses and diseases even before making contact with the patient. The World Health Organisation recommends staying at least three feet away from a person who is sick, but we have to go much closer.
- With the low pass rate of FFP3 fit testing, a high number of members are being deployed without adequate respiratory protection at the start of their shift.
- One of my greatest concern is that despite the Ebola situation and the impact that it had, there has been no proper engagement with Unison Health & Safety in respect of C-19 and this has resulted in us not being able to provide satisfactory answers to our members who are voicing their concerns in respect of their own personal safety and the risk of infecting their family members after being in contact with suspected / confirmed C-19 patients.
- The WHO also recommends wearing a mask if you are caring for or attending to a patient who MAY have C-19, but not all ambulance crew members have an FFP3 respirator with them when they approach the patient; those who failed the fit test have to wait for a 3M to be brought to them.
I have been contacted by clinicians who are concerned because they do not have an FFP3 fitted mask and they also have family members living in the same household who have high risk medical conditions who may by default infect their at-risk relative.
- The current belief is that the incubation period is between one to fourteen days, but could be as long as 28 days, which is an unpredictable timescale for our members to continually be placed at risk.
The most asked questions
- “when I have attended to a patient that we (or GP or 111) believe is suspected of being contaminated with C-19, to the point that the patient must be swabbed and remain isolated, should I not then also self-isolate?”
- At what point should I self-isolate?
- I may be / am pregnant but have not yet informed the Trust; is it safe for me to be assigned to suspected C-19 patients?
- I am breastfeeding, is it safe for me to respond to suspected C-19 patients
- I have a history of chest infections and respiratory infections, is it safe for me to respond to C-19 patients?
- What has the Trust agreed with Unison in respect of staff self-isolating and the protection of their financial income with due regard to the recent Government statement in respect of NHS employees?
- What steps has East of England Ambulance Service taken to ensurethat ALL ambulance clinicians are in possession of the appropriate PPE prior to the clinicians making contact with suspected C-19 patients, with particular regard to employees that failed the FFP3 Fit Test?
- When an East of England Ambulance Service employee has been in contact with a suspected C-19 patient and the clinical assessment & advice indicates that the patient should be swabbed, remain at home and self-isolate, should not the members of staff who have made contact with and clinically assessed the patient, also self-isolate if the information provided to the crew prior to them making contact with the patient failed to notify them that the patient was a suspected C-19 patientand as a consequence they did not don the level of PPE which they would otherwise have worn if they HAD been informed of the patients status?
- When an East of England Ambulance Service employee has been in contact with a suspected C-19 patient, can the member of staff then be informed if the swab test of their patient is found to be positive or not?
- Where ambulance clinician’s uniforms become contaminated, it has been stated that the employees are to place their uniform inside a dissolvable plastic bag and take it home to be washed whilst still inside the plastic bag which will dissolve during the wah cycle at >60 degrees. The information which we have been made aware states that the dissolvable bags are suitable for healthcare facilities and care homes in the commercial washing machines, but are NOTsuitable for domestic washing machines.
Who manufactures the plastic dissolvable bags that the Trust is referring to and what does the manufacturers conformity certificate state in respect of their use in commercial and domestic washing machines? If employees use the Trust provided plastic bags in their domestic washing machines and they subsequently are damaged and the source of the damage is identified as the dissolvable plastic bag, what action will the Trust take to repair or replace the damaged washing machine?
All these issues should have been discussed at great length in the earliest stages and jointly agreed statements issue to all staff in order to reassure them and proper training conducted in the correct donning and doffing of full PPE carried out post haste.
As the Branch Health & Safety Officer I am extremely disappointed that I have not been fully consulted with in all matters relating to the current C-19 Pandemic.
East of England Ambulance Service
Unison Health & Safety Officer