Resuscitation Council UK – Update B

Covid-19 Patients and Levels of PPE

This is a rapidly changing situation. Clinicians must be aware that not all information about the patient is passed to AOC, so the MDT messages may not have all the information that might be expected. The minimum level of PPE that should be worn when initially making contact with a patient with Covid-19 like illness is gloves, apron, surgical mask (and eye protection) if risked assessed as being needed. If your risk assessment does not support the use of PPE, then why wear it? Save it.

With hypoxic patients, early intervention with oxygen is usually advised. The use of supplementary oxygen via a mask will limit the potential spread of aerosol droplets. The use of a nebuliser will not increase the risk because the mist is coming directly from the reservoir and not from the patient’s airway.

With regard to patients that present with Covid-19 like illness we should refer to the NEWS2score and be alert to the possibility that the patient might be at risk of rapid deterioration which could lead to cardiac arrest. It also warns that not wearing the correct level of PPE will delay CPR so your risk assessment on scene should also take into consideration if changing to a higher level of PPE is indicated and if so, it should be done sooner rather than later, before the patient deteriorates.

If, after you have completed the treatment of your patient, they remain stable or improve, then that is good all round and your risk assessment based on the situation earlier was still correct and in line with the UKRC update.

We are also advised Do not listen or feel for breathing by placing your ear and cheek close to the patient’s mouth and if a defibrillator is readily available, defibrillate shockable rhythms rapidly prior to starting chest compressions. The early restoration of circulation may prevent the need for further resuscitation measures. We are further advised that No chest compressions in isolation or airway procedures (including the insertion of airways, suctioning or ventilating a patient) should be undertaken without full AGP PPE.

The UKRC advise that any airway intervention, performed without wearing the correct PPE will subject the clinician to a significant risk of infection and recommends that full AGP level PPE must be available and that all clinicians involved are wearing that higher level of PPE before entering the area. Only those wearing the same level of PPE or higher therefore should enter your area. All others must remain outside your area even if you have to identify another person to restrict access.

In a Nutshell:

NOT ALL patients require us to wear PPE
Minimum PPE for patients with Covid-19 symptoms is gloves, apron, mask (& eye protection) if needed
Placing oxygen mask on a patient WILL LIMIT the spread of aerosol droplets
Using nebulisers DOES NOT increase the risk of aerosol droplets spreading
DO NOT check for breath sounds by placing your face near to patient’s head
Chest compressions in isolation on their own DO NOTrequire level 3 PPE protection
Airway procedures and ALS DO require level 3 PPE protection