PEP COVID‑19

Access, Vascular ^

Citation Design Setting Clinical Bottom Line
Ruetzler K, Drozd A, Gasecka A, Bielski K, Wieczorek W, Al-Jeabory M, et al. Pediatric intravascular access in simulated COVID-19 patients among paramedics wearing personal protective equipment. Resusc Plus 2021; 5:100073. Randomized Crossover SIM In regard to vascular access in the pediatric population while the clinician is in AGP PPE, use of NIO-P and EZ-IO had the highest efficiency for first intravascular access attempt and the shortest procedure times.

Aerosolized/Nebulized Medication   ^          

Citation

Design Setting   Clinical Bottom Line
ASPR TRACIE. (2017). EMS Infectious Disease Playbook. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Guidline PH-Paramedic Supports: caution when performing AGMPs.
Bischoff WE, Swett K, Leng I, Peters TR. Exposure to influenza virus aerosols during routine patient care. J Infect Dis 2013; 207(7):1037-46 Prospective Observational ED-MD Increased risk for health care provider infection.
Cates CJ, Welsh EJ, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev. 2013 Sep 13; (9):CD000052. Review ED-MD Nebuliser delivery produced outcomes that were not significantly better than metered-dose inhalers delivered by spacer in adults or children.
Clinical management of severe acute respiratory infection when novel corona- virus (nCoV) infection is suspected [interim guidance]. Geneva: World Health Organization; 2020. Guideline Other Use the appropriate PPE, including gloves, long-sleeved gowns, eye protection, and fit-tested particulate respirators (N95 or equivalent, or higher level of protection).
Buick JE, Cheskes S, Feldman M, Verbeek PR, Hillier M, Yuen Chin Leong YC, Drennan IR. COVID-19: What Paramedics Need to Know!  CJEM 2020; 22(4): 426-30. Review PH-Paramedic Paramedics should consider alternatives to AGMPs.
Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With the Guidelines®-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists: Supporting Organizations: American Association of Critical Care Nurses and National EMS Physicians. Circulation. 2020; 10.1161. Guideline ED-MD Use HEPA filter, use VL when available, minimize attempts, consider SGA.
Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. Updated March 10, 2020. Guideline Other Take PPE percautions.
Judson SD, Munster VJ. Nosocomial Transmission of Emerging Viruses via Aerosol-Generating Medical Procedures. Viruses. 2019; 11(10):940. Review SIM Description of literature gap on the subject. Recommendations for future research.
Brown A, Schwarcz L, Counts CR, Barnard LM, Yang BY, Emert JM, Latimer A, Drucker C, Lynch J, Kudenchuk PJ, Sayre MR, Rea T. Risk for Acquiring Coronavirus Disease Illness among Emergency Medical Service Personnel Exposed to Aerosol-Generating Procedures. Emerg Infect Dis. 2021 Sep;27(9):2340-2348. Retrospective Cohort Study PH-Medic We observed a very low risk for COVID-19 infection attributable to patient encounters among EMS first responders, supporting clinical strategies that maintain established practices fortreating patients in emergency conditions.
Koh HP, Shamsudin NS, Tan MMY, Mohd Pauzi Z. The outcomes and acceptance of pressurized metered-dose inhaler bronchodilators with venturi mask modified spacer in the outpatient emergency department during the COVID-19 pandemic. J Clin Pharm Ther. 2021 Aug;46(4):1129-1138. Retrospective-Observational ED-MD The bronchodilator delivered via pMDI-VMMS appeared to be comparable to nebulizer in treating mild to moderate asthma and COPD exac-
erbations in the outpatient ED.
Murthy S, Gomersall CD, Fowler RA. Care for Critically Ill Patients With COVID-19. JAMA 2020. Opinion ICU Recommends usual management of viral pneumonia & PPE for aerosol generating procedures.
Provincial Infection Control Network of British Columbia, PICNet. Respiratory Infection Outbreak Guidelines for Health Care Facilities. April 2018. Guideline ED-MD All HCPs should wear, at minimum, surgical mask and eye protection, although using the precautionary principle, an N95 respirator would be preferred.
Simonds AK, Hanak A, Chatwin M, et al. Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections. Health Technol Assess 2010;14(46):131–172. Prospective Cohort Study In-Patient Increased risk for health care provider infection at 1m.
Somogyi R, Vesely AE, Azami T, et al. Dispersal of respiratory droplets with open vs closed oxygen delivery masks: implications for the transmission of severe acute respiratory syndrome. Chest. 2004;125(3):1155–1157. Report SIM Use caution Common masks create a plume of droplets.
Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7(4):e35797. Systematic Review ICU Increased risk for health care provider infection when using AGMPs.

Air Medical Transport  ^

Citation Design Setting Clinical Bottom Line
Creel-Bulos C, Miller C, Hassani B, Farthing H, et al. "Pushing Geographic Boundaries: Interfacility transport and remote extracorporeal membrane oxygenation cannulation of patients during COVID-19 pandemic". Perfusion. 2022 Mar 23:2676591221078694. Retrospective Case Series PH-CCT Transport distances ranged from 2.2 to 236 miles (median 22.5 miles; IQR 8.3–79); round trip times from 18 to 476 min (median 83 min; IQR 44–194). No transport associated complications occurred. Median duration of ECMO support was 17 days (IQR 9.5–34.5). Length of stay in the Intensive Care Unit (median 36 days; IQR 17–49) and hospital (median 39 days; IQR 25–57) varied. Amongst those discharged, 60% survived.
de Carvalho VP, da Silva BG, Ferreira FL, Elias AA, de Aguiar Filho AS, Galindo Neto NM. Aeromedical interhospital transport of an adult with COVID-19 on extracorporeal membrane oxygenation: case report. Rev Esc Enferm USP. 2022 Mar 14;56:e20210432. Case Report PH-CCT RN Air transport of adults on cardiopulmonary bypass to referral centers, under the care of an experienced multidisciplinary team, can contribute to positive results.
Air Medical Physician Association Position Statement on COVID-19. Air Med J 2020; 39(3):221. Position statement PH-CCT AMPA supports the WHO recommendation to employ standard, contact, and airborne precautions when caring for and transporting patients with suspected or confirmed infection with SARS-CoV-2 who are undergoing AGMPs.
Jeyanathan J, Bootland D, Al-Rais A, Leung J, Wijesuriya J, Banks L, Breen T, DeCoverly R, Curtis L, McHenry A, Wright D, Griggs JE, Lyon RM. Lessons learned from the first 50 COVID-19 critical care transfer missions conducted by a civilian UK Helicopter Emergency Medical Service team. Scand J Trauma Resusc Emerg Med. 2022 Jan 15;30(1):6. Retrospective Cohort PH-CCT Critical care transfer of COVID-19-positive patients by civilian HEMS services, including air transfer, can be achieved safely with specifc planning, protocols and precautions.
de Carvalho VP, da Silva BG, Ferreira FL, Elias AA, de Aguiar Filho AS, Galindo Neto NM. Aeromedical interhospital transport of an adult with COVID-19 on extracorporeal membrane oxygenation: case report. Rev Esc Enferm USP. 2022 Mar 14;56:e20210432. Case Report PH-CCT Air transport of adults on cardiopulmonary bypass to referral centers, under the care of an experienced multidisciplinary team, can contribute to positive results.
Albrecht R, Knapp J, Theiler L, Eder M, Pietsch U. Transport of COVID-19 and other highly contagious patients by helicopter and fixed-wing air ambulance: a narrative review and experience of the Swiss air rescue Rega. Scand J Trauma Resusc Emerg Med 2020; 28(1):40. Narrative review PH-CCT Discusses benefits of a HEMS capable small patient isolation unit.
Bellini C, Gente M. Neonatal Transport and COVID-19 outbreak. Air Med J 2020; 39(3):154-155. Descriptive PH-CCT Suggests using a ground ambulance whenever possible due to difficulties disinfecting the helicopter.
Bascetta T, Bolton L, Kurtzman E, Hantzos W, Standish H, Margarido P, et al. Air Medical Transport of Patients Diagnosed With Confirmed Coronavirus Disease 2019 Infection Undergoing Extracorporeal Membrane Oxygenation: A Case Review and Lessons Learned. Air Med J 2021; 40(2):130-4. Case Report
PH-Paramedic/CCT Transporting COVID-19 patients requirign ECMO is possible by air with careful planning.
Beaussac M, Boutonnet M, Koch L, Paris R, Di Filippo J, Distinguin B, Murris S, Dupre HL, Muller V, Turc J. Oxygen Management During Collective Aeromedical Evacuation of 36 COVID-19 Patients With ARDS. Mil Med. 2021 Jul 1;186(7-8):e667-e671. Retrospective Observational PH-Paramedic/CCT Oxygen consumption was higher than expected, despite anticipation and predefined oxygen management measures, and encourages to a great caution in the processing of such collective medevac missions.
Martin DT. Fixed Wing Patient Air Transport during the Covid-19 Pandemic. Air Med J 2020; 39(3):149-153. Opinion Paper PH-CCT This article outlines indications for transport.
Frakes MA, Richards JB, Cocchi MN, Cohen A, Cohen JE, Dargin J, Friedman FD, Kaye AS, Rettig JS, Seethala R, Wilcox SR. Critical Care Transport of Patients With COVID-19. J Intensive Care Med. 2021 Jun;36(6):704-710 Retrospective Observational PH-Medic/CCT Few patients with COVID-19 had an adverse event in transport.
Salas de Armas IA, Akkanti BH, Janowiak L, Banjac I, Dinh K, Hussain R, Cabrera R, Herrera T, Sanger D, Akay MH, Patel J, Patel MK, Kumar S, Jumean M, Kar B, Gregoric ID. Inter-hospital COVID ECMO air transportation. Perfusion. 2021 May;36(4):358-364. Descriptive PH- MD/CCT To date, 14 patients have been
placed on ECMO support at an outside facility and successfully transported via helicopter to our hub hospital using this protocol.
Emerging infectious diseases including severe acute respiratory syndrome (SARS): guidelines for commercial air travel and air medical transport. Aviat Space Environ Med 2004; 75(1):85-6. Guideline PH-CCT It is recommended that cases of suspected infectious disease, should not be transported by air, If there is a need for AMT, it is advisable to transport as early on as possible before the patient is extremely ill.
Imaeda T, Hattori N, Abe R, Iwase S, Saito D, Koizumi K, Chaisirin W, Taniguchi T, Nakada TA. Interhospital transportation of a COVID-19 patient undergoing veno-venous extracorporeal membrane oxygenation by helicopter. Am J Emerg Med. 2021 May;43:290.e5-290.e7. Case Report
PH-Medic/CCT Discusses important factors for the safe and appropriate interhospital transportation of COVID-19 patients on ECMO as well as staff and patient safety.
Rikken QGH, Mikdad S, Mota MTC, De Leeuw MA, Schober P, Schwarte LA, Giannakopoulos GF. Operational experience of the Dutch helicopter emergency medical services (HEMS) during the initial phase of the COVID-19 pandemic: jeopardy on the prehospital care system? Eur J Trauma Emerg Surg. 2021 Jun;47(3):703-711. Retrospective Observational PH-Medic/CCT A decrease in the number of deployments and increase in the number of cancelled missions was observed during the COVID-19 study period.
Spoelder EJ, Tacken MCT, van Geffen GJ, Slagt C. Helicopter transport of critical care COVID-19 patients in the Netherlands: protection against COVID-19 exposure-a challenge to critical care retrieval personnel in a novel operation. Scand J Trauma Resusc Emerg Med. 2021 Feb 26;29(1):41. Retrospective Observational PH-Medic/CCT Occupational COVID-19 exposure during helicopter transport of ventilated critical care COVID-19
patients can be performed safely when proper PPE is applied.
Turc J, Dupré HL, Beaussac M, Murris S, Koch L, Paris R, Di Filippo J, Distinguin B, Muller V, Boutonnet M. Collective aeromedical transport of COVID-19 critically ill patients in Europe: A retrospective study. Anaesth Crit Care Pain Med. 2021 Feb;40(1):100786. Descriptive PH-Medic/CCT Collective aero-MEDEVAC of COVID-19 critically ill patients could provide a reliable solution to help control the burden of the disease

Cardiac Arrest Outcomes ^

Citation Design    
Setting    Clinical Bottom Line
Chan PS, Girotra S, Tang Y, Al-Araji R, Nallamothu BK, McNally B. Outcomes for Out-of-Hospital Cardiac Arrest in the United States During the Coronavirus Disease 2019 Pandemic. Retrospective Observational PH-Paramedic Rates of sustained ROSC for OHCA was lower during the pandemic, even in communities with low COVID-19 mortality rates.
Mathew S, Harrison N, Chalek AD, Gorelick D, Brennan E, Wise S, et al. Effects of the COVID-19 pandemic on out-of-hospital cardiac arrest care in Detroit. Am J Emerg Med 2021; 46:90-6. Retrospective Observational PH-Paramedic The rate of ROSC remained similar despite the implementation of an early termination of resuscitation protocol in
response to COVID-19.
Natalzia P, Murk W, Thompson JJ, Dorsett M, Cushman JT, Reed P, et al. Evidence-based crisis standards of care for out-of-hospital cardiac arrests in a pandemic. Resuscitation 2020; 156:149-56. Observational PH-Paramedic In a pandemic scenario, pre-hospital crisis standard protocols that might not otherwise be considered have the potential to greatly improve overall survival.
Lin CH, Lin HY, Tseng WP, Ma MH, Tsai MS, Chen SY, et al. Resuscitation teamwork during the COVID-19 pandemic in the emergency department: Challenges and solutions. Resuscitation 2021; 160:18-9. Letter to the Editor
PH-Paramedic Although our model is beneficial, non-technical skills and resuscitation teamwork should be modified according to the environment of different facilities.
Kienbacher CL, Grafeneder J, Tscherny K, Krammel M, Fuhrmann V, Niederer M, et al. The use of personal protection equipment does not impair the quality of cardiopulmonary resuscitation: A prospective triple-cross over randomised controlled non-inferiority trial. Resuscitation 2021; 160:79-83. RCT SIM PPE including masks with and without expiration valve is safe for use without concerns regarding the impairment of CPR quality.
Scquizzato T, Landoni G, Paoli A, Lembo R, Fominskiy E, Kuzovlev A, et al. Effects of COVID-19 pandemic on out-of-hospital cardiac arrests: A systematic review. Resuscitation 2020. Systematic Review PH-Paramedic Out-of-hospital cardiac arrests had worse short-term outcomes during the pandemic than a non-pandemic period.

