Coronavirus Discussion Thread

Tigger said:
Many texts from AMR saying to reuse gowns if you wore it but the patient was not suspicious for COVID. Also folks need to be wearing full PPE if participating in the decon process so unless the sole provider with contact also does the decon (takes forever), I am not sure how we will not have both ambulance crew members in full PPE.
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I guess I am so old that I remember when Universal Precautions were, well, universal. That has kept me well for almost 20 years through hep-C, AIDS/HIV, Swine Flu, and ebola. Now "my" current service is all upset that I say, no, reusing gowns and much more so N95 masks is not an acceptable process. When did assuring that the scene was safe before entering cease to be a critical fail? These request are folly and appear to say that ou employers just do not give two cents about our wellbing if it costs them money. By the way, the problem is not that no gowns are available but that gown substitutes are more costly and require washing with adequate bleach. That's the real complaint, otherwise these managers would be on line and on the phone placing orders to chef's coats and aprons, long-sleeve scrub, and raingear.

I hope others will post their take on this sudden safety-no-longer-important stuff.
 
Summit said:
There is guidance on reuse of masks. Are you saying you're actually reusing gowns? What's a recipe for self contamination? That is.
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My current department is indeed telling use to put used single-use disposable gowns in paper bag on scene and re-use them. Pretty much ditto for used N95 masks if we do not "THINK" the patient has COVID. Since when do we use our gut feel for our scene-safe determination?
 
Aprz said:
To me, reusing the mask doesn't make sense. The front of the mask is contaminated. If you are using it because it is possible the patient has something, how do you know if they did or didn't have something, and that when you reuse it, how are you avoiding cross contamination? Wherever you put it, you are contaminating something. Back in your pocket? Contaminated. Plastic bag? Contaminated. Touch the front with your hand? Contaminated? It seems pretty impossible to not cross contaminate, if you are reusing it. I feel like reusing it just leads to a false sense of security.

This Page is No Longer Available

This document recommends practices for extended use and limited reuse of NIOSH-certified N95 filtering facepiece respirators (commonly called “N95 respirators”).
www.cdc.gov www.cdc.gov

Scroll down to the bottom where it says is titled in bold "Risksof Extended Use and Reuse of Respirators". The whole page talks about how it is past practice to reuse, but the problems associated with reuse. To me, it seems like a circle jerk. We are short mask, reuse it to conserve mask, but the mask is contaminated.
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I agree with you whole-heartedly. The suggestion of reusing N95s and gowns is just plain irresponsible. The better solution for gowns is buying launder-able cloth long-sleeve scrubs, chef coats and aprons, or rain gear. Did the mental midgets who made those suggestion never hear of Universal Precautions and learn that not assuring a safe scene is a critical fail. Any scene with a potental SARS-CoV-2 patient is NOT safe UNLESS you are using the appropriate PPE. That includes at an absolute minimum Mask, eye protection, gown, and gloves. Anything less is just playing cards against the house -- do it often enough and you WILL go broke.
 
@RedBlanketRunner do you have any advice on processing plastic gowns? We are being told to be "creative" in reuse. Someone suggested "wiping them off" and I just laughed.

I was thinking 70% ipa dip or bleach dip by someone with a VOC filtered full face respirator as long as there was no visible bioburden.

Or just buying a bunch of trashbags and cutting holes...

Washable gowns are apparently on 6 week backorder and I hate those things too... so much opportunity to self contaminate in doffing.
 
CA on lockdown.

Stay at home order issued by the governor, and martial law may be next.

Wild times.
 
SandpitMedic said:
CA on lockdown.

Stay at home order issued by the governor, and martial law may be next.

Wild times.
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I heard about that. What are they doing for food?
 
I guess those who are homeless or don't have adequate food supply at home will either rely on Gov. Newsome to feed them or the looting will begin shortly. Standby.
 
PotatoMedic said:
I heard about that. What are they doing for food?
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Restaurants, grocery stores, banks, and other essential services are still open. People are allowed to leave their house