Clinician Mental Health/Wellness During Disaster  ^

Citation Design Setting Clinical Bottom Line
Theron E, Erasmus HC, Wylie C, Khan W, Geduld H, Stassen W. The lived experiences of emergency care personnel in the Western Cape, South Africa during the COVID-19 pandemic: A longitudinal hermeneutic phenomenological study. Afr J Emerg Med. 2022 Dec;12(4):410-417. Qualitative Interviews PH-Medic/MD/RN The importance of compassion and encouragement as forms of support was highlighted in the study. Robust and sustained support structures in a time of change, low mood, and exhaustion are essential.
Srikanth P, Monsey LM, Meischke HW, Baker MG. Determinants of Stress, Depression, Quality of Life, and Intent to Leave in Washington State Emergency Medical Technicians During COVID-19. J Occup Environ Med. 2022 Aug 1;64(8):642-648. Cross-Sectional Survey PH-Medic Increased exposure to hazards has impacted EMT mental health. Emergency medical technicians are vital to healthcare, so improving EMT health and well-being is important, as attrition during a pandemic could impact public health.
Sahin CE, Deger MS, Sezerol MA, Ozdemir MY. Covid-19 phobia in prehospital emergency medical services workers in Turkey. Niger J Clin Pract. 2022 Aug;25(8):1239-1246. Cross-Sexctional Survey PH-Medic Close contact with patients, working conditions, and the heavy schedule of nightshifts increase psychological and social fear in emergency health care workers. It is important to provide psychosocial support to emergency healthcare workers during the pandemic period.
Habibi Soola A, Mozaffari N, Mirzaei A. Spiritual Coping of Emergency Department Nurses and Emergency Medical Services Staff During the COVID-19 Pandemic in Iran: An Exploratory Study. J Relig Health. 2022 Apr;61(2):1657-70. Cross-sectional PH-Medic Our findings indicated that positive religious behavior was the main spiritual coping strategy used by healthcare workers.
McGuinness SL, Johnson J, Eades O, Cameron PA, Forbes A, Fisher J, et al. Mental Health Outcomes in Australian Healthcare and Aged-Care Workers during the Second Year of the COVID-19 Pandemic. Int J Environ Res Public Health. 2022 Apr 19;19(9):4951 Mixed Methods Cohort Study Other Australian HCWs employed during 2021 experienced adverse mental health outcomes, with prevalence differences observed according to occupation.
Keller E, Widestrom M, Gould J, Fang R, Davis KG, Gillespie GL. Examining the Impact of Stressors during COVID-19 on Emergency Department Healthcare Workers: An International Perspective. Int J Environ Res Public Health. 2022 Mar 21;19(6):3730. Cross-sectional Study ED-Other Linear regressions showed that stressful life events are significantly associated with both physical symptoms and work–family conflict.
Chang YT, Hu YJ. Burnout and Health Issues among Prehospital Personnel in Taiwan Fire Departments during a Sudden Spike in Community COVID-19 Cases: A Cross-Sectional Study. Int J Environ Res Public Health. 2022 Feb 16;19(4):2257. Survey PH-Medic This study is the first investigation of physical and mental health burdens among prehospital personnel in Taiwan fire departments during the COVID-19 pandemic. The physical and mental health status of these personnel should be continuously monitored, and intervention provided as necessary.
Oteir AO, Nazzal MS, Jaber AF, Alwidyan MT, Raffee LA. Depression, anxiety and insomnia among frontline healthcare workers amid the coronavirus pandemic (COVID-19) in Jordan: a cross-sectional study. BMJ Open. 2022 Jan 31;12(1):e050078. Cross-sectional Survey PH-Medic The COVID-19 pandemic has exerted strenuous emotional, psychological and physical pressures on the health of frontline HCWs.
Unal M, Yilmaz A, Yilmaz H, Tasdemir GY, Uluturk M, et al. The impact of COVID-19 on social support perception and stress of prehospital care providers. Australas Emerg Care. 2022 May 5:S2588-994X(22)00028-8. Cross-sectional Survey PH-Medic The findings are suggestive of high perceptions of multidimensional social support and low acute stress symptom levels of the PCPs during the COVID-19 pandemic period.
İlhan B, Küpeli İ. Secondary traumatic stress, anxiety, and depression among emergency healthcare workers in the middle of the COVID-19 outbreak: A cross-sectional study. Am J Emerg Med. 2022 Feb;52:99-104. Prospective Cross Sectional Study ED-Other High levels of STS, anxiety, and depression were determined among emergency nurses and auxiliary staff during the pandemic. Poor job satisfaction and financial difficulties were associated with the mental health of emergency HCWs.
Al Hariri M, Hamade B, Bizri M, Salman O, Tamim H, Al Jalbout N. Psychological impact of COVID-19 on emergency department healthcare workers in a tertiary care center during a national economic crisis. Am J Emerg Med. 2022 Jan;51:342-7.  Cross-sectional Survey ED-Other At our tertiary care center in a low-income, low resource country amidst the COVID-19 pandemic, the HCWs reported marked psychological disturbances on different scales. In particular, the financial burden was associated with increased anxiety and clinical depression, but was not associated with burnout.
El Gindi H, Shalaby R, Gusnowski A, Vuong W, Surood S, et al. The Mental Health Impact of the COVID-19 Pandemic Among Physicians, Nurses, and Other Health Care Providers in Alberta: Cross-sectional Survey. JMIR Form Res. 2022 Mar 9;6(3):e27469. Cross-Sectional Study ED-Other This cross-sectional study explored a high level of mental health burdens during the COVID-19 pandemic among HCWs in Alberta. Levels of psychological symptoms were more noticeable in the female gender and the nursing profession.
Menon GR, Yadav J, Aggarwal S, Singh R, Kaur S, Chakma T, et al. Psychological distress and burnout among healthcare worker during COVID-19 pandemic in India-A cross-sectional study. PLoS One. 2022 Mar 10;17(3):e0264956. Cross-Sectional Study Other Overall, 52.9% of the participants had the risk of psychological distress that needed further evaluation. Risk of psychological distress was significantly associated with longer hours of work, income; screening of COVID-19 patients  contact tracing, High Emotional exhaustion score and High Depersonalisation score.
Awais SB, Martins RS, Khan MS. Paramedics in pandemics: protecting the mental wellness of those behind enemy lines. Br J Psychiatry. 2021 Feb;218(2):75-76. Opinion PH-Medic COVID-19 pandemic has
potential to have a severe and long-lasting psychological impact
on frontline healthcare workers such as paramedics.
Kim YJ, Choe JY, Kwon KT, Hwang S, Choi GS, Sohn JH, Kim JK, Yeo IH, Cho YJ, Ham JY, Song KE, Lee NY. How to keep patients and staff safe from accidental SARS-CoV-2 exposure in the emergency room: Lessons from South Korea's explosive COVID-19 outbreak. Infect Control Hosp Epidemiol. 2021 Jan;42(1):18-24. Cross-sectional ED-MD Problematic accidental exposure and nosocomial transmission of COVID-19 can be successfully prevented through active isolation and surveillance policies and comprehensive PPE use despite longer ER stays and the presence of more severely ill patients during a severe COVID-19 outbreak.
Al Hariri M, Hamade B, Bizri M, Salman O, Tamim H, Al Jalbout N. Psychological impact of COVID-19 on emergency department healthcare workers in a tertiary care center during a national economic crisis. Am J Emerg Med. 2022 Jan;51:342-347.  Cross Sectional Survey Other At our tertiary care center in a low-income, low resource country amidst the COVID-19 pandemic, the HCWs reported marked psychological disturbances on different scales. In particular, the financial burden was associated with increased anxiety and clinical depression, but was not associated with burnout.
Chang YT, Hu YJ. Burnout and Health Issues among Prehospital Personnel in Taiwan Fire Departments during a Sudden Spike in Community COVID-19 Cases: A Cross-Sectional Study. Int J Environ Res Public Health. 2022 Feb 16;19(4):2257. Cross Sectional Survey PH-Medic The paramedics reported higher scores for personal burnout than the emergency medical technicians (EMTs). Personal and work-related burnout were associated with higher perceived pressure.
El Gindi H, Shalaby R, Gusnowski A, Vuong W, Surood S, Hrabok M, Greenshaw AJ, Agyapong V. The Mental Health Impact of the COVID-19 Pandemic Among Physicians, Nurses, and Other Health Care Providers in Alberta: Cross-sectional Survey. JMIR Form Res. 2022 Mar 9;6(3):e27469.  Cross Sectional Survey Other This cross-sectional study explored a high level of mental health burdens during the COVID-19 pandemic among HCWs in Alberta. Levels of psychological symptoms were more noticeable in the female gender and the nursing profession.
Frenkel MO, Pollak KM, Schilling O, Voigt L, Fritzsching B, et al. Stressors faced by healthcare professionals and coping strategies during the early stage of the COVID-19 pandemic in Germany. PLoS One. 2022 Jan 18;17(1):e0261502.  Cross Sectional Survey PH-Medic The results on pandemic-specific work stressors reveal that healthcare professionals might benefit from coping strategies that facilitate the utilization of social support. At the workplace, team commitment and knowledge exchange might buffer against adverse psychological stress responses. Schedules during pandemics should give healthcare workers the opportunity to interact with families and friends in ways that facilitate social support outside work. 
Hendrickson RC, Slevin RA, Hoerster KD, Chang BP, Sano E, McCall CA, Monty GR, Thomas RG, Raskind MA. The Impact of the COVID-19 Pandemic on Mental Health, Occupational Functioning, and Professional Retention Among Health Care Workers and First Responders. J Gen Intern Med. 2022 Feb;37(2):397-408. Cross Sectional Survey PH-Medic RELEVANCE: These results demonstrate potentially treatable psychiatric symptoms in HCW and FR experiencing CROS, impacting both wellbeing and the health care system. Mitigating CROS, particularly by addressing factors driving demoralization, may improve HCW and FR mental health, occupational functioning, and retention.
İlhan B, Küpeli İ. Secondary traumatic stress, anxiety, and depression among emergency healthcare workers in the middle of the COVID-19 outbreak: A cross-sectional study. Am J Emerg Med. 2022 Feb;52:99-104.  Cross Sectional Survey Other Conclusion: High levels of STS, anxiety, and depression were determined among emergency nurses and auxiliary staff during the pandemic. Poor job satisfaction and financial difficulties were associated with the mental health of emergency HCWs. The mental health of the emergency HCWs should be evaluated regularly. In addition to professional psychological support, social and financial support should be provided as well.
Keller E, Widestrom M, Gould J, Fang R, Davis KG, Gillespie GL. Examining the Impact of Stressors during COVID-19 on Emergency Department Healthcare Workers: An International Perspective. Int J Environ Res Public Health. 2022 Mar 21;19(6):3730. Cross Sectional Survey Other Fatigue was the most common symptom reported to occur daily (28.4%, n = 31), followedby muscle pain (13.8%, n = 15) and backache (11.9%, n = 13). Nurse practitioners reported the highest number of physical symptoms and the highest average scores and counts of stressful life events, while registered nurses indicated the highest work–family conflict levels. 
Menon GR, Yadav J, Aggarwal S, Singh R, Kaur S, et al. Psychological distress and burnout among healthcare worker during COVID-19 pandemic in India-A cross-sectional study. PLoS One. 2022 Mar 10;17(3):e0264956.  Cross Sectional Survey PH-Medic The study has identified key factors that could have been likely triggers for psychological distress among healthcare workers who were engaged in management of COVID cases .
Oteir AO, Nazzal MS, Jaber AF, Alwidyan MT, Raffee LA. Depression, anxiety and insomnia among frontline healthcare workers amid the coronavirus pandemic (COVID-19) in Jordan: a cross-sectional study. BMJ Open. 2022 Jan 31;12(1):e050078. Cross Sectional Survey PH-Medic Results showed that the participants reported severe symptoms of anxiety (29.5%), depression (34.5%) and insomnia (31.9%), with no observed differences based on gender, job title, marital status or educational level. Moreover, in the multivariate linear regression, none of the independent factors were associated with GAD-7, PHQ-9 or ISI scores, and the only exception was increased severity of insomnia among paramedics.
Al-Mansour K. Stress and turnover intention among healthcare workers in Saudi Arabia during the time of COVID-19: Can social support play a role? PLoS One. 2021 Oct 7;16(10):e0258101.  Cross-sectional PH-Medic Stress is associated with turnover intention among healthcare workers in Saudi Arabia.
Khan MF, Mahmood M, Hasrat MN, Javed B, Javed O. Perception, preparedness and response of health care personals towards COVID-19 pandemic in Azad Jammu & Kashmir, Pakistan: A cross sectional interview based study. Clin Epidemiol Glob Health. 2021 Jul-Sep;11:100783. Cross-sectional PH-Medic Majority of HCPs perceive covid-19 as a serious health concern. However, most of the HCPs are neither well trained for the current pandemic nor fully satisfied about personal protection, work load, and wages.
Al-Shiakh S, Tran QK, Caggiula A, Berezowski I, Barnawi B, Pourmand A. Attitudes among healthcare professionals towards cardiopulmonary resuscitation during COVID-19. Am J Emerg Med. 2022 Feb;52:34-42.  Cross-Sectional PH-Medic

The ongoing COVID-19 pandemic significantly affected healthcare workers' attitudes towards perform-

ing CPR for OHCA. Confidence levels and willingness to perform CPR increased over time during the study period.

Pazmiño Erazo EE, Alvear Velásquez MJ, Saltos Chávez IG, Pazmiño Pullas DE. Factors associated with psychiatric adverse effects in healthcare personnel during the COVID-19 pandemic in Ecuador. Rev Colomb Psiquiatr (Engl Ed). 2021 Jul-Sep;50(3):166-175. Cross-sectional PH-Medic Ecuador. Of these, 27.3% presented
symptoms of depression, 39.2% anxiety symptoms, 16.3% insomnia and 43.8% symptoms of PTSD.
Vitrat V, Maillard A, Raybaud A, Wackenheim C, Chanzy B, Nguyen S, Valran A, Bosch A, Noret M, Delory T. Effect of Professional and Extra-Professional Exposure on Seroprevalence of SARS-CoV-2 Infection among Healthcare Workers of the French Alps: A Multicentric Cross-Sectional Study. Vaccines (Basel). 2021 Jul 27;9(8):824. Descriptive Other This report highlights that a sustained availability of personal protective equipment limits the SARS-CoV-2 infection rate.
Matto HC, Sullivan K. Ashes2Art:  Mitigation Strategies for Short-and Long-term Distress in Emergency Services Personnel During COVID-19. Clin Soc Work J. 2021;49(4):437-444. Opinion PH-Medic This paper suggests that enhancing well-being through mindfulness-focused creative arts engagement might be one efective tool to be included as part of routine self-care protocols for first responders and their families.
Jahan I, Ullah I, Griffiths MD, Mamun MA. COVID-19 suicide and its causative factors among the healthcare professionals: Case study evidence from press reports. Perspect Psychiatr Care. 2021 Oct;57(4):1707-1711. Descriptive PH-Medic The suicide case cases comprised
doctors (n = 11), nurses (n = 9), paramedics (n = 5), and one medical student.
Gualano MR, Sinigaglia T, Lo Moro G, Rousset S, Cremona A, Bert F, Siliquini R. The Burden of Burnout among Healthcare Professionals of Intensive Care Units and Emergency Departments during the COVID-19 Pandemic: A Systematic Review. Int J Environ Res Public Health. 2021 Aug 2;18(15):8172. Systematic Review ICU The prevalence of overall burnout
ranged from 49.3% to 58%. Nurses seemed to be at higher risk.
Vanhaecht K, Seys D, Bruyneel L, Cox B, Kaesemans G, Cloet M, Van Den Broeck K, Cools O, De Witte A, Lowet K, Hellings J, Bilsen J, Lemmens G, Claes S. COVID-19 is having a destructive impact on health-care workers' mental well-being. Int J Qual Health Care. 2021 Feb 20;33(1):mzaa158. Cross-sectional Other All symptoms were significantly more pronounced during versus before COVID-19. For hypervigilance, there was a 12-fold odds during versus before COVID-19.
Abed Alah M, Ali K, Abdeen S, Al-Jayyousi G, Kasem H, Poolakundan F, Al-Mahbshii S, Bougmiza I. The psychological impact of COVID-19 on health care workers working in a unique environment under the umbrella of Qatar Red Crescent Society. Heliyon. 2021 Jun 5;7(6):e07236. Cross-sectional PH-Medic Compared to nurses, technicians and paramedics were more likely to report anxiety symptoms
Khorasanee R, Grundy T, Isted A, Breeze R. The effects of COVID-19 on sickness of medical staff across departments: A single centre experience. Clin Med (Lond). 2021 Mar;21(2):e150-e154. Retrospective Observational Other COVID-19 caused a burden of sickness on the medical workforce which must be accounted for in future workforce
planning.
Hesselink G, Straten L, Gallée L, Brants A, Holkenborg J, Barten DG, Schoon Y. Holding the frontline: a cross-sectional survey of emergency department staff well-being and psychological distress in the course of the COVID-19 outbreak. BMC Health Serv Res. 2021 May 29;21(1):525. Survey ED-MD Mean self-perceived stress symptom levels almost doubled during the peak
of the first wave (≤0.005).
Borges LM, Barnes SM, Farnsworth JK, Bahraini NH, Brenner LA. A commentary on moral injury among health care providers during the COVID-19 pandemic. Psychol Trauma 2020;12:S138-S140. Commentary ED-MD Discusses benefits of a HEMS capable small patient isolation unit.
Qiu JY, Zhou DS, Liu J, Yuan TF. Mental wellness system for COVID-19. Brain Behav Immun 2020;87:51-52. Descriptive Other Here we describe the recent systemic efforts being developed in our center to maintain mental wellness.
Assari S, Habibzadeh P. The COVID-19 Emergency Response Should Include a Mental Health Component. Arch Iran Med. 2020;23(4):281–282. Published 2020 Apr 1.   Opinion PH-Paramedic Higher levels of psychological distress, post-traumatic stress and burnout among healthcare workers.
Barnett DJ, Levine R, Thompson CB, Wijetunge GU, Oliver AL, Bentley MA, et al. Gauging U.S. Emergency Medical Services workers' willingness to respond to pandemic influenza using a threat- and efficacy-based assessment framework. PloS one 2010; 5(3):e9856. Survey PH-Paramedic Varied willingness to report in a pandemic.
Douglas PK, Douglas DB, Harrigan DC, Douglas KM. Preparing for pandemic influenza and its aftermath: mental health issues considered. Int J Emerg Ment Health. 2009;11(3):137-44. Review Other Some HCWs are at higher risk of mental health issues from pandemics.
Elcin M, Onan A, Odabasi O, Saylam M, Ilhan H, Daylan Kockaya P, et al. Developing a Simulation-Based Training Program for the Prehospital Professionals and Students on the Management of Middle East Respiratory Syndrome. Simulation in healthcare 2016; 11(6):394-403. Prospective Observational PH-Paramedic Training increased preparedness.
Flores S, Gavin N, Romney ML, Tedeschi C, Olsen E, Heravian A, et al. COVID-19: New York City pandemic notes from the first 30 days. Am J Emerg Med 2020; 38(7):1534-5. Review ED-MD Concerns about exposure risk were high amongst our providers, and an emphasis on PPE and supplies has been paramount.
Lateef F, Lim SH, Tan EH. New paradigm for protection: the emergency ambulance services in the time of severe acute respiratory syndrome. Prehospital emergency care 2004; 8(3):304-7. Opinion PH-Paramedic Training and mitigation strategies helped paramedics become psychologically prepared.
Oliver AL, Poplin GS, Kahn CA. Emergency Medical Services and 9-1-1 pandemic influenza preparedness: A national assessment. Am J Emerg Med 2012; 30(3):505-9. Report PH-Paramedic This study's finding that only 13.3% of states had complete plans delineating the role of 9-1-1 during a pandemic.
Ong JJY, Bharatendu C, Goh Y, Tang JZY, Sooi KWX, Tan YL, et al. Headaches Associated With Personal Protective Equipment - A Cross-Sectional Study Among Frontline Healthcare Workers During COVID-19. Headache 2020. Cross-Sectional Study PH-Paramedic Most healthcare workers develop de novo PPE-associated headaches or exacerbation of their pre-existing headache disorders.
Warchoł-Biedermann K, Daroszewski P, Bączyk G, Greberski K, Bugajski P, Karoń J, et al. Dysfunctional coping mediates the relationship between stress and mental health in health Cross-Setional Study
PH-Paramedic Nurses and paramedics report significantly higher stress levels than physicians. A positive and significant relationship was observed between stress, dysfunctional coping strategies and mental health.
Munawar K, Choudhry FR. Exploring stress coping strategies of frontline emergency health workers dealing Covid-19 in Pakistan: A qualitative inquiry. Am J Infect Control 2021; 49(3):286-92. Qualitative PH-Paramedic Media increased anxiety but religious coping, passion to serve humanity and country, considering this pandemic just an
emergency, as well as positive opinions, and views regarding their roles during the pandemic boosted their resilience and coping mechanisms.
Kelker H, Yoder K, Musey P Jr, Harris M, Johnson O, Sarmiento E, et al. Prospective study of emergency medicine provider wellness across ten academic and community hospitals during the initial surge of the COVID-19 pandemic. BMC Emerg Med 2021; 21(1):36. Qualitative ED-MD There were concerns of safety, fear anxiety and stress that improved but endured the pregression over the four weeks providers were a resilient group, feelings of isolation and burnout per-
sisted, but did not significantly worsen.
Firew T, Sano ED, Lee JW, Flores S, Lang K, Salman K, et al. Protecting the front line: a cross-sectional survey analysis of the occupational factors contributing to healthcare workers' Cross-Sectional PH-Paramedic HCWs have experienced significant physical and psychological risk while working during the COVID-19 pandemic.
Rebmann T, Charney RL, Loux TM, Turner JA, Abbyad YS, Silvestros M. Emergency Medical Services Personnel's Pandemic Influenza Training Received and Willingness to Work during a Future Pandemic. Prehospital emergency care 2020:1-9. Survey PH-Paramedic Predictors of willingness to work when requested included believing it is their responsibility to work, believing their coworkers were likely to work, receiving prophylaxis.
Silverman A, Simor A, Loutfy MR. Toronto Emergency Medical Services and SARS. Emerging infectious diseases 2004; 10(9):1688-9. Report
PH-Paramedic >200 paramedics had contact with patients with SARS and were quarantined. These events seriously affected EMS and their staff.
Tippett VC, Watt K, Raven SG, Kelly HA, Coory M, Archer F, et al. Anticipated behaviors of emergency prehospital medical care providers during an influenza pandemic. Prehosp Disaster Med 2010; 25(1):20-5. Survey PH-Paramedic Confidence in the employer's capacity to respond appropriately to a pandemic significantly increased employee willingness to work (OR = 2.83; 95% CI = 1.9-4.1).
Wong TW, Yau JK, Chan CL, Kwong RS, Ho SM, Lau CC, et al. The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. European journal of emergency medicine 2005;12(1):13-8. Survey ED-MD The three most important variables that could account for the distress level were loss of control/vulnerability, fear for self-health and spread of the virus.
Bahadirli S, Sagaltici E. Post-traumatic stress disorder in healthcare workers of emergency departments during the pandemic: A cross-sectional study. Am J Emerg Med. 2021 Dec;50:251-255.  Cross-Sectional Study ED-Other The results of our study showed that both profession groups are at risk for PTSD, and contrary to the existing literature, this rate may be higher in physicians than in nurses. HCWs in the EDs needed protective and supportive mental health models in terms of PTSD. 
Chahley ER, Reel RM, Taylor S. The lived experience of healthcare professionals working frontline during the 2003 SARS epidemic, 2009 H1N1 pandemic, 2012 MERS outbreak, and 2014 EVD epidemic: A qualitative systematic review. SSM Qual Res Health. 2021 Dec;1:100026.  Qualitative Systematic Review PH-Medic Five themes were conceptualized: Uncertainty, Adapting to Change, Commitment, Sacrifice, and Resilience.
Jahan I, Ullah I, Griffiths MD, Mamun MA. COVID-19 suicide and its causative factors among the healthcare professionals: Case study evidence from press reports. Perspect Psychiatr Care. 2021 Oct;57(4):1707-1711. Case Series PH-Medic There is a total of 26 worldwide HCP COVID‐19‐related suicide cases
Katsuta N, Ito K, Fukuda H, Seyama K, Hori S, Shida Y, Nagura R, Nojiri S, Sato H. Elevated depressive symptoms among newer and younger healthcare workers in Japan during the COVID-19 pandemic. Neuropsychopharmacol Rep. 2021 Dec; 41(4):544-547. Prospective Observational Study Other Younger and newer employees demonstrated the highest rates of depression independent of occupation. Therefore, mental healthcare programs focusing on these vulnerable groups need to be established.
Koontalay A, Suksatan W, Prabsangob K, Sadang JM. Healthcare Workers' Burdens During the COVID-19 Pandemic: A Qualitative Systematic Review. J Multidiscip Healthc. 2021 Oct 27;14:3015-3025. Qualitative Systematic Review PH-Medic The study results demonstrate that the COVID-19 pandemic has had an impact on all aspects of life, especially for healthcare providers, who work on the frontlines. The pandemic has affected the frontline workers’ physical and psychological health, causing them to experience emotional distress such as fear, anxiety, depression, and stress. In addition, the pandemic can increase posttraumatic stress disorder, leading to burnout and discontinuity of healthcare workloads to ensure the patients’ safety and the high quality of care provided to the patients.
Samara MT, Peppou LE, Giannouchos TV, Nimatoudis I, Papageorgiou C, Economou M, Souliotis K. COVID-19 psychological impact, knowledge and perceptions of healthcare professionals in Greece: Α nationwide cross-sectional study. Psychiatriki. 2021 Dec 20;32(4):271-281. Cross-Sectional Study Other the results of our study suggest that the prevalence of depressive, anxiety and stress symptoms in Greek healthcare professionals is placed in the lower end of the range reported from various recent studies across the world.
Sangal RB, Bray A, Reid E, Ulrich A, Liebhardt B, Venkatesh AK, King M. Leadership communication, stress, and burnout among frontline emergency department staff amid the COVID-19 pandemic: A mixed methods approach. Healthc (Amst). 2021 Dec;9(4):100577. Mixed Methods PH-Medic This work suggests that effective local leadership communication, characterized by information consolidation, consistency, and bi-directionality, leads to higher perceptions of support and lower stress and burnout among ED frontline workers.
Soto-Cámara R, García-Santa-Basilia N, Onrubia-Baticón H, Cárdaba-García RM, Jiménez-Alegre JJ, Reques-Marugán AM, Molina-Oliva M, Fernández-Domínguez JJ, Matellán-Hernández MP, Morales-Sanchez A, Navalpotro-Pascual S. Psychological Impact of the COVID-19 Pandemic on Out-of-Hospital Health Professionals: A Living Systematic Review. J Clin Med. 2021 Nov 27;10(23):5578.  Systematic Review PH-Medic The mental health of out-of-hospital HPs was affected. Being a woman or having direct contact with patients showing suspicious signs of COVID-19 or confirmed cases were the factors related to a greater risk of developing high levels of stress and anxiety; in the case of depressive symptoms, it was having a clinical history of illnesses that could weaken their defenses against infection.
Th'ng F, Rao KA, Ge L, Mao D, Neo HN, Molina JA, Seow E. A One-Year Longitudinal Study: Changes in Depression and Anxiety in Frontline Emergency Department Healthcare Workers in the COVID-19 Pandemic. Int J Environ Res Public Health. 2021 Oct 26;18(21):11228. Qualitative Surveys ED-Other The profle of severity and type of accident.
Yeo IH, Kim YJ, Kim JK, Lee DE, Choe JY, Kim CH, Park JB, Seo KS, Park SY, Lee SH, Cho JK, Lee SH. Impact of the COVID-19 Pandemic on Emergency Department Workload and Emergency Care Workers' Psychosocial Stress in the Outbreak Area. Medicina (Kaunas). 2021 Nov 19;57(11):1274. Cross-Sectional Survey ED-Other Working hours, intensity, role changes, depression and anxiety scores were higher in the higher level emergency department.
Akinbami LJ, Petersen LR, Sami S, Vuong N, Lukacs SL, Mackey L, Atas J, LaFleur BJ. Coronavirus Disease 2019 Symptoms and Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Positivity in a Large Survey of First Responders and Healthcare Personnel, May-July 2020. Clin Infect Dis 2021; 73(3):e822-e825. Survey Other This studies findings highlight the limitations of symptom-based screening.
Bobles-Pérez E, González-Díaz B, Miranda-García M, Borja-Aburto VH. Infection and death by COVID-19 in a cohort of healthcare workers in Mexico. Scand J Work Environ Health. 2021 Jul 1;47(5):349-355.  Retrospective Observational PH-Medic We found that doctors had the lowest risk of COVID-19 infection, while other groups who provide indirect to patients had an increased risk of infection and death, such as ambulance personnel, social workers and patient transporters.
Collantoni E, Saieva AM, Meregalli V, Girotto C, Carretta G, Boemo DG, Bordignon G, Capizzi A, Contessa C, Nesoti MV, Donato D, Flesia L, Favaro A. Psychological Distress, Fear of COVID-19, and Resilient Coping Abilities among Healthcare Workers in a Tertiary First-Line Hospital during the Coronavirus Pandemic. J Clin Med. 2021 Apr 2;10(7):1465. Cross-Sectional In-Patient Findings evidenced that the psychological consequences of the pandemic were non-homogeneously distributed across HCWs categories and pointed out the presence of specific in-hospital and out-of-hospital risk factors.
Libardi MBO, Arrais ADR, Antloga CSX, Faiad C, Rodrigues CML, Barros ÂF. Gender, psychosocial stressors, wellbeing and coping in prehospital care workers. Rev Bras Enferm. 2021 May 28;74(suppl 3):e20200579. Cross-Sectional PH-Medic Women were more affected by psychosocial stressors, which probably reduced their wellbeing at work.
Molvik M, Danielsen AS, Grøsland M, Telle KE, Kacelnik O, Eriksen-Volle HM. SARS-CoV-2 in health and care staff in Norway, 2020. Tidsskr Nor Laegeforen. 2021 Feb 9;141(3).  Descriptive Other The incidence in the health service for the entire period was 1.48 % (5673/382 332).
Rodriguez RM, Montoy JCC, Hoth KF, Talan DA, Harland KK, Eyck PT, Mower W, Krishnadasan A, Santibanez S, Mohr N; Project COVERED Emergency Department Network. Symptoms of Anxiety, Burnout, and PTSD and the Mitigation Effect of Serologic Testing in Emergency Department Personnel During the COVID-19 Pandemic. Ann Emerg Med. 2021 Jul;78(1):35-43.e2. Survey ED-MD One-fifth of ED personnel appeared to be at risk for PTSD. Increased provision of serologic testing may help to mitigate anxiety.
Srivastava A, Srivastava S, Upadhyay R, Gupta R, Jakhar K, Pandey R. Stressor Combat Strategies and Motivating Factors Among Health Care Service Providers During COVID-19 Pandemic. Cureus. 2021 Apr 27;13(4):e14726.  Survey PH-Medic As compared to doctors, paramedical staffs were more stressed with frequent protocol changes (88%), emotional exhaustion (68%).
Vaishya R, Sibal A, Malani A, Prasad KH. SARS-CoV-2 infection after COVID-19 immunization in healthcare workers: A retrospective, pilot study. Indian J Med Res. 2021 May&Jun;153(5&6):550-554.  Retrospective Observational ED-MD The COVID-19 infection after vaccination occurred in a smaller subset (2.63%) of HCWs,
Vujanovic AA, Lebeaut A, Leonard S. Exploring the impact of the COVID-19 pandemic on the mental health of first responders. Cogn Behav Ther 2021; 50(4):320-335. Survey PH-Medic Results indicated that COVID-19-exposed first responders were more likely to be emergency medical services [EMS] personnel. COVID-19-exposed first responders reported higher alcohol use severity. COVID-19-related worry and medical vulnerability were incrementally associated with more severe symptoms of anxiety and depression. Among the subset of first responders (n = 122) who reported COVID-19 exposure, COVID-19-related worry was significantly associated with PTSD symptom severity.

Compressions/Defibrillation  ^

Citation Design Setting Clinical Bottom Line
Couper K, Taylor-Phillips S, Grove A, Freeman K, Osokogu O, Court R, et al. COVID-19 in cardiac arrest and infection risk to rescuers: A systematic review. Resuscitation 2020; 151:59-66. Systematic Review
PH-Paramedic We did not find any direct evidence that chest compressions or defibrillation either are or are not associated with aerosol generation or transmission of infection.
Edelson DP, Sasson C, Chan PS, Atkins DL, Aziz K, Becker LB, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the. Circulation 2020;141(25):e933-e943. Consensus Statement ED-MD Wear airborne PPE, limit personel, use a HEPA filter, use most experienced provider for ETI, use closed circuit AW system including suction, use mechanical compressions where possible. This document provids algorithms.
Burns TA, Touzeau C, Kaufman BT, Butsch AL, Vesselinov R, Stone RM. Decreases in out of hospital cardiac arrest (OHCA) outcome metrics persist when known COVID patients are excluded from analysis. Am J Emerg Med. 2022 Jan;51:64-68. Retrospective Cohort PH-Medic When known COVID patients are excluded, pre-pandemic OHCA resuscitation patients were more likely to achieve ROSC and CPC 1 or 2 discharge. The prevalence of known COVID positive patients among all OHCA resuscitations during the pandemic was not sufficient to fully account for the marked decrease in both ROSC and CPC 1 or 2 discharges. Other causative factors must be sought. 
Cekmen B, Bildik B, Bozan O, Atis SE, Koksal M, Uzuncu HB, Akilli NB. Chest compression quality during CPR of potential contagious patients wearing personal protection equipment. Am J Emerg Med. 2022 Feb;52:128-131. Randomized Control Study SIM Changing the rescuer every 1 min instead of every 2 min while performing CPR with full PPE may prevent the decrease in compression quality that may occur as the resuscitation time gets longer.
COVID-19 infection risk to rescuers from patients in cardiac arrest https://costr.ilcor.org/document/covid-19-infection-risk-to-rescuers-from-patients-in-cardiac-arrest Accessed: 2020-04-15. Systematic Review PH-Paramedic
Low/very low quality evidence: use PPE, consider defib “is reasonable” before donning more PPE, wear full PPE for AGMPs such as compressions/CPR.
Buick JE, Cheskes S, Feldman M, Verbeek PR, Hillier M, Yuen Chin Leong YC, Drennan IR. COVID-19: What Paramedics Need to Know!  CJEM 2020; 22(4): 426-30. Review PH-Paramedic No evidence on outcomes or specific interventions for out-of-hospital cardiac arrests related to COVID-19.
Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With the Guidelines®-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists: Supporting Organizations: American Association of Critical Care Nurses and National EMS Physicians. Circulation 2020; 10.1161/CIRCULATIONAHA.120.047463.  Guideline ED-MD For COVID-19 positive pts: guide front-line providers in determining the appropriateness of starting and terminating CPR for patients with COVID-19, taking into account patient risk factors to estimate the likelihood of survival.
Małysz M, Smereka J, Jaguszewski M, Dąbrowski M, Nadolny K, Ruetzler K, et al. An optimal chest compression technique using personal protective equipment during resuscitation in the COVID-19 pandemic: A randomized crossover simulation study. Kardiol Pol 2020. RCT
SIM In the case of manual continous compressions by paramedics dressed in PPE AGP, it is advisable to change the person performing resuscitation every minute.

CPAP/BiPAP  ^

Citation Design Setting Clinical Bottom Line
Colombo C, Albani A, Banfi F, Maltana MA, Meroni L, Villa P, Brambilla AM. Using vital signs measurements to identify patients with COVID-19 who require early continuous positive airway pressure. Emerg Nurse. 2022 Jan 4;30(1):25-31. Retrospective Observational ED-MD Based on the results, the authors have devised a triage flow chart that uses selected vital signs measurements (oxygen saturation, respiratory rate and receipt of pre-hospital oxygen therapy) to identify patients requiring early CPAP.
ASPR TRACIE. (2017). EMS Infectious Disease Playbook. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Guideline PH-Paramedic Exercise caution when performing AGMPs.
Buick JE, Cheskes S, Feldman M, Verbeek PR, Hillier M, Yuen Chin Leong YC, Drennan IR. COVID-19: What Paramedics Need to Know!  CJEM 2020; 22(4): 426-30. Review PH-Paramedic Consider alternatives to AGMPs.
Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7(4):e35797. Systematic Review ICU Increased risk for of HCW infection.
Masuda Y, Teoh SE, Yeo JW, Tan DJH, Jimian DL, Lim SL, Ong MEH, Blewer AL, Ho AFW. Variation in community and ambulance care processes for out-of-hospital cardiac arrest during the COVID-19 pandemic: a systematic review and meta-analysis. Sci Rep. 2022 Jan 17;12(1):800. Retrospective Cohort ED-MD CPAP. It was identified that the typical characteristics of patients requiring early CPAP were: male (P=.013) with a median age of 68 years (P=.000), oxygen saturation of 92% (P=.000), temperature ≥38°C (P=.008), respiratory rate of 26 breaths per minute (P=.000) and had received pre-hospital oxygen therapy before arriving at the ED (P=.000).

ECMO ^

Citation Design Setting Clinical Bottom Line
Schmiady MO, Hofmann M, Sromicki J, Halbe M, van Tilburg K, Aser R, Mestres CA, Maisano F, Ferrari E. Initiation of an inter-hospital extracorporeal membrane oxygenation transfer programme for critically ill patients with coronavirus disease 2019: bringing extracorporeal membrane oxygenation support to peripheral hospitals. Interact Cardiovasc Thorac Surg. 2021 May 10;32(5):812-816. Retrospective Observational ICU Out-of-centre ECMO implants in well-selected patients with COVID-19 is feasible and safe if a well-established organization is available and if the implantation is done by an experienced and regularly trained team.
Creel-Bulos C, Miller C, Hassani B, Farthing H, Caridi-Schieble M, Connor MJ Jr, et al. "Pushing Geographic Boundaries: Interfacility transport and remote extracorporeal membrane oxygenation cannulation of patients during COVID-19 pandemic". Perfusion. 2022 Mar 23:2676591221078694. Retrospective Cohort PH-MD Transport distances ranged from 2.2 to 236 miles (median 22.5 miles; IQR 8.3–79); round trip times from 18 to 476 min (median 83 min; IQR 44–194). No transport associated complications occurred. Median duration of ECMO support was 17 days (IQR 9.5–34.5). Length of stay in the Intensive Care Unit (median 36 days; IQR 17–49) and hospital (median 39 days; IQR 25–57) varied. Amongst those discharged, 60% survived.
Widmeier E, Duerschmied D, Benk C, Staudacher D, Wengenmayer T, Supady A. Mobile ECMO retrieval of patients during the COVID-19 pandemic. Artif Organs. 2021 Oct;45(10):1168-1172.  Case Series PH-Medic Out-of-center initiation of ECMO during the COVID-19 pandemic was feasible and safe for patients and staff. 

Epidemiology  ^

Citation Design Setting Clinical Bottom Line
Chan SY, Tsai YF, Yen MY, Yu WR, Hung CC, Kuo TL, Chen CC, Yen YF, Huang SH, Huang TC, Huang SJ. Out-of-hospital cardiac arrest and in-hospital mortality among COVID-19 patients: A population-based retrospective cohort study. J Microbiol Immunol Infect. 2022 Aug 11:S1684-1182(22)00108-6. Retrospective Observational PH-Medic Time to OHCA occurrence is rapid in COVID-19 patients. Close monitoring of patients’ vital signs and disease severity during isolation is important, particularly for those with older age, fever, and hypoxemia.
Backhaus I, Hermsen D, Timm J, Boege F, Lübke N, Göbels K, et al. Underascertainment of COVID-19 cases among first responders: a seroepidemiological study. Occup Med (Lond). 2022 Apr 19;72(3):225-8. Survey PH-Medic The high seroprevalence and under ascertainment rate highlight the need to mitigate potential transmission within and between first responders and patients. Workplace control measures such as increased and regular COVID-19-testing and the prompt vaccination of all personnel are necessary.
Oh TH, Woo SH, Hong S, Lee C, Lee WJ, Jeong SK. Clinical Features of Patients Presenting to the Emergency Department With Cardiovascular Adverse Reactions After COVID-19 mRNA Vaccination. J Korean Med Sci. 2022 Mar 7;37(9):e73.  Retrospective Observational Other Most patients who visited the ED with cardiovascular adverse reactions were discharged from the ED, but some were admitted for other medical diseases as well as adverse vaccine reactions.
Kimball E, Buchwalder K, Upchurch C, Kea B. Intermittent complete heart block with ventricular standstill after Pfizer COVID-19 booster vaccination: A case report. J Am Coll Emerg Physicians Open. 2022 Apr 20;3(2):e12723.  Case Report Other After stabilization and extensive workup, the patient was diagnosed with lymphocytic myocarditis and complete heart block that is suspected to be secondary to COVID-19 booster vaccination.
McKinnon JE, Wang DD, Zervos M, Saval M, Marshall-Nightengale L, et al. Safety and tolerability of hydroxychloroquine in health care workers and first responders for the prevention of COVID-19: WHIP COVID-19 Study. Int J Infect Dis. 2022 Mar;116:167-73. Randomized Control Trial PH-Medic This randomized placebo-controlled trial was able to demonstrate the safety of HCQ out-patient chemoprophylaxis in high-risk groups against COVID-19.
Blek N, Szarpak L, Ladny JR. Effect of the COVID-19 Pandemic in the Prehospital Management of Patients with Suspected Acute Stroke: A Retrospective Cohort Study. Int J Environ Res Public Health. 2022 Apr 14;19(8):4769. Retrospective Observational PH-Medic The overall number of suspected stroke patients treated by EMS remained unchanged during COVID-19 compared to the pre-COVID-19 period; however, the average time from call tohospital admission increased by 15 min. 
Riyapan S, Chantanakomes J, Roongsaenthong P, Tianwibool P, et al. Impact of the COVID-19 outbreak on out-of-hospital cardiac arrest management and outcomes in a low-resource emergency medical service system: a perspective from Thailand. Int J Emerg Med. 2022 Jun 9;15(1):26. Retrospective Observational PH-Medic There was a signifcant decrease in the rate of survival to hospital discharge of patients with OHCA during the COVID-19 outbreak in Thailand. Maintaining the frst responder response quality and encouraging prehospital advanced airway insertion might improve the survival rate during the COVID-19 outbreak.
Baert V, Beuscart JB, Recher M, Javaudin F, Hugenschmitt D, Bony T, et al. Coronavirus Disease 2019 and Out-of-Hospital Cardiac Arrest: No Survivors. Crit Care Med. 2022 May 1;50(5):791-8. Retrospective Observational PH-Medic Our results highlighted a zero survival rate in out-of-hospital cardiac arrest patients with confirmed coronavirus disease 2019. This finding raises important questions with regard to the futility of resuscitation for coronavirus disease 2019 patients and the management of the associated risks.
Kalani N, Hatami N, Ali S, Mehramiz NJ, Rahmanian F, et al. Self-Referred Walk-in (SRW) versus Emergency Medical Services Brought Covid-19 Patients. Bull Emerg Trauma. 2022 Jan;10(1):21-6. Cross Sectional Study PH-Medic It seems that severe acute respiratory syndrome occurs soon in some patients that lead to the need for an ambulance to transfer the patient to the hospital. Therefore, EMS transfer patients should be considered for more risk of severe COVID-19; considering comorbidities of heart disease and hypertension as red flags.
Damjanovic D, Pooth JS, Steger R, Boeker M, Steger M, Ganter J, et al. Observational study on implications of the COVID-19-pandemic for cardiopulmonary resuscitation in out-of-hospital cardiac arrest: qualitative and quantitative insights from a model region in Germany. BMC Emerg Med. 2022 May 18;22(1):85.  Retrospective Observational PH-Medic In our region, bystander CPR in witnessed OHCA cases as well as the number of patients transported to hospital signifcantly decreased during the frst pandemic wave.
Eskol JR, Zegers FD, Wittrock D, Lassen AT, Mikkelsen S. Increased ambulance on-scene times but unaffected response times during the first wave of the COVID-19 pandemic in Southern Denmark. BMC Emerg Med. 2022 Apr 9;22(1):61.  Retrospective Observational PH-Medic The increased on-scene times of the ambulances may largely be attributed to time utilised to exert the increased competencies concerning treat-and-release of patients.
Grunau B, O'Brien SF, Kirkham TL, Helmer J, Demers PA, Asamoah-Boaheng M, et al. A Prospective Observational Cohort Comparison of SARS-CoV-2 Seroprevalence Between Paramedics and Matched Blood Donors in Canada During the COVID-19 Pandemic. Ann Emerg Med. 2022 Jul;80(1):38-45. Prospective Cohort PH-Medic Overall, paramedics demonstrated similar evidence of prior SARS-CoV-2 infection to that of blood donors. However, among unvaccinated individuals, evidence of prior infection was higher among paramedics compared to blood donors.
Jouffroy R, Brami E, Scannavino M, Daniel Y, Bertho K, Abriat A, et al. Association between prehospital shock index and mortality among patients with COVID-19 disease. Am J Emerg Med. 2022 Jun;56:133-6.  Retrospective Observational PH-MD Neither prehospital initial SI nor lactatemia were associated with ICU admission and 30-day mortality among COVID-19 patients initially cared for by a Paris Fire Brigade BLS or ALS team.
Al-Shiakh S, Tran QK, Caggiula A, Berezowski I, Barnawi B, Pourmand A. Attitudes among healthcare professionals towards cardiopulmonary resuscitation during COVID-19. Am J Emerg Med. 2022 Feb;52:34-42. Cross-Sectional Survey PH-Medic The ongoing COVID-19 pandemic significantly affected healthcare workers' attitudes towards performing CPR for OHCA. Confidence levels and willingness to perform CPR increased over time during the study period.
Davis WD, Abbey JL, Gamberi B, Vezina L, Whiteaker KS. Electrocardiogram Changes Associated With a Case of COVID-19 Infection: A Pathophysiological Perspective. Adv Emerg Nurs J. 2022 Apr-Jun 01;44(2):127-35.  Case Report Other This case presentation illustrates ECG changes associated with cardiovascular disease progression.
Madej M, Sebastian A, Morgiel E, Korman L, Szmyrka M, Sokolik R, et al. The assessment of the risk of COVID-19 infection and its course in the medical staff of a COVID-only and a non-COVID hospital. Adv Clin Exp Med. 2022 May 13.  Prospective Cohort Other The study results indicate that employees of thehospital treating only COVID patients have a higher risk of infection.
Argenziano MG, Bruce SL, Slater CL, Tiao JR, Baldwin MR, Barr RG, et al. Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series. BMJ 2020; 369:m1996. Descriptive ED-MD Patients admitted to hospital with covid-19 at this medical center faced major morbidity and mortality, with high rates of acute kidney injury and inpatient dialysis, prolonged intubations, and a bimodal distribution of time to intubation from symptom onset.
Duanmu Y, Brown IP, Gibb WR, Singh J, Matheson LW, Blomkalns AL, et al. Characteristics of Emergency Department Patients With COVID-19 at a Single Site in Northern California: Clinical Observations and Public Health Implications. Acad Emerg Med 2020; 27(6):505-509. Descriptive ED-MD The majority of ED patients who tested positive for COVID‐19 presented with cough or fever and had a benign clinical course, with older patients more likely to require admission.
Giwa AL, Desai A, Duca A. Novel 2019 coronavirus SARS-CoV-2 (COVID-19): an overview for emergency clinicians. Pediatr Emerg Med Pract 2020; 17(5):1-24. Narrative Review ED-MD This review analyzes information from worldwide research and experience on the epidemiology, prevention, and treatment of COVID-19, and offers links to the most reliable and trustworthy resources to help equip healthcare professionals in managing this public health challenge.
Miró Ò, Llorens P, Jiménez S, Piñera P, Burillo-Putze G, Martín A, et al. Frequency, Risk Factors, Clinical Characteristics, and Outcomes of Spontaneous Pneumothorax in Patients With Coronavirus Disease 2019: A Case-Control, Emergency Medicine-Based Multicenter Study. Chest 2021; 159(3):1241-55. Case Series
ED-MD Spontaneous Pneumothoax is uncommon in COVID patients (<1%) but more common than in non-COVID 19 patients.
Piva S, Filippini M, Turla F, Cattaneo S, Margola A, De Fulviis S, et al. Clinical presentation and initial management critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Brescia, Italy. J Crit Care 2020; 58:29-33. Descriptive ICU Many could be managed with noninvasive ventilation, despite the risk of aerosolization.
Yang BY, Barnard LM, Emert JM, Drucker C, Schwarcz L, Counts CR, et al. Clinical Characteristics of Patients With Coronavirus Disease 2019 (COVID-19) Receiving Emergency Medical Services in King County, Washington. JAMA Netw Open 2020;3(7):e2014549. Observational PH-Paramedic Screening based on conventional COVID-19 symptoms or corresponding examination findings of febrile respiratory illness may not possess the necessary sensitivity for early diagnostic suspicion in the prehospital setting.
Pickkers P, van der Hoeven H, Citerio G. COVID-19: 10 things I wished I'd known some months ago. Intensive Care Med 2020;46(7):1449-1452. Opinion ICU This viewpoint addresses 10 points that may be of interest both the logistics, as well as actual clinical care of critically ill COVID-19 patients.
Rashid M, Gale CP, Curzen N, Ludman P, De Belder M, Timmis A, et al. Impact of COVID19 Pandemic on the Incidence and Management of Out of Hospital Cardiac Arrest in Patients Presenting with Acute Myocardial Infarction in England.  J of the American Heart Association 2020:e018379. Observational ED-MD This study observed a significant in-
crease in incidence of OHCA during COVID-19 period.
Örgel M, Gogol M, Graulich T, Omar M, Ranker A, Böttcher C, et al. A Retrospective Analysis of the Initial Effect of COVID-19 on German Prehospital Care During Lockdown in Germany. Open Access Emerg Med 2021; 13:97-105. Observational PH-Paramedic We found a decreasing effect of the COVID-19 pandemic in Germany on the number of emergency calls as well as missions, and an increase of the severity of cases in pre-clinical care.
Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, et al. Treatment of out-of-hospital cardiac arrest in the COVID-19 era: A 100 days experience from the Lombardy region. PLoS One 2020; 15(10):e0241028. Ovservational Other Compared to 2019, during the 2020 COVID-19 outbreak we observed a lower attitude of lay-people to start CPR, while resuscitation attempts by BLS and ALS staff were not influenced by suspected/confirmed infection.
Fried JA, Ramasubbu K, Bhatt R, et al. The Variety of Cardiovascular Presentations of COVID-19 [published online ahead of print, 2020 Apr 3]. Circulation. 2020; 10.1161/CIRCULATIONAHA.120.047164. Review Other Have a low threshold to assess for shock in acute systolic HF associated with COVID . ECMO may be considered for those experiencing cardiogenic shock.
Giwa A, Desai A. Novel coronavirus COVID-19: an overview for emergency clinicians. Emergency medicine practice 2020;22(2):1-21. Opinion
ED-MD
Fatality rate of COVID-19 is approximately 4%, though sampling error may be large. This review analyzes information on the epidemiology, prevention, and treatment of COVID-19, and offers links to the most reliable and trustworthy resources to help equip healthcare professionals in managing this public health challenge.
Lauer SA, Grantz KH, Bi Q, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med. 2020; [Epub ahead of print 10 March 2020]. Retrospective Observational Other This work provides additional evidence for a median incubation period for COVID-19 of approximately 5 days.
Moriguchi T., Harii N., Goto J., Harada D., Sugawara H., Takamino J., et al. A first Case of Meningitis/Encephalitis associated with SARS-Coronavirus-2. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2020. Case Report ED-MD In the case of Meningitis/Encephalitis the specific SARS-CoV-2 RNA was not detected in the nasopharyngeal swab but was detected in a CSF.
Paciullo F, Giannandrea D, Gianfredi V, Borgognoni F, Verdecchia P, L'Angiocola PD, et al. Epidemiology of emergency calls for time-dependent acute illnesses during COVID-19 Letter to Editor
ED-MD There has been an increase in out-of-hospital cardiac arrests and a reduction of hospital admissions for ACS have been reported.
Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention [published online ahead of print, 2020 Feb 24]. JAMA. 2020;10.1001. Report Other Most cases were classified as mild (81%; ie, nonpneumonia and mild pneumonia). However, 14% were severe.
Yang BY, Barnard LM, Emert JM, Drucker C, Schwarcz L, Counts CR, et al. Clinical Characteristics of Patients With Coronavirus Disease 2019 (COVID-19) Receiving Emergency Medical Services in King County, Washington. JAMA Network Open 2020; 3(7):e2014549. Retrospective  Cohort PH-Paramedic Screening based on conventional COVID-19 symptoms or corresponding examination findings of febrile respiratory illness may not possess the necessary sensitivity for early diagnostic suspicion in the prehospital setting.
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published correction appears in Lancet. 2020 Mar 28;395(10229):1038] [published correction appears in Lancet. 2020 Mar 28;395(10229):1038]. Lancet. 2020; 395(10229):1054–1062.   Retrospective Cohort Other Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days.
Borkowska MJ, Smereka J, Safiejko K, Nadolny K, Maslanka M, Filipiak KJ, Jaguszewski MJ, Szarpak L. Out-of-hospital cardiac arrest treated by emergency medical service teams during COVID-19 pandemic: A retrospective cohort study. Cardiol J. 2021;28(1):15-22.  Retrospective Observational PH-Medic Return of spontaneous circulation in EMS was observed only in 9.4% of resuscitated patients.
Chow JH, Yin Y, Yamane DP, Davison D, Keneally RJ, Hawkins K, Parr KG, Al-Mashat M, Berger JS, Bushardt RL, Mazzeffi MA, Nelson SJ. Association of prehospital antiplatelet therapy with survival in patients hospitalized with COVID-19: A propensity score-matched analysis. J Thromb Haemost. 2021 Nov;19(11):2814-2824. Prospective Observational PH-Medic Prehospital antiplatelet therapy in patients with COVID-19, there was an association with significantly lower in-hospital mortality.
De Carvalho H, Leonard-Pons L, Segard J, Goffinet N, Javaudin F, Martinage A, Cattin G, Tiberghien S, Therasse D, Trotignon M, Arabucki F, Ribes S, Le Bastard Q, Montassier E. Electrocardiographic abnormalities in COVID-19 patients visiting the emergency department: a multicenter retrospective study. BMC Emerg Med. 2021 Nov 19;21(1):141. Retrospective Cohort Study ED-MD ECG performed at ED admission may be useful to predict death in COVID-19 patients. Our data suggest that the presence of abnormal axis and left bundle branch block on ECG indicated a higher risk of inhospital mortality in COVID-19 patients who presented to the ED. We also confirmed that ST segment elevation was rare in COVID-19 patients.
Gan JM, Kho J, Akhunbay-Fudge M, Choo HM, Wright M, Batt F, Mandal AKJ, Chauhan R, Missouris CG. Atypical presentation of COVID-19 in hospitalised older adults. Ir J Med Sci. 2021 May;190(2):469-474.  Retrospective In-Patient In the atypical group, common presenting complaints were fall in 18(36%), reduced mobility or generalised weakness in 18 (36%) and delirium in 11 (22%).
Glober NK, Supples M, Faris G, Arkins T, Christopher S, Fulks T, Rayburn D, Weinstein E, Liao M, O'Donnell D, Lardaro T. Out-of-hospital cardiac arrest volumes and characteristics during the COVID-19 pandemic. Am J Emerg Med. 2021 Oct;48:191-197. Retrospective Observational ED-MD Total OHCA increased during the COVID-19 pandemic when compared with the prior year.
Hasani-Sharamin P, Saberian P, Sadeghi M, Mireskandari SM, Baratloo A. Characteristics of Emergency Medical Service Missions in Out-of-Hospital Cardiac Arrest and Death Cases in the Periods of Before and After the COVID-19 Pandemic. Prehosp Disaster Med. 2021 Dec;36(6):676-683. Cross-Sectional Study PH-Medic This study showed that the number of missions in the Tehran EMS in 2020 were decreased compared to that of 2019, however the number of missions in 2019 was more than that of 2018. Respiratory problems, infectious diseases, poisoning, death, and OHCA were increased compared to the previous two years and cardiovascular complaints, neurological problems, and motor vehicle collisions (MVCs) in 2020 were fewer than that of the other two years.
Jain N, Berkenbush M, Feldman DC, Eskin B, Allegra JR. Effect of COVID19 on prehospital pronouncements and ED visits for stroke and myocardial infarction. Am J Emerg Med. 2021 May;43:46-49. Descriptive PH-Medic We found pre-hospital ALS death pronouncements increased.
Lavigne T, De Tavernier B, Van Regenmortel N, De Tavernier W, Christiaen J, Hubloue I, Anseeuw K. Effect of the First Wave of the Belgian COVID-19 Pandemic on Physician-Provided Prehospital Critical Care in the City of Antwerp (Belgium). Prehosp Disaster Med. 2022 Feb;37(1):12-18.  Retrospective Cohort Study PH-Medic The frequency of physician-staffed prehospital interventions decreased significantly. There was a marked reduction in interventions for lower illness severity and an increase in higher illness severity and mortality.
Lee J, Kim D, Lee WJ, Woo SH, Jeong S, Kim SH. Association of the COVID-19 Pandemic and Low-rescue Suicide Attempts in Patients Visiting the Emergency Department after Attempting Suicide. J Korean Med Sci. 2021 Aug 30;36(34):e243. Retrospective Observational ED-MD The COVID-19 pandemic was associated with low-rescue suicide attempts in patients visiting the ED after attempting suicide.
Mälberg J, Hadziosmanovic N, Smekal D. Physiological respiratory parameters in pre-hospital patients with suspected COVID-19: A prospective cohort study. PLoS One. 2021 Sep 2;16(9):e0257018. Prospective Cohort PH-Medic Patients taking smaller, faster breaths with less pressure had higher odds of having COVID-19 in this study. Smaller, faster breaths and higher dead space percentage also increased the odds of hospital admission.
Moeller AL, Mills EHA, Collatz Christensen H, Gnesin F, Blomberg SNFN, Zylyftari N, Jensen B, Ringgren KB, Broccia MD, Bøggild H, Torp-Pedersen C. Symptom presentation of SARS-CoV-2-positive and negative patients: a nested case-control study among patients calling the emergency medical service and medical helpline. BMJ Open. 2021 May 24;11(5):e044208.  Prospective Observational Other Symptoms including nasal congestion, irritation/pain in throat, cough, muscle/joint pain, loss of taste and smell, and headache were common symptoms of COVID-19 for patients younger than 60 years; whereas loss of appetite and feeling unwell were more commonly seen among patients over 60 years.
Montalbani B, Bargagna P, Mastrangelo M, Sarubbi S, Imbastaro B, De Luca GP, Anibaldi G, Erbuto D, Pompili M, Comparelli A. The COVID-19 Outbreak and Subjects With Mental Disorders Who Presented to an Italian Psychiatric Emergency Department. J Nerv Ment Dis. 2021 Apr 1;209(4):246-250. Retrospective Observational ED-MD The present study aims to assess the sociodemographic and clinical features of patients who required a psychiatric consultation in the emergency department
Naganathan S, Paiva M, Soliman L, Amanullah S, Aluisio AR, Genisca AE. Epidemiology and Clinical Characteristics of Emergency Department Patients with COVID-19 in a Rhode Island Healthcare System. R I Med J (2013). 2021 Jun 1;104(5):24-29.  Descriptive ED-MD This study presents the clinical and sociodemographic characteristics of ED patients with COVID-19.
O'Reilly GM, Mitchell RD, Mitra B, Akhlaghi H, Tran V, Furyk JS, Buntine P, Wong A, Gangathimmaiah V, Knott J, Raos M, Chatterton E, Sevior C, Parker S, Baker S, Loughman A, Lowry N, Freeman D, Sri-Ganeshan M, Chapman N, Siu S, Noonan MP, Smit V, Cameron PA; COVED Project Team. Epidemiology and clinical features of emergency department patients with suspected COVID-19: Insights from Australia's 'second wave' (COVED-4). Emerg Med Australas. 2021 Apr;33(2):331-342.  Prospective Observational ED-MD Presence of SARS-CoV-2 on nasopharyngeal swab was associated with an increase in the odds of death and mechanical ventilation in hospital.
Örgel M, Gogol M, Graulich T, Omar M, Ranker A, Böttcher C, Liodakis E, Krettek C, Macke C. A Retrospective Analysis of the Initial Effect of COVID-19 on German Prehospital Care During Lockdown in Germany. Open Access Emerg Med. 2021 Mar 5;13:97-105.  Retrospective Observational PH-Medic They  found a decreasing effect of the COVID-19 pandemic in Germany on the number of emergency calls.
Perotte R, Sugalski G, Underwood JP, Ullo M. Characterizing COVID-19: A chief complaint based approach. Am J Emerg Med. 2021 Jul;45:398-403.  Reetrospective Observational ED-MD Complaints, fever and shortness of breath were the most prevalent initial presenting symptoms.
Rashid Hons M, Gale Hons CP, Curzen Hons N, Ludman Hons P, De Belder Hons M, Timmis Hons A, Mohamed Hons MO, Lüscher Hons TF, Hains Hons J, Wu J, Shoaib A, Kontopantelis E, Roebuck C, Denwood T, Deanfield J, Mamas MA. Impact of Coronavirus Disease 2019 Pandemic on the Incidence and Management of Out-of-Hospital Cardiac Arrest in Patients Presenting With Acute Myocardial Infarction in England. J Am Heart Assoc. 2020 Nov 17;9(22):e018379.  Retrospective Observational ICU In this national cohort of hospitalized patients with acute myocardial infarction, we observed a significant in-crease in incidence of OHCA during COVID-19 period paralleled with reduced access to guideline-recommended care andincreased in-hospital mortality.
Rollman JE, Kloner RA, Bosson N, Niemann JT, Gausche-Hill M, Williams M, Clare C, Tan W, Wang X, Shavelle DM, Rafique AM. Emergency Medical Services Responses to Out-of-Hospital Cardiac Arrest and Suspected ST-Segment-Elevation Myocardial Infarction During the COVID-19 Pandemic in Los Angeles County. J Am Heart Assoc. 2021 Jun 15;10(12):e019635.  Cross-Sectional PH-Medic Paramedics in Los Angeles County, CA responded to increased PI-OHCA and decreased PI-STEMI following the stay-at-home order.
Satty T, Ramgopal S, Elmer J, Mosesso VN, Martin-Gill C. EMS responses and non-transports during the COVID-19 pandemic. Am J Emerg Med. 2021 Apr;42:1-8. doi: 10.1016/j.ajem.2020.12.078. Epub 2020 Dec 31.  Descriptive PH-Medic We found a decline in overall EMS response volumes and an increase in the rate of non-transports independent of patient demographics and other response characteristics.
Scquizzato T, D'Amico F, Rocchi M, Saracino M, Stella F, Landoni G, Zangrillo A. Impact of COVID-19 Pandemic on Out-of-Hospital Cardiac Arrest System-of-Care: A Systematic Review and Meta-Analysis. Prehosp Emerg Care. 2021 Sep 14:1-12.  Systematic Review and Meta-analysis PH-Medic The COVID-19 pandemic affected the system-of-care of out-of-hospital cardiac arrest, and patients had worse short-term outcomes compared to pre-pandemic periods. Advanced airway management strategy shifted from
Scquizzato T, Landoni G, Scandroglio AM, Franco A, Calabrò MG, Paoli A, D'Amico F, Yavorovskiy A, Zangrillo A. Outcomes of out-of-hospital cardiac arrest in patients with SARS-CoV-2 infection: a systematic review and meta-analysis. Eur J Emerg Med. 2021 Dec 1;28(6):423-431. Systematic Review and Meta-analysis PH-Medic One-fifth of out-of-hospital cardiac arrest patients had SARS-CoV-2 infection. These patients had low rates of return of spontaneous circulation and survival and were characterized by higher nonshockable rhythms but similar bystander-initiated cardiopulmonary resuscitation rate.
Solà-Muñoz S, Yuguero O, Azeli Y, Roig G, Prieto-Arruñada JA, Español J, Morales-Álvarez J, Muñoz M, Verge JJ, Jiménez-Fàbrega X. Impact on polytrauma patient prehospital care during the first wave of the COVID-19 pandemic: a cross-sectional study. Eur J Trauma Emerg Surg. 2021 Oct;47(5):1351-1358. Cross-Sectional PH-Medic During the frst wave of the pandemic, the number of polytrauma patients decreased and there was a change in.
Soni A, Garg SK, Gupta R, Gupta P, Kansay R, Singhal A. Epidemiologic characteristics and pre-hospital care of traumatic injuries during the COVID-19 pandemic in an emerging and developing country: A single tertiary centre experience. J Clin Orthop Trauma. 2021 Dec;23:101654. Prospective Observational Study PH-Medic Emphasizing on pre-hospital care measures, with special focus on co-ordination between primary, secondary and tertiary health care facilities is the need of the hour and can prevent additional morbidities, avoiding overburden of the already compromised healthcare centres.
Teoh SE, Masuda Y, Tan DJH, Liu N, Morrison LJ, Ong MEH, Blewer AL, Ho AFW. Impact of the COVID-19 pandemic on the epidemiology of out-of-hospital cardiac arrest: a systematic review and meta-analysis. Ann Intensive Care. 2021 Dec 7;11(1):169.  Systematic Review and Meta-Analysis PH-Medic Compared to the pre-pandemic period, the COVID-19 pandemic period was signifcantly associated with increased OHCA incidence and worse outcomes.
Troncoso RD Jr, Garfinkel EM, Leon D, Lopez SM, Lin A, Jones D, Trautman S, Levy MJ, Margolis AM. Decision Making and Interventions During Interfacility Transport of High-Acuity Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection. Air Med J. 2021 Jul-Aug;40(4):220-224. Descriptive PH-MD/CCT The safe transport of critically ill patients with COVID-19 requires experience with vasopressors, paralytic medications, inhaled vasodilators, prone positioning, and ventilator management.
Yu JH, Liu CY, Chen WK, Yu SH, Huang FW, Yang MT, Chen CY, Shih HM. Impact of the COVID-19 pandemic on emergency medical service response to out-of-hospital cardiac arrests in Taiwan: a retrospective observational study. Emerg Med J. 2021 Sep;38(9):679-684.  Retrospective Observational PH-Medic EMS response time for patients with OHCA was prolonged during the COVID-19 pandemic.
Fitzpatrick D, Duncan EAS, Moore M, Best C, Andreis F, Esposito M, Dobbie R, Corfield AR, Lowe DJ. Epidemiology of emergency ambulance service calls related to COVID-19 in Scotland: a national record linkage study. Scand J Trauma Resusc Emerg Med. 2022 Jan 28;30(1):9.  Retrospective Cohort PH-Medic The non-conveyance rate of people that were categorised as COVID-19 negative was higher than in the preceding year in the same service.
Gulen M, Satar S, Acehan S, Bozkurt M, Aslanturkiyeli EF, Sevdimbas S, Esen CI, Balcik M, Uzucek MD, Sahin GK, Firat BT. Have the Diagnoses of Patients Transported by Ambulances Changed in the Early Stage of the COVID-19 Pandemic? Prehosp Disaster Med. 2022 Feb;37(1):4-11. Retrospective Cohort PH-Medic Despite this decrease in critical patient calls, non-emergency patient calls continued and 52.2% of the patients transported by ambulance in 2020 were discharged from the ED.
Kalani N, Hatami N, Ali S, Mehramiz NJ, Rahmanian F, Raeyat Doost E, Haghbeen M, Abiri S, Foroughian M, Ebrahimi M. Self-Referred Walk-in (SRW) versus Emergency Medical Services Brought Covid-19 Patients. Bull Emerg Trauma. 2022 Jan;10(1):21-26.  Cross Sectional Survey PH-Medic It seems that severe acute respiratory syndrome occurs soon in some patients that lead to the need for an ambulance to transfer the patient to the hospital. Therefore, EMS transfer patients should be considered for more risk of severe COVID-19; considering comorbidities of heart disease and hypertension as red flags.
Lavigne T, De Tavernier B, Van Regenmortel N, De Tavernier W, Christiaen J, Hubloue I, Anseeuw K. Effect of the First Wave of the Belgian COVID-19 Pandemic on Physician-Provided Prehospital Critical Care in the City of Antwerp (Belgium). Prehosp Disaster Med. 2022 Feb;37(1):12-18. Retrospective Cohort PH-MD The frequency of physician-staffed prehospital interventions decreased significantly. There was a marked reduction in interventions for lower illness severity and an increase in higher illness severity and mortality.
Masuda Y, Teoh SE, Yeo JW, Tan DJH, Jimian DL, Lim SL, Ong MEH, Blewer AL, Ho AFW. Variation in community and ambulance care processes for out-of-hospital cardiac arrest during the COVID-19 pandemic: a systematic review and meta-analysis. Sci Rep. 2022 Jan 17;12(1):800. Systematic Review/Meta Analysis PH-Medic Resuscitation duration did not difer signifcantly between pandemic and pre-pandemic timeframes.
McKinnon JE, Wang DD, Zervos M, Saval M, Marshall-Nightengale L, Kilgore P, Pabla P, Szandzik E, Maksimowicz-McKinnon K, O'Neill WW. Safety and tolerability of hydroxychloroquine in health care workers and first responders for the prevention of COVID-19: WHIP COVID-19 Study. Int J Infect Dis. 2022 Mar;116:167-173. Randomized Control Trial PH-Medic This randomized placebo-controlled trial was able to demonstrate the safety of HCQ out-patient chemoprophylaxis in high-risk groups against COVID-19.
Seo AR, Lee WJ, Woo SH, Moon J, Kim D. Pre-Hospital Delay in Patients With Acute Stroke During the Initial Phase of the Coronavirus Disease 2019 Outbreak. J Korean Med Sci. 2022 Feb 14; 37(6):e47. Cross Sectional Cohort PH-Medic In the initial phase after the sudden COVID-19 outbreak, EMS response times for acute stroke were delayed and the clinical outcomes of patients with acute stroke deteriorated.

Field Assessment Units/ED Avoidance  ^

Citation Design Setting Clinical Bottom Line
Ryu MY, Park HA, Han S, Park HJ, Lee CA. Emergency Transport Refusal during the Early Stages of the COVID-19 Pandemic in Gyeonggi Province, South Korea. Int J Environ Res Public Health. 2022 Jul 11;19(14):8444. Retrospective Observational PH-Medic Although fever prevented transport refusal during the pre-COVID-19 period(aOR, 0.620; 95% CI, 0.567–0.679), it became a significant risk factor for transport refusal during the post-COVID-19 period (aOR, 1.619; 95% CI, 1.534–1.709). 
Couturier K, Nelson AR, Burns K, Cone DC, Rollins M, et al. EMS Non-Transport of Low-Risk COVID-19 Patients. Prehosp Emerg Care. 2022 Jun 13:1-5. Retrospective Observational PH-Medic Within this small study, EMS clinicians in our system were able to safely and accurately apply a non-transport protocol for patients presenting with symptoms consistent with COVID-19.
Pozner J, Winslow J, Schinde S, Patel MD, Grover JM. EMS Involvement in COVID-19 Vaccination Efforts - Results of a North Carolina Statewide Survey. Prehosp Emerg Care. 2022 Apr 12:1-4.  Retrospective Survey PH-Medic This study demonstrates the large role that EMS clinicians and systems have played and continue to play in COVID-19 vaccination efforts in the state of North Carolina, including planning and logistics, patient screening and observation, vaccine preparation and administration, and home vaccination.
Jarman AF, Ford JS, Maynard MJ, Simmons ZL, Mackey KE, Mumma BE, Rose JS. Prehospital Testing and Surveillance for SARS-CoV-2: A Special Report from the Sacramento (California USA) Mobile Integrated Health Unit. Prehosp Disaster Med. 2022 Apr;37(2):265-268. Retrospective Cohort PH-Medic Cooperative prehospital models are an effective model to deliver out-of-hospital testing and disease surveillance that may serve as a blueprint for community-based care delivery for a number of disease states and future epidemics or pandemics.
Lin M, Beliavsky A, Katz K, Powis JE, Ng W, Williams V, et al. What can early Canadian experience screening for COVID-19 teach us about how to prepare for a pandemic? CMAJ 2020; 192(12):E314-E318. Descriptive ED-MD Barriers to assessment and testing for COVID-19 outside of acute care hospitals are likely contributing to these avoidable emergency department visits.
Mileder LP, Schüttengruber G, Prattes J, Wegscheider T. Simulation-based training and assessment of mobile pre-hospital SARS-CoV-2 diagnostic teams in Styria, Austria. Medicine (Baltimore ) 2020; 99(29):e21081. Observational SIM Using several proven educational concepts, they have successfully drafted and implemented a training program for mobile prehospital SARS-CoV-2 diagnostic teams.
Pulia MS, O'Brien TP, Hou PC, Schuman A, Sambursky R. Multi-tiered screening and diagnosis strategy for COVID-19: a model for sustainable testing capacity in response to pandemic. Ann Med 2020; 52(5):207-214. Descriptive Other The ability to triage patients  is a critical component to our national pandemic response.
Esteve-Esteve M, Bautista-Rentero D, Zanón-Viguer V. Risk of influenza transmission in a hospital emergency department during the week of highest incidence. Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias 2018; 30(1):7-13. Retrospective Observational ED-MD The risk attributable to visiting the emergency department risk was 70.5%, whereas risk attributable to community exposure was 2%.
Glauser W. Proposed protocol to keep COVID-19 out of hospitals. CMAJ 2020;192(10):E264-E265. Opinion PH-Paramedic Supports: EMS initiated non-transport with home supports.
Jaffe E, Sonkin R, Alpert EA, Magid A, Knobler HY. Flattening the COVID-19 curve: The unique role of Emerg medical services in containing a global pandemic. Israel Medical Association J 2020; 22(8):410-6. Observational
PH-Paramedic Maximizing EMS with phone triage and field testing may significanlty distance patients from the ED.
Jaffe E, Strugo R, Bin E, Blustein O, Rosenblat I, Alpert EA, et al. The role of emergency medical services in containing COVID-19. Am J Emerg Med 2020; 38(7):1526-7. Letter to the Editor PH-Paramedic Maximizing EMS during a pandemic by carrying out phone triage, home testing, and drive-in testing significantly decreases visits to physicians' offices and hospitals.
Nacoti M., Ciocca A., Giuppoini A., Brambillasca P., Lussana F., Pisano M et al. At the Epicenter of the Covid-19 Pandemic and Humanitarian Crises in Italy: Changing Perspectives on Preparation and Mitigation. New England Journal of Emergency Medicine 2020 March 21 ahead of print. Report Other Supports commmunity based acute care pre and post DC.
Spina S., Marrazzo F., Migliari M., Stucchi R., Sforza A., Fumagalli R. The response of Milan's Emergency Medical System to the COVID-19 outbreak in Italy. Lancet (London, England) 2020; 395(10227):e49-e50. Report PH-Paramedic Specific algorithms, detailed protocols, and specialised teams must be fostered within each EMS department to allocate the right resources to the right individuals when cases of COVID-19 present.
Constantine ST, Callaway D, Driscoll JN, Murphy S. Implementation of Drive-Through Testing for COVID-19 With Community Paramedics. Disaster Med Public Health Prep. 2021 Feb 16:1-7.  Descriptive  PH-Medic In our health care system, we pivoted the traditional MIH/CP model to rapidly initiate remote drive-through testing for COVID-19 in pre-screened individuals.
Harrison NE, Ehrman RR, Curtin A, Gorelick D, Hill AB, Brennan E, Dunne R. Factors Associated With Voluntary Refusal of Emergency Medical System Transport for Emergency Care in Detroit During the Early Phase of the COVID-19 Pandemic. JAMA Netw Open. 2021 Aug 2;4(8):e2120728.  Retrospective Observational PH-Medic EMS transport refusals increased with the COVID-19 outbreak’s peak and remained elevated despite receding public health restrictions, COVID-19 incidence, total EMS responses, and prehospital deaths.
Siman-Tov M, Strugo R, Podolsky T, Blushtein O. An assessment of treatment, transport, and refusal incidence in a National EMS's routine work during COVID-19. Am J Emerg Med. 2021 Jun;44:45-49.  Retrospective Observational PH-Medic Patients' refusal to transport rose from 13.4% in 2019 to 19.9% in 2020. Cases of refusals followed by death within 8 days were more prevalent in 2020.

High Flow NRB Mask  ^

Citation Design Setting Clinical Bottom Line
Buick JE, Cheskes S, Feldman M, Verbeek PR, Hillier M, Yuen Chin Leong YC, Drennan IR. COVID-19: What Paramedics Need to Know!  CJEM 2020; 22(4): 426-30. Review PH-Paramedic Avoid AGMPs, consider MDI.
Simonds AK, Hanak A, Chatwin M, et al. Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections. Health Technol Assess 2010; 14(46):131–172. Prospective Cohort Study ED-MD These findings suggest that health-care workers providing NIV working within 1 m of an infected patient should have a higher level of respiratory protection, but that infection control measures may have less relevance for these procedures.
Somogyi R, Vesely AE, Azami T, et al. Dispersal of respiratory droplets with open vs closed oxygen delivery masks: implications for the transmission of severe acute respiratory syndrome. Chest. 2004; 125(3):1155–1157. Report SIM Use caution Common masks create a plume of droplets.
Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7(4):e35797. Systematic Review ICU Significant risk of HCW infection.
Kedzierewicz R, Derkenne C, Fraudin A, Vanhaecke P, Jouffroy R, Jost D, Prunet B. Logistical Challenge With Prehospital Use of High-Flow Nasal Oxygen Therapy in COVID-19-Induced Respiratory Distress: A Case Report. J Emerg Med. 2021 Jul;61(1):37-40.  Case Report PH-Medic This case report is an opportunity to question the feasibility of HFNO therapy in the prehospital setting.

Hydroxychloroquine ^

Citation Design Setting Clinical Bottom Line
Abdulrahman A, AlSayed I, AlMadhi M, AlArayed J, Mohammed SJ, Sharif AK, Alansari K, AlAwadhi AI, AlQahtani M. The Efficacy and Safety of Hydroxychloroquine in Patients with COVID-19: A Multicenter National Retrospective Cohort. Infect Dis Ther. 2021 Mar;10(1):439-455.  Retrospective Observational Other Our results showed no significant beneficial effect of using hydroxychloroquine on the outcome of patients with COVID-19. Moreover, the risk of hypoglycemia due to hydroxychloroquine would possess a significant risk  use.
Rajasingham R, Bangdiwala AS, Nicol MR, Skipper CP, Pastick KA, Axelrod ML, Pullen MF, Nascene AA, Williams DA, Engen NW, Okafor EC, Rini BI, Mayer IA, McDonald EG, Lee TC, Li P, MacKenzie LJ, Balko JM, Dunlop SJ, Hullsiek KH, Boulware DR, Lofgren SM; COVID PREP team. Hydroxychloroquine as Pre-exposure Prophylaxis for Coronavirus Disease 2019 (COVID-19) in Healthcare Workers: A Randomized Trial. Clin Infect Dis. 2021 Jun 1;72(11):e835-e843.  Randomized Control Trial Other Pre-exposure prophylaxis with hydroxychloroquine once or twice weekly did not significantly reduce laboratory-confirmed COVID-19 or COVID-19–compatible illness among healthcare workers.

Intubation/Advanced Airway  ^

Citation Design Setting Clinical Bottom Line
Szarpak L, Peacock FW, Rafique Z, Ladny JR, Nadolny K, et al. Comparison of Vie Scope® and Macintosh laryngoscopes for intubation during resuscitation by paramedics wearing personal protective equipment. Am J Emerg Med. 2022 Mar;53:122-6. Randomized Control Trial PH-Medic The use of the Vie Scope® laryngoscope in OHCA patients improved the first attempt success rate, and reduced intubation time compared to Macintosh laryngoscope in paramedics wearing PPE for against aerosol generating procedures.
Szarpak L, Peacock FW, Rafique Z, Ladny JR, Nadolny K, et al. Comparison of Vie Scope® and Macintosh laryngoscopes for intubation during resuscitation by paramedics wearing personal protective equipment. Am J Emerg Med. 2022 Mar;53:122-126. Randomized Control Trial SIM The use of the Vie Scope® laryngoscope in OHCA patients improved the first attempt success rate, and reduced intubation time compared to Macintosh laryngoscope in paramedics wearing PPE for against aerosol generating procedures. 
Edelson DP, Sasson C, Chan PS, Atkins DL, Aziz K, Becker LB, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the. Circulation 2020;141(25):e933-e943. Consensus Statement ED-MD Wear airborne PPE, limit personel, use a HEPA filter, use most experienced provider for ETI, use closed circuit AW system including suction, use mechanical compressions where possible. This document provids algorithms.
Yang WS, Hou SW, Lee BC, Chiang WC, Chien YC, Chen SY, et al. Taipei Azalea - Supraglottic airways (SGA) preassembled with high-efficiency particulate air (HEPA) filters to simplify prehospital airway management for patients with out-of-hospital cardiac arrests (OHCA) during Coronavirus Disease 2019 (COVID-19) pande. Resuscitation. Descriptive PH-Paramedic Describes a novel way to pre-attach a high-efficiency particulate air (HEPA) filters to SGA.
Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetist. Anaesthesia 2020;75(6):785-799. Guideline ED-MD Most appropriate intubator. HFNP in the non-hypoxemic is not recommended when pt is suspected COVID-19. Closed suction mandatory.  This article provides checklists.
ASPR TRACIE. (2017). EMS Infectious Disease Playbook. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Guideline PH-Paramedic Supports caution, use RSI where possible, have exhaust on.
Chen WQ, Ling WH, Lu CY, Hao YT, Lin ZN, Ling L, et al. Which preventive measures might protect health care workers from SARS? BMC Public Health 2009; 9:81. Retrospective Observational Other ETI significantly increases risk to HCW.
Cheung JC., Ho LT., Cheng JV., Cham EYK., Lam KN. Staff safety during emergency airway management for COVID-19 in Hong Kong. The Lancet Respiratory medicine 2020; 8(4):e19. Retrospective Observational/Opinion ED-MD

Endotracheal intubation is done by an expert.

We recommend avoiding bag mask ventilation for as long as possible.

Clinical management of severe acute respiratory infection when novel corona- virus (nCoV) infection is suspected [interim guidance]. Geneva: World Health Organization; 2020. Guideline ED-MD Performed by a trained and experienced provider using airborne precautions.
COVID-19 infection risk to rescuers from patients in cardiac arrest https://costr.ilcor.org/document/covid-19-infection-risk-to-rescuers-from-patients-in-cardiac-arrest Accessed: 2020-04-15. Systematic Review PH-Paramedic low/very low quality evidence: wear full PPE for AGMPs such as ETI/compressions/CPR.
Buick JE, Cheskes S, Feldman M, Verbeek PR, Hillier M, Yuen Chin Leong YC, Drennan IR. COVID-19: What Paramedics Need to Know!  CJEM 2020; 22(4): 426-30. Review PH-Paramedic Paramedics should consider early placement of an advanced airway/SGA.
Fowler RA, Guest CB, Lapinsky SE, Sibbald WJ, Louie M, Tang P, et al. Transmission of severe acute respiratory syndrome during intubation and mechanical ventilation. Am J Respir Crit Care Med 2004; 169(11):1198-202. Retrospective Observational Other Risk of developing SARS for HCWs performing endotracheal intubation (relative risk [RR], 13.29; 95% confidence interval [CI], 2.99 to 59.04; p = 0.003).
Murthy S, Gomersall CD, Fowler RA. Care for Critically Ill Patients With COVID-19. JAMA 2020. Opinion ICU Supports Airbonre precautions during procedure.
Pei LY, Gao ZC, Yang Z, Wei DG, Wang SX, Ji JM, et al. Investigation of the influencing factors on severe acute respiratory syndrome among health care workers. Beijing da xue xue bao Yi xue ban = Journal of Peking University Health sciences 2006; 38(3):271-5. Case Control
In-Patient Increased risk for health care provider and patient infection Increased risk for patient health Support room air ventilation hands sterilized by iodine gloves education double exposure suits.
Provincial Infection Control Network of British Columbia, PICNet. Respiratory Infection Outbreak Guidelines for Health Care Facilities. April 2018. Guideline ED-MD Use caution.
Raboud J, Shigayeva A, McGeer A, Bontovics E, Chapman M, Gravel D, et al. Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto, Canada. PLoS ONE 2010; 5(5):e10717, 2010. Retrospective Cohort In-Patient Increased risk for health care provider infection: close contact with the airway and failure of infection control practices to prevent exposure to respiratory secretions.
Feldman O, Samuel N, Kvatinsky N, Idelman R, Diamand R, Shavit I. Endotracheal intubation of COVID-19 patients by paramedics using a box barrier: A randomized crossover manikin study. PLoS One 2021; 16(3):e0248383. Randomized Crossover SIM Use of a box barrier during intubation did not impact first-pass success; however, total intubation time may be prolonged.
Leung KKY, Ku SW, Fung RCM, Hui WF, Au CC, Cheung WL, et al. Airway management in children with COVID-19. Hong Kong Med J 2021. Opinion ICU Bag-mask ventilation should be avoided if possible, also that bacterial and viral filters should be placed.
Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7(4):e35797. Systematic Review ICU Significant risk of HCW infection.
Verbeek PR, McClelland IW, Silverman AC, Burgess RJ. Loss of paramedic availability in an urban emergency medical services system during a severe acute respiratory syndrome outbreak. Academic emergency medicine 2004; 11(9):973-8. Descriptive Report PH-Paramedic Increased risk for health care provider and patient infection Increased risk ambulance vehicle contamination.
Wei WI, Tuen HH, Ng RW, Lam LK. Safe tracheostomy for patients with severe acute respiratory syndrome. Laryngoscope 2003; 113(10):1777-9. Case Series ICU Support: PPE Donning and Doffing; one provider along procedure.
Yang WS, Hou SW, Lee BC, Chiang WC, Chien YC, Chen SY, et al. Taipei Azalea - Supraglottic airways (SGA) preassembled with high-efficiency particulate air (HEPA) filters to simplify prehospital airway management for patients with out-of-hospital cardiac arrests (OHCA) during Coronavirus Disease 2019 (COVID-19) pandemic. Resuscitation. Retrospective  Cohort PH-Paramedic Describes a novel way to pre-attach a high-efficiency particulate air (HEPA) filters to SGA.
Çağlar A, Kaçer İ, Hacımustafaoğlu M, Öztürk B, Öztürk S. Impact of personal protective equipment on prehospital endotracheal intubation performance in simulated manikin. Australas Emerg Care. 2021 Sep;24(3):235-239.  Prospective Observational SIM PPE use is associated with increased intubation time and decreased success rate. Video laryngoscopy assistance in cases where PPE use is required facilitates faster endotracheal intubation
Gadek L, Szarpak L, Konge L, Dabrowski M, Telecka-Gadek D, Maslanka M, Drela WL, Jachowicz M, Iskrzycki L, Bialka S, Peacock FW, Smereka J. Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial. J Clin Med. 2021 Dec 8;10(24):5740.  Randomized Cross Over SIM The McGrath videolaryngoscope appears to possess significant advantages over the Macintosh direct laryngoscope when used by paramedics in suspected or confirmed COVID-19 intubation scenarios.
Sanfilippo F, Tigano S, La Rosa V, Morgana A, Murabito P, Oliveri F, Longhini F, Astuto M. Tracheal intubation while wearing personal protective equipment in simulation studies: a systematic review and meta-analysis with trial-sequential analysis. Braz J Anesthesiol. 2022 Mar-Apr;72(2):291-301.  Systematic Review and Meta-Analysis PH-Medic The success rate of tracheal intubation was not influenced by PPE.
Hawkins A, Stapleton S, Rodriguez G, Gonzalez RM, Baker WE. Emergency Tracheal Intubation in Patients with COVID-19: A Single-center, Retrospective Cohort Study. West J Emerg Med. 2021 May 17;22(3):678-686. Retrospective Observational ED-MD An average twofold increase in the rate of tracheal intubation was observed after March 24, 2020, corresponding with an influx of COVID-19 positive cases.
Leung KKY, Ku SW, Fung RCM, Hui WF, Au CC, Cheung WL, Szeto WH, Wong JCP, Kwan KF, Hon KL. Airway management in children with COVID-19. Hong Kong Med J. 2021 Mar 10. Opinion ED-MD This study's  novel approach provides a framework for airway management that could benefit paediatric critical care practitioners who provide care for any children with a novel viral illness, with a focus on infection prevention during high-risk airway management procedures.

Manual BVM (no advanced airway)  ^

Citation Design Setting Clinical Bottom Line
Cheung JC., Ho LT., Cheng JV., Cham EYK., Lam KN. Staff safety during emergency airway management for COVID-19 in Hong Kong. The Lancet Respiratory medicine 2020;8(4):e19. Retrospective Observational/Opinion ED-MD We recommend avoiding bag mask ventilation for as long as possible. We recommend avoiding bag mask ventilation for as long as possible.
COVID-19 infection risk to rescuers from patients in cardiac arrest https://costr.ilcor.org/document/covid-19-infection-risk-to-rescuers-from-patients-in-cardiac-arrest Accessed: 2020-04-15. Systematic Review PH-Paramedic Use 2 handed technique with a good seal.
Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7(4):e35797. Systematic Review ICU Sig risk for HCW infection.

Medical Communication Centre Triage/Screening  ^

Citation Design Setting Clinical Bottom Line
Chou E, Hsieh YL, Wolfshohl J, Green F, Bhakta T. Onsite telemedicine strategy for coronavirus (COVID-19) screening to limit exposure in ED. Emerg Med J 2020;37(6):335-337. Descriptive ED-MD The implementation of telemedicine can be a promising protocol in making ED care more cost-effective and efficient.
Dami F, Berthoz V. Lausanne medical dispatch centre's response to COVID-19. Scand J Trauma Resusc Emerg Med 2020;28(1):37. Descriptive PH- Paramedic A non-emergency medical dispatch and specific help lines may save your dispatch from drowning; protect your staff; have a B plan (such as deported-based dispatch); and maintain protocols for downgrading your response.
Goyal M, Ospel JM, Southerland AM, Wira C, Amin-Hanjani S, Fraser JF, et al. Prehospital Triage of Acute Stroke Patients During the COVID-19 Pandemic. Stroke 2020;51(7):2263-2267. Position Statement PH-Paramedic Provides a conceptual framework for acute stroke patient triage and transfer during the COVID-19.
Hollander JE, Carr BG. Virtually Perfect? Telemedicine for Covid-19. N Engl J Med 2020;382(18):1679-1681. Opinion Paper
Other Telemedicine is well suited for scenarios in which infrastructure remains intact and clinicians are available to see patients.
Lin CH, Tseng WP, Wu JL, Tay J, Cheng MT, Ong HN, et al. A Double Triage and Telemedicine Protocol to Optimize Infection Control in an Emergency Department in Taiwan During the COVID-19 Pandemic: Retrospective Feasibility Study. J Med Internet Res 2020;22(6):e20586. Descriptive ED-MD The implementation of the double triage and telemedicine protocol in the ED during the COVID-19 pandemic has high potential to improve infection control.
Maves RC, Downar J, Dichter JR, Hick JL, Devereaux A, Geiling JA, et al. Triage of Scarce Critical Care Resources in COVID-19 An Implementation Guide for Regional Allocation: An Expert Panel Report of the Task Force for Mass Critical Care and the American College of Chest Physicians. Chest 2020; 158(1):212-225. Guideline ED-MD This article discusses the principles of tertiary triage and methods for implementing such a system.
Marincowitz C, Stone T, Bath P, Campbell R, Turner JK, Hasan M, et al. Accuracy of telephone triage for predicting adverse outcomes in suspected COVID-19: an observational cohort study. BMJ Qual Saf. 2022 Mar 30:bmjqs-2021-014382. Prospective Observational PH-Medic Patients advised to self-care or receive nonurgent clinical assessment had a small but non-negligible risk of serious clinical deterioration. Repeat contact with telephone services needs recognition as an important predictor of subsequent adverse outcomes.
Marincowitz C, Sutton L, Stone T, Pilbery R, Campbell R, et al. Prognostic accuracy of triage tools for adults with suspected COVID-19 in a prehospital setting: an observational cohort study. Emerg Med J. 2022 Apr;39(4):317-324. Retrospective Cohort PH-Medic Use of NEWS2, PMEWS, PRIEST tool and WHO algorithm could improve sensitivity of EMS triage of patients with suspected COVID-19 infection. Use of the PRIEST tool would improve sensitivity of triage without increasing the number of patients conveyed to hospital.
Flores S, Gavin N, Romney ML, Tedeschi C, Olsen E, Heravian A, et al. COVID-19: New York City pandemic notes from the first 30 days. Am J Emerg Med 2020; 38(7):1534-1535. Descriptive ED-MD Telemedicine has also allowed us to extend our footprint of care into the home, through a follow-up program involving video visits. Concerns about exposure risk were high amongst our providers, and an emphasis on PPE and supplies has been paramount.
Jaffe E, Strugo R, Bin E, Blustein O, Rosenblat I, Alpert EA, et al. The role of emergency medical services in containing COVID-19. Am J Emerg Med 2020;38(7):1526-1527. Letter to Editor
PH-Paramedic Maximizing EMS during a pandemic by carrying out phone triage, home testing, and drive-in testing significantly decreases visits to physicians' offices and hospitals.
Anhang Price R, Fagbuyi D, Harris R, Hanfling D, Place F, Taylor TB, et al. Feasibility of web-based self-triage by parents of children with influenza-like illness: a cautionary tale. JAMA pediatrics 2013; 167(2):112-8. Prospective Validation Other Feasible but needed to improve its specificity without compromising patient safety.
ASPR TRACIE. (2017). EMS Infectious Disease Playbook. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Guildline PH-Paramedic Supports dispatch screening.
Challen K, Goodacre SW, Wilson R, Bentley A, Campbell M, Fitzsimmons C, et al. Evaluation of triage methods used to select patients with suspected pandemic influenza for hospital admission. EMJ 2012; 29(5):383-8. Prospective Cohort Study ED-MD Method did not reliably discriminate between patients with good and poor outcomes.
Clancy T, Neuwirth C, Bukowski G. Lessons learned in implementing a 24/7 public health call center in response to H1N1 in the state of New Jersey. American journal of disaster medicine 2009; 4(5):253-60. Retrospective Observational Other Feasible.
Clinical management of severe acute respiratory infection when novel corona- virus (nCoV) infection is suspected [interim guidance]. Geneva: World Health Organization; 2020. Guideline Other Supports screening.
Buick JE, Cheskes S, Feldman M, Verbeek PR, Hillier M, Yuen Chin Leong YC, Drennan IR. COVID-19: What Paramedics Need to Know!  CJEM 2020; 22(4): 426-30. Review PH-Paramedic Supports comms pre-screen.
Dami F, Berthoz V. Lausanne medical dispatch centre's response to COVID-19. Scand J Trauma Resusc Emerg Med 2020; 28(1):37. Opinion PH-Paramedic A non-emergency medical dispatch and specific help lines may save your dispatch from drowning; protect your staff; have a B plan (such as deported-based dispatch); and maintain protocols for downgrading your response.
Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With the Guidelines®-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists: Supporting Organizations: American Association of Critical Care Nurses and National EMS Physicians [published online ahead of print, 2020 Apr 9]. Circulation. 2020;10.1161/CIRCULATIONAHA.120.047463.   Guideline ED-MD For EMS, telecommunicators should alert dispatched EMS teams to don PPE if there is any suspicion for COVID-19 infection.
Eppes CS, Garcia PM, Grobman WA. Telephone triage of influenza-like illness during pandemic 2009 H1N1 in an obstetric population. Obstet Gynecol 2012; 207(1):3-8. Prospective Observational Other This triage system improved efficiency of resource utilization without incurring apparent influenza-like illness morbidity.
Espino JU, Hogan WR, Wagner MM. Telephone triage: a timely data source for surveillance of influenza-like diseases. AMIA Annual Symposium proceedings AMIA Symposium 2003:215-9. Prospective Observational ED-MD Emergency room TT calls are one to five weeks ahead of surveillance data collected by the CDC.
Fagbuyi DB, Brown KM, Mathison DJ, Kingsnorth J, Morrison S, Saidinejad M, et al. A rapid medical screening process improves emergency department patient flow during surge associated with novel H1N1 influenza virus. Ann Emerg Med 2011; 57(1):52-9. Prospective Observational ED-MD Associated with improved patient flow without affecting rates of return to the ED within 48 hours or 7 days.
Foo CL, Tham KY, Seow E. Evolution of an emergency department screening questionnaire for severe acute respiratory syndrome. Academic emergency medicine 2004;11(2):156-61. Prospective Observational ED-MD Keeping it relatively simple, user-friendly, and regularly updated, nurses were able to screen patients rapidly.
Goodacre S, Irving A, Wilson R, Beever D, Challen K. The PAndemic INfluenza Triage in the Emergency Department (PAINTED) pilot cohort study. Health Technol Assess 2015; 19(3):v-xxi, 1. Prospective Cohort Study ED-MD A standardised assessment form is acceptable to clinicians and could be used to collect research data in an influenza pandemic, but analysis may be limited by missing data.
Goyal M, Ospel JM, Southerland AM, Wira C, Amin-Hanjani S, Fraser JF, et al. Prehospital Triage of Acute Stroke Patients During the COVID-19 Pandemic. Stroke 2020; 51(7):2263-7. Position Paper PH-Pararmedic Provides a conceptual framework for acute stroke patient triage and transfer during the COVID-19.
Kaposy C, Bandrauk N, Pullman D, Singleton R, Brunger F. Adapting the Hamilton Health Sciences critical care pandemic triage protocol. Healthc Q. 2010;13(2):60–63.   Report Other Discusses planning.
Koenig KL, Beÿ CK, McDonald EC. 2019-nCoV: The Identify-Isolate-Inform (3I) Tool Applied to a Novel Emerging Coronavirus. The western journal of emergency medicine 2020; 21(2):184-190. Review PH-Paramedic Feasible.
Smith EC, Burkle FM, Holman PF, Dunlop JM, Archer FL. Lessons from the front lines: the prehospital experience of the 2009 novel H1N1 outbreak in Victoria, Australia. Disaster medicine and public health preparedness 2009; 3(S2):S154-9. Report PH-Paramedic Current guidelines regarding PPE use are adequate. Compliance with PPE needs to be addressed through the use of intra-agency communications and regular information updates.
Haimovich AD, Ravindra NG, Stoytchev S, Young HP, Wilson FP, Dijk D, Schulz WL, Taylor A. Development and Validation of the Quick COVID-19 Severity Index: A Prognostic Tool for Early Clinical Decompensation. Ann Emerg Med. 2020;76(4):442–453. Retrospective Observational Other Quick COVID-19 Severity Index predicts 24-hour respiratory decompensation.
Mitra B, Luckhoff C, Mitchell RD, O'Reilly GM, Smit DV, Cameron PA. Temperature screening has negligible value for control of COVID-19. Emerg Med Australas. 2020; 32(5):867-869 Retrospective Observational Other Screening for fever lacks sensitivity for detecting COVID-19.
Cavanagh N, Tavares W, Taplin J, Hall C, Weiss D, Blanchard I. A rapid review of pandemic studies in paraMed. Australasian J of ParaMed 2020; 17:1-12. Rapid Review PH-Paramedic This rapid review identified 24 citations related to pandemics and paramedicine that incorporated five broad themes,including: general planning and preparedness, workforce,
ethics, triage, and vaccination.
Candel BGJ, Vaes SMM, van Bree EM, Groenen SMA, Derkx F, Mignot LAA, et al. Telemedicine in the emergency department to decrease personal protective equipment use: a before-and-after study. Emerg Med J 2021; 38(3):224-8. Before & After ED-MD PPE use by physicians can successfully
Zhang J, Zhou L, Yang Y, Peng W, Wang W, Chen X. Therapeutic and triage strategies for 2019 novel coronavirus disease in fever clinics. Lancet Respir Med 2020; 8(3):e11–e12. Retrospective Cohort OR Supports: triaging using fever status.
Bourn SS, Crowe RP, Fernandez AR, Matt SE, Brown AL, Hawthorn AB, Myers JB. Initial prehospital Rapid Emergency Medicine Score (REMS) to predict outcomes for COVID-19 patients. J Am Coll Emerg Physicians Open. 2021 Jun 29;2(4):e12483.  Retrospective PH-Medic Initial prehospital REMS was modestly predictive of ED and hospital dispo-sitions for patients with COVID-19.
Eggleton EJ. Simple, fast and affordable triaging pathway for COVID-19. Postgrad Med J. 2021 Mar;97(1145):192-195. Opinion ED-MD A succinct triaging pathway that aims to be fast, reliable and affordable is presented.
Ehni HJ, Wiesing U, Ranisch R. Saving the most lives-A comparison of European triage guidelines in the context of the COVID-19 pandemic. Bioethics. 2021 Feb;35(2):125-134. Review Other This study provides a detailed overview on the ethical elements of the recommendations.
Jensen T, Holgersen MG, Jespersen MS, Blomberg SN, Folke F, Lippert F, Christensen HC. Strategies to Handle Increased Demand in the COVID-19 Crisis: A Coronavirus EMS Support Track and a Web-Based Self-Triage System. Prehosp Emerg Care. 2021 Jan-Feb;25(1):28-38. Cross-Sectional PH-Medic The web triage was widely used but no significant correlation was seen with 1813 medical helpline call volume.
Spangler D, Blomberg H, Smekal D. Prehospital identification of Covid-19: an observational study. Scand J Trauma Resusc Emerg Med. 2021 Jan 6;29(1):3.  Descriptive PH-Medic Prehospital suspicion should not be relied upon as a single factor to rule out the need for isolation precautions.
Tu Y, Zhou X, Shao L, Zheng J, Wang J, Wang Y, Tong W, Wang M, Wu J, Zhu J, Yan R, Ji Y, Chen L, Zhu D, Wang H, Chen S, Liu R, Lin J, Zhang J, Huang H, Zhao Y, Ge M. Predicting Progression of COVID-19 Infection to Prioritize Medical Resource Allocation: A Novel Triage Model Based on Patient Characteristics and Symptoms at Presentation. Front Public Health. 2021 May 11;9:610280.  Retrospective Observational Other Men, increased age, fever, hypertension, cardio-cerebrovascular disease, dyspnea, cough, and myalgia are independent risk factors for disease progression. This study describes a novel triage aid.
McCann-Pineo M, Li T, Barbara P, Levinsky B, Debono J, Berkowitz J. Utility of Emergency Medical Dispatch (EMD) Telephone Screening in Identifying COVID-19 Positive Patients. Prehosp Emerg Care. 2021 Jul 12:1-10. Retrospective Observational PH-Medic The sensitivity of the EMD telephonic screening process was moderately able to identify COVID-19 positive patients.
Ornaghi S, Callegari C, Milazzo R, La Milia L, Brunetti F, Lubrano C, Tasca C, Livio S, Savasi VM, Cetin I, Vergani P. Performance of an extended triage questionnaire to detect suspected cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in obstetric patients: Experience from two large teaching hospitals in Lombardy, Northern Italy. PLoS One. 2020 Sep 15;15(9):e0239173. Prospective Observatonal In-Patient An exhaustive triage questionnaire can effectively discriminate women at low risk of SARS-CoV-2 infection

Oxymetry Monitoring  ^

Citation Design Setting Clinical Bottom Line
Jouffroy R, Jost D, Prunet B. Prehospital pulse oximetry: a red flag for early detection of silent hypoxemia in COVID-19 patients. Crit Care 2020; 24(1):313. Retrospective Observational PH-Paramedic Prehospital pulse oximetry might be used as a red flag for early detection of “silent hypoxemia” in COVID-19 patients.
Jouffroy R, Lemoine S, Derkenne C, Kedzierewicz R, Scannavino M, Bertho K, et al. Prehospital management of acute respiratory distress in suspected COVID-19 patients. Am J Emerg Med 2020.
Observational PH-MD/CCT   Pulse oxymetry might be a valuable marker for rapidly determining
suspected COVID-19-patients requiring prehospital mechanical ventilation.
Colombo C, Albani A, Banfi F, Maltana MA, Meroni L, Villa P, Brambilla AM. Using vital signs measurements to identify patients with COVID-19 who require early continuous positive airway pressure. Emerg Nurse. 2022 Jan 4;30(1):25-31. Retrospective Observtional ED-MD The authors have devised a triage flow chart that uses selected vital signs measurements (oxygen saturation, respiratory rate and receipt of pre-hospital oxygen therapy) to identify patients requiring early CPAP.

POCUS ^

Citation Design Setting Clinical Bottom Line
Sorlini C, Femia M, Nattino G, Bellone P, Gesu E, Francione P, Paternò M, Grillo P, Ruffino A, Bertolini G, Cariati M, Cortellaro F; Fenice Network (Italian Group for Clinical Research in Emergency Medicine). The role of lung ultrasound as a frontline diagnostic tool in the era of COVID-19 outbreak. Intern Emerg Med. 2021 Apr;16(3):749-756.  Retrospective ED-MD Lung POCUS is a sensitive frst-line screening tool for ED patients presenting with symptoms suggestive of SARS-CoV-2 infection.

PPE/Clinician Safety  ^

Citation Design Setting Clinical Bottom Line
Hussein K, Shachor-Meyouhas Y, Dabaja-Younis H, Szwarcwort-Cohen M, et al. COVID-19: Healthcare Workers May Be at Greater Risk Outside Their Work Environment-A Retrospective Observational Study. Rambam Maimonides Med J. 2022 Apr 26;13(2):e0011. Retrospective Observational ED The low percentage of asymptomatic COVID-19 among our HCW may reflect the high compliance to personal protective equipment use despite treating hundreds of COVID-19 patients. 
Smith LE, Serfioti D, Weston D, Greenberg N, Rubin GJ. Adherence to protective measures among healthcare workers in the UK: a cross-sectional study. Emerg Med J. 2022 Feb;39(2):100-5. Cross-Sectional Survey Other Uptake of personal protective behaviours among UK HCWs at the start of the pandemic was variable.
Cekmen B, Bildik B, Bozan O, Atis SE, Koksal M, Uzuncu HB, Akilli NB. Chest compression quality during CPR of potential contagious patients wearing personal protection equipment. Am J Emerg Med. 2022 Feb;52:128-31.  SIM PH-Medic Changing the rescuer every 1 min instead of every 2 min while performing CPR with full PPE may prevent the decrease in compression quality that may occur as the resuscitation time gets longer.
Szarpak L, Peacock FW, Rafique Z, Ladny JR, Nadolny K, et al. Comparison of Vie Scope® and Macintosh laryngoscopes for intubation during resuscitation by paramedics wearing personal protective equipment. Am J Emerg Med. 2022 Mar;53:122-6.  Randomized Control Trial PH-Medic The use of the Vie Scope® laryngoscope in OHCA patients improved the first attempt success rate, and reduced intubation time compared to Macintosh laryngoscope in paramedics wearing PPE for against aerosol generating procedures.
Alabdali A, Almakhalas K, Alhusain F, Albaiz S, Almutairi K, Aljerian N. The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Outbreak at King Abdul-Aziz Medical City-Riyadh from Emergency Medical Services Perspective. Prehosp Disaster Med 2020; 35(4):457-461. Descriptive PH-Paramedic Highlights importance of training, education and
infection control procedures.
Díaz-Guio DA, Ricardo-Zapata A, Ospina-Velez J, Gómez-Candamil G, Mora-Martinez S, Rodriguez-Morales AJ. Cognitive load and performance of health care professionals in donning and doffing PPE before and after a simulation-based educational intervention and its implications during the COVID-19 pandemic for biosafety. Infez Med 2020;28:111-117. Observational SIM Training in donning and doffing may reduce cognitive load on staff.
Garcia-Castrillo L, Petrino R, Leach R, Dodt C, Behringer W, Khoury A, et al. European Society For Emergency Medicine position paper on emergency medical systems' response to COVID-19. Eur J Emerg Med 2020;27(3):174-177. Position Statement ED-MD The risk of contagion and transmission of the health professionals adds a substantial burden to their daily work.
Germonpre P, Van Rompaey D, Balestra C. Evaluation of Protection Level, Respiratory Safety, and Practical Aspects of Commercially Available Snorkel Masks as Personal Protection Devices Against Aerosolized Contaminants and SARS-CoV2. Int J Environ Res Public Health 2020;17(12). SIM Other Snorkel masks may be an effective substitue for standard masks.
Barnicle R, Bracey A, Zahid B, Davic A, Weingart S. Prioritising intubator safety in a pandemic: the details matter. Emerg Med J 2021; 38(3):217-9. Guideline ED-MD Use of a detailed checklist and buddy system for intubation maximizes provider safety without sacrificing first-pass success.
Cavanagh N, Tavares W, Taplin J, Hall C, Weiss D, Blanchard I. A rapid review of pandemic studies in paraMed. Australasian J of ParaMed 2020; 17:1-12. Rapid Review PH-Paramedic This rapid review identified 24 citations related to pandemics and paramedicine that incorporated five broad themes,including: general planning and preparedness; workforce;
ethics; triage; and vaccination.
Lemoine S, Chabernaud JL, Travers S, Prunet B. COVID-19 in pediatric patients: What the prehospital teams need to know. Arch Pediatr 2020;27(5):281-282. Descriptive PH-Paramedic Prehospital teams who take care of children with symptoms that may be caused by COVID-19, and do not require hospital treatment, should leave the child at home with instructions for the parents.
Poonia SK, Rajasekaran K. Information Overload: A Method to Share Updates among Frontline Staff during the COVID-19 Pandemic. Otolaryngol Head Neck Surg 2020;163(1):60-62. Descriptive PH-Paramedic The quicksheet has been a beneficial tool to distill and organize the most important and relevant information for frontline staff.
Sonis JD, Black L, Baugh J, Benzer TI, Hayes BD, Raja AS, et al. Leveraging existing quality improvement communication strategies during the COVID-19 crisis. Am J Emerg Med 2020;38(7):1523-1524. Descriptive ED-MD Leveraging existing Q&S infrastructure and communication tools has been critical in keeping frontline staff informed and has led to a supportive environment.
Tang O, Bigelow BF, Katz MJ. Earlier and widespread screening for SARS-CoV-2 is needed for first responders. Am J Emerg Med 2020. Observational   PH-Paramedic Active monitoring of first responders is an important component.
Pickkers P, van der Hoeven H, Citerio G. COVID-19: 10 things I wished I'd known some months ago. Intensive Care Med 2020; 46(7):1449-1452. Opinion ICU This viewpoint addresses 10 points that may be of interest both the logistics, as well as actual clinical care of critically ill COVID-19 patients.
Bartoszko JJ, Farooqi MAM, Alhazzani W, Loeb M. Medical Masks vs N95 Respirators for Preventing COVID-19 in Health Care Workers A Systematic Review and Meta-Analysis of Randomized Trials [published online ahead of print, 2020 Apr 4]. Influenza Other Respir Viruses. 2020;10.1111/irv.12745.   Systematic Review Other Low certainty: N-95 for high risk or AGMPs, otherwise surg msk is no worse.
Chen WQ, Ling WH, Lu CY, Hao YT, Lin ZN, Ling L, et al. Which preventive measures might protect health care workers from SARS? BMC Public Health 2009; 9:81. Retrospective Observational Other Supports PPE and avoiding face to face contact with confirmed cases.
Clinical management of severe acute respiratory infection when novel corona- virus (nCoV) infection is suspected [interim guidance]. Geneva: World Health Organization; 2020. Guideline In-Patient Use PPE (medical mask, eye protection, gloves and gown).
Cook TM. Personal protective equipment during the COVID-19 pandemic - a narrative review [published online ahead of print, 2020 Apr 4]. Anaesthesia. 2020; 10.1111/anae.15071. Review Other Fitted high filtration mask for AGMPs. Uncertainty remains around certain details of personal protective equipment including use of hoods, mask type and the potential for re-use of equipment.
COVID-19 infection risk to rescuers from patients in cardiac arrest https://costr.ilcor.org/document/covid-19-infection-risk-to-rescuers-from-patients-in-cardiac-arrest Accessed: 2020-04-15. Systematic Review PH-Paramedic Low/very low quality evidence: use PPE, consider defib “is reasonable” before donning more PPE, wear full PPE for AGMPs such as compressions/CPR.
Buick JE, Cheskes S, Feldman M, Verbeek PR, Hillier M, Yuen Chin Leong YC, Drennan IR. COVID-19: What Paramedics Need to Know!  CJEM 2020; 22(4): 426-30. Review PH-Paramedic When no interventions are performed, paramedics providing care or who are in close proximity to the patient should wear a surgical type mask, gown, gloves and eye protection, either goggles or a face shield.
Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With the Guidelines®-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists: Supporting Organizations: American Association of Critical Care Nurses and National EMS Physicians [published online ahead of print, 2020 Apr 9]. Circulation.   Guideline ED-MD PPE to guard against contact with both airborne and droplet particles, Limit personnel.
Germonpre P, Van Rompaey D, Balestra C. Evaluation of Protection Level, Respiratory Safety, and Practical Aspects of Commercially Available Snorkel Masks as Personal Protection Devices Against Aerosolized Contaminants and SARS-CoV2. Int J Environ Res Public Health 2020; 17(12). Prospective Observational Other Snorkel masks may be an effective substitue for standard masks.
Grasselli G, Pesenti A, Cecconi M. Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. JAMA 2020. Opinion ICU Supports isolation of positive patients.
Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. Updated March 10, 2020. Guideline ED-MD HCP in the room should wear an N95 or higher-level respirator such as disposable filtering facepiece respirators, PAPRs, and elastomeric respirators, eye protection, gloves, and a gown.
Ko PC, Chen WJ, Ma MH, Chiang WC, Su CP, Huang CH, et al. Emergency medical services utilization during an outbreak of severe acute respiratory syndrome (SARS) and the incidence of SARS-associated coronavirus infection among emergency medical technicians. Academic emergency medicine 2004; 11(9):903-11. Prospective Observational PH-Paramedic Despite use of PPE the incidence of P-SARS among all 322 EMTs was 0.6% (2/322; 95% CI = 0.2% to 2.2%) and the mortality rate was 0.3% (1/322; 95% CI = 0.1% to 1.7%).
Lemoine S, Chabernaud JL, Travers S, Prunet B. COVID-19 in pediatric patients: What the prehospital teams need to know. Arch Pediatr 2020; 27(5):281-2. Opinion PH-Paramedic prehospital teams who take care of children with symptoms that may be caused by COVID-19, and do not require hospital treatment, should leave the child at home with instructions for the parents.
Loeb M, McGeer A, Henry B, Ofner M, Rose D, Hlywka T, et al. SARS among critical care nurses, Toronto. Emerg Infect Dis. 2004; 10(2):251-5. Retrospective Observational ICU Risk was lower with consistent use of a N95 mask than with consistent use of a surgical mask.
Murthy S, Gomersall CD, Fowler RA. Care for Critically Ill Patients With COVID-19. JAMA 2020. Opinion ICU Supports isolating postive patients.
Pei LY, Gao ZC, Yang Z, Wei DG, Wang SX, Ji JM, et al. Investigation of the influencing factors on severe acute respiratory syndrome among health care workers. Beijing da xue xue bao Yi xue ban = Journal of Peking University Health sciences 2006; 38(3):271-5. Case Control In-Patient gloves (OR=0.102), hands sterilized by iodine (OR=0.231), room air ventilation (OR=0.32), were significantly protective; conversely, tracheal intubation (OR=30.793) was a significant risk factor.
PHAC. Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care Settings, 2017. Guideline PH-Paramedic Facial protection (i.e., masks and eye protection, or face shields, or masks with visor attachment).
Pickkers P, van der Hoeven H, Citerio G. COVID-19: 10 things I wished I'd known some months ago. Intensive Care Med 2020; 46(7):1449-52. Opinion ICU This viewpoint addresses 10 points that may be of interest both the logistics, as well as actual clinical care of critically ill COVID-19 patients.
Poonia SK, Rajasekaran K. Information Overload: A Method to Share Updates among Frontline Staff during the COVID-19 Pandemic. Otolaryngol Head Neck Surg 2020; 163(1):60-2. Opinion PH-Paramedic The quicksheet has been a beneficial tool to distill and organize the most important and relevant information for frontline staff.
Provincial Infection Control Network of British Columbia, PICNet. Respiratory Infection Outbreak Guidelines for Health Care Facilities. April 2018. Guideline ED-MD Ensure that staff members have quick and easy access to the PPE and cleaning products required when providing care.
Smith EC, Burkle FM, Holman PF, Dunlop JM, Archer FL. Lessons from the front lines: the prehospital experience of the 2009 novel H1N1 outbreak in Victoria, Australia. Disaster medicine and public health preparedness 2009; 3(S2):S154-9. Report PH-Paramedic Current guidelines regarding PPE use are adequate for use during an outbreak of infectious disease.
Sonis JD, Black L, Baugh J, Benzer TI, Hayes BD, Raja AS, et al. Leveraging existing quality improvement communication strategies during the COVID-19 crisis. Am J Emerg Med 2020; 38(7):1523-4. Opinion ED-MD Leveraging existing Q&S infrastructure and communication tools has been critical in keeping frontline staff informed and has led to a supportive environment.
Tang O, Bigelow BF, Katz MJ. Earlier and widespread screening for SARS-CoV-2 is needed for first responders. Am J Emerg Med 2020. Opinion PH-Paramedic Active monitoring of first responders is an important component.
Teleman MD, Boudville IC, Heng BH, Zhu D, Leo YS. Factors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore. Epidemiology & Infection 2004; 132(5):797-803. Case Control In-Patient Both hand washing (adjusted OR 0.07, 95 % CI 0.008-0.66, P=0.02) and wearing of N95 masks (adjusted OR 0.1, 95% CI 0.02-0.86, P=0.04) remained strongly protective but gowns and gloves had no effect.
Verbeek PR, McClelland IW, Silverman AC, Burgess RJ. Loss of paramedic availability in an urban emergency medical services system during a severe acute respiratory syndrome outbreak. Academic emergency medicine 2004; 11(9):973-8. Descriptive Report PH-Paramedic The primary reason for quarantine was unprotected exposure to a health care institution experiencing a SARS outbreak. suggests a dedicated paramedic surveillance and quarantine program.
Visentin LM, Bondy SJ, Schwartz B, Morrison LJ. Use of personal protective equipment during infectious disease outbreak and nonoutbreak conditions: a survey of emergency medical technicians. CJEM 2009; 11(1):44-56. Survey PH-Paramedic Personal protective equipment is not consistently employed as per medical directives. Reasons given for non-use included non-availability, judgment of non-necessity or technical difficulties.
Cash RE, Rivard MK, Camargo CA Jr, Powell JR, Panchal AR. Emergency Medical Services Personnel Awareness and Training about Personal Protective Equipment during the COVID-19 Pandemic. Prehosp Emerg Care. 2021 Nov-Dec;25(6):777-784. Cross- Sectional PH-Medic CDC guidance on COVID-19 for EMS may have increased N95 fit testing and training, but there remain substantial gaps in training on PPE use among EMS personnel.
Grant M, Harrison R, Nuñez A, Kurtz T, Phelps S, Brokaw J, Shusterman D. Seroprevalence of SARS-CoV-2 Among Firefighters/Paramedics in San Francisco, CA. J Occup Environ Med. 2021 Nov 1;63(11):e807-e812. Cross- Sectional PH-Medic Safe workplace practices, community public health intervention, and low community infection rates appear to have been protective factors for emergency responders in San Francisco during our study period.
Jespersen S, Mikkelsen S, Greve T, Kaspersen KA, Tolstrup M, Boldsen JK, Redder JD, Nielsen K, Abildgaard AM, Kolstad HA, Østergaard L, Thomsen MK, Møller HJ, Erikstrup C. Severe Acute Respiratory Syndrome Coronavirus 2 Seroprevalence Survey Among 17 971 Healthcare and Administrative Personnel at Hospitals, Prehospital Services, and Specialist Practitioners in the Central Denmark Region. Clin Infect Dis. 2021 Nov 2;73(9):e2853-e2860. Prospective Cohort PH-Medic We found large differences in the prevalence of SARS-CoV-2 antibodies in staff working in the healthcare sector within a small geographical area of Denmark.
McKinnon JE, Wang DD, Zervos M, Saval M, Marshall-Nightengale L, Kilgore P, Pabla P, Szandzik E, Maksimowicz-McKinnon K, O'Neill WW. Safety and tolerability of hydroxychloroquine in health care workers and first responders for the prevention of COVID-19: WHIP COVID-19 Study. Int J Infect Dis. 2022 Mar;116:167-173. Randomized Placebo-Controlled Trial PH-Medic This  trial was able to demonstrate the safety of HCQ out-patient chemoprophylaxis in high-risk groups against COVID-19.
Mendola M, Tonelli F, Garletti FS, Greco D, Fiscella M, Cucchi I, Costa MC, Carrer P. COVID-19 impact and vaccine effectiveness among healthcare workers of a large University Hospital in Lombardy, Italy. Med Lav. 2021 Dec 23;112(6):453-464. Case Series PH-Medic HCWs have been at high risk of COVID-19 infection. Male sex and advanced age appear to be predisposing factor and negative prognostic factor respectively. An out-of-hospital setting appears to be the main source of COVID-19 confirming that the correct use of protective devices during work counters the risk of infection. Vaccination seems to reduce both documented cases of infection and severe illness.
Montague BT, Wipperman MF, Hooper AT, Hamon SC, Crow R, Elemo F, Hersh L, Langdon S, Hamilton JD, O'Brien MP, Simões EAF. Anti-SARS-CoV-2 IgA Identifies Asymptomatic Infection in First Responders. J Infect Dis. 2022 Feb 15;225(4):578-586. Longitudinal Serosurvey PH-Medic First responders are at high risk of infection with SARS-CoV-2. IgA testing identified a significant portion of cases missed by IgG testing and its use as part of serologic surveys may improve retrospective identification of asymptomatic infection.
Vieira V, Tang IW, Bartell S, Zahn M, Fedoruk MJ. SARS-CoV-2 antibody seroprevalence among firefighters in Orange County, California. Occup Environ Med. 2021 Nov;78(11):789-792.  Serosurvey Other Using a strong serosurvey design and large firefighter cohort, we observed a SARS-CoV-2 IgG seroprevalence of 5.3%. The seroprevalence among OC firefighters in October 2020 was lower than the general county population estimated seroprevalence (11.5%) in August.  
Agarwal A, Ranjan P, Saraswat A, Kasi K, Bharadiya V, Vikram N, Singh A, Upadhyay AD, Baitha U, Klanidhi KB, Chakrawarty A. Are health care workers following preventive practices in the COVID-19 pandemic properly? - A cross-sectional survey from India. Diabetes Metab Syndr. 2021 Jan-Feb;15(1):69-75.  Cross-Sectional Other Suboptimal compliance in preventive practices like handling PPE, distancing in cafeteria/duty rooms and hand hygiene is not uncommon in HCWs.
Brown A, Schwarcz L, Counts CR, Barnard LM, Yang BY, Emert JM, Latimer A, Drucker C, Lynch J, Kudenchuk PJ, Sayre MR, Rea T. Risk for Acquiring Coronavirus Disease Illness among Emergency Medical Service Personnel Exposed to Aerosol-Generating Procedures. Emerg Infect Dis. 2021 Sep;27(9):2340-2348. Retrospective Observational PH-Medic We observed a very low risk for COVID-19 infection attributable to patient encounters among EMS first responders.
Griswold DP, Gempeler A, Kolias A, Hutchinson PJ, Rubiano AM. Personal protective equipment for reducing the risk of COVID-19 infection among health care workers involved in emergency trauma surgery during the pandemic: An umbrella review. J Trauma Acute Care Surg. 2021 Apr 1;90(4):e72-e80. Systematic Review OR The use of PPE drastically reduces the risk of COVID-19 compared with no mask use in health care workers. N95 and equivalent respirators provide more protection than surgical masks.
Kienbacher CL, Grafeneder J, Tscherny K, Krammel M, Fuhrmann V, Niederer M, Neudorfsky S, Herbich K, Schreiber W, Herkner H, Roth D. The use of personal protection equipment does not impair the quality of cardiopulmonary resuscitation: A prospective triple-cross over randomised controlled non-inferiority trial. Resuscitation. 2021 Mar;160:79-83.  Randomized Control Trial PH-Medic PPE including masks with and without expiration valve is safe for use without concerns regarding the impairment of CPR quality.
Rivard L, Pester J, McMahon K, Check R, Kelly B, Balakrishnan V, Jeanmonod D, Jeanmonod R. The efficacy of continuous use disposable N95 masks in clinical practice in the emergency department. Am J Emerg Med. 2021 Jun;44:124-127.  Prospective Observational ED-MD Continuous use of disposable N95s throughout an ED shift is reasonable during a PPE shortage
Sadeghi M, Saberian P, Hasani-Sharamin P, Dadashi F, Babaniamansour S, Aliniagerdroudbari E. The Possible Factors Correlated with The Higher Risk of Getting Infected by COVID-19 in Emergency Medical Technicians; A Case-Control Study. Bull Emerg Trauma. 2021 Apr;9(2):67-72. Retrospective Observational PH-Medic We found that the type and method of use of PPE were correlated with the increasing risk of COVID-19 in EMTs.
Schmitz D, Vos M, Stolmeijer R, Lameijer H, Schönberger T, Gaakeer MI, de Groot B, Eikendal T, Wansink L, Ter Avest E. Association between personal protective equipment and SARS-CoV-2 infection risk in emergency department healthcare workers. Eur J Emerg Med. 2021 Jun 1;28(3):202-209.  Survey ED-MD In this cross-sectional study, the use of high-level PPE (FFP2 or equivalent and eye protection) by ED personnel during all contacts with patients with suspected or confirmed SARS-CoV-2 does not seem to be associated with a lower infection rate of ED staff compared to lower level PPE use.
Smith LE, Serfioti D, Weston D, Greenberg N, Rubin GJ. Adherence to protective measures among healthcare workers in the UK: a cross-sectional study. Emerg Med J. 2022 Feb;39(2):100-105. Cross Sectional Survey Other Uptake of personal protective behaviours among UK HCWs at the start of the pandemic was variable. Factors associated with adherence provide insight into ways to support HCWs to adopt personal protective behaviours, such as ensuring that adequate PPE is available and designing workplaces to facilitate physical distancing.

Proning  ^

Citation Design Setting Clinical Bottom Line
Pan A, Peddle M, Auger P, Parfeniuk D, MacDonald RD. Interfacility Transport of Mechanically Ventilated Patients with Suspected COVID-19 in the Prone Position. Prehosp Emerg Care. 2022 Mar 2:1-6. Retrospective Observational PH-CCT  
Althunayyan S, Almutary AM, Junaidallah MA, Heji AS, et al. Prone position protocol in awake COVID-19 patients: A prospective study in the emergency department. J Infect Public Health. 2022 Apr;15(4):480-5.  Prospective Cohort ED-MD After applying the prone position in the ED, significant and immediate improvement was observed in oxygenation, respiratory rate, respiratory distress, and carbon dioxide levels. A linear relationship between the level of improvement in oxygenation and reduction in ICU admission was observed.
Caputo ND, Strayer RJ, Levitan R. Early Self-Proning in Awake, Non-intubated Patients in the Emergency Department: A Single ED's Experience During the COVID-19 Pandemic. Acad Emerg Med 2020; 27(5):375-378. Observational ED-MD Awake early self-proning in the emergency department demonstrated improved oxygen saturation in our COVID-19 positive patients.
Jiang LG, LeBaron J, Bodnar D, Caputo ND, Chang BP, Chiricolo G, et al. Conscious Proning: An Introduction of a Proning Protocol for Nonintubated, Awake, Hypoxic Emergency Department COVID-19 Patients. Acad Emerg Med 2020; 27(7):566-569. Descriptive ICU Intubated patients with ARDS experience physiological benefits to the prone position.
Downing J, Cardona S, Alfalasi R, Shadman S, Dhahri A, Paudel R, Buchongo P, Schwartz B, Tran QK. Predictors of intubation in COVID-19 patients undergoing awake proning in the emergency department. Am J Emerg Med. 2021 Nov;49:276-286.  Retrospective Cohort Study ED-MD Among COVID-19 patients treated with awake PP in the ED prior to admission, ROX index and P/F ratio, particularly 24 h after admission, may be useful tools in identifying patients at high risk of intubation.
Boomhower J, Noland HE, Frakes MA, Seethala RR, Cohen JE, Wilcox SR. Transport of a Nonintubated Prone Patient with Severe Hypoxemic Respiratory Failure Due to COVID-19. Prehosp Emerg Care. 2021 Jan-Feb;25(1):55-58.  Case Report PH-Medic In this case report, we describe the first known report of transporting a non-intubated, critically ill COVID-19 patient in the prone position. 
Şan İ, Yıldırım Ç, Bekgöz B, Gemcioğlu E. Transport of awake hypoxemic probable COVID 19 patients in the prone position. Am J Emerg Med. 2021 Aug;46:420-423. Retrospective Observational PH-Medic

Transports more than 15 min, prone position may be recommended because the partial oxygen pres-

sure of the patients increases.

Pan A, Peddle M, Auger P, Parfeniuk D, MacDonald RD. Interfacility Transport of Mechanically Ventilated Patients with Suspected COVID-19 in the Prone Position. Prehosp Emerg Care. 2022 Mar 2:1-6. Retrospective Cohort PH-CCT Patients with severe hypoxemic respiratory failure due to COVID-19 can be safely transported in the prone position by specially trained critical care paramedic crews.

Pulse Oxymetry  ^

Citation Design Setting Clinical Bottom Line
Jouffroy R, Jost D, Prunet B. Prehospital pulse oximetry: a red flag for early detection of silent hypoxemia in COVID-19 patients. Crit Care 2020; 24(1):313. Observational PH-Paramedic Prehospital pulse oximetry might be used as a red flag for early detection of “silent hypoxemia” in COVID-19 patients.
Jouffroy R, Lemoine S, Derkenne C, Kedzierewicz R, Scannavino M, Bertho K, Frattini B, Lemoine F, Jost D, Prunet B. Prehospital management of acute respiratory distress in suspected COVID-19 patients. Am J Emerg Med. 2021 Jul;45:410-414.  Retrospective Observational PH-Medic Pulse oximetry might be a valuable marker for rapidly determining suspected COVID-19-patients requiring prehospital mechanical ventilation.
Lancet EA, Gonzalez D, Alexandrou NA, Zabar B, Lai PH, Hall CB, Braun J, Zeig-Owens R, Isaacs D, Ben-Eli D, Reisman N, Kaufman B, Asaeda G, Weiden MD, Nolan A, Teo H, Wei E, Natsui S, Philippou C, Prezant DJ. Prehospital hypoxemia, measured by pulse oximetry, predicts hospital outcomes during the New York City COVID-19 pandemic. J Am Coll Emerg Physicians Open. 2021 Mar 17;2(2):e12407. Population-Based Longitudinal Study  PH-Medic An out-of-hospital SpO2 ≤90% strongly supports a triage decision for immediate hospital admission.

Screening ^

Citation Design Setting Clinical Bottom Line
McRae AD, Hohl CM, Rosychuk R, Vatanpour S, Ghaderi G, Archambault PM, Brooks SC, Cheng I, Davis P, Hayward J, Lang E, Ohle R, Rowe B, Welsford M, Yadav K, Morrison LJ, Perry J; Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) investigators for the Network of Canadian Emergency Researchers and the Canadian Critical Care Trials Group. CCEDRRN COVID-19 Infection Score (CCIS): development and validation in a Canadian cohort of a clinical risk score to predict SARS-CoV-2 infection in patients presenting to the emergency department with suspected COVID-19. BMJ Open. 2021 Dec 2;11(12):e055832. Prospective Cohort ED-Other The CCEDRRN COVID-19 Infection Score uses clinical characteristics and publicly available indicators of disease incidence to quantify a patient’s probability of SARS-CoV-2 infection. The score can identify patients at sufficiently high risk of SARS-CoV-2 infection to warrant isolation and empirical therapy prior to test confirmation while also identifying patients at sufficiently low risk of infection that they may not need testing.

Suction  ^

Citation Design Setting Clinical Bottom Line
Edelson DP, Sasson C, Chan PS, Atkins DL, Aziz K, Becker LB, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the. Circulation 2020;141(25):e933-e943. Consensus Statement ED-MD Wear airborne PPE, limit personel, use a HEPA filter, use most experienced provider for ETI, use closed circuit AW system including suction, use mechanical compressions where possible. This document provids algorithms.
Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetist. Anaesthesia 2020;75(6):785-799. Guideline ED-MD Most appropriate intubator. HFNP in the non-hypoxemic is not recommended when pt is suspected COVID-19. Closed suction mandatory.  This article provides checklists.
COVID-19 infection risk to rescuers from patients in cardiac arrest https://costr.ilcor.org/document/covid-19-infection-risk-to-rescuers-from-patients-in-cardiac-arrest Accessed: 2020-04-15. Systematic Review PH-Paramedic Very low quality evidence: suctioning is aerosol generating.

Termination Rules ^

Citation Design Setting Clinical Bottom Line
Jung H, Lee MJ, Cho JW, Lee SH, Lee SH, Mun YH, Chung HS, Kim YH, Kim GM, Park SY, Jeon JC, Kim C; WinCOVID-19 consortium. External validation of multimodal termination of resuscitation rules for out-of-hospital cardiac arrest patients in the COVID-19 era. Scand J Trauma Resusc Emerg Med. 2021 Jan 27;29(1):19.  Retrospective Observational PH-Medic The KoCARC TOR rule I, which included a combination of three factors including not being witnessed by emergency medical technicians, presenting with an asystole at the scene, and not experiencing prehospital shock delivery or return of spontaneous circulation, was found to be superior to all other TOR rules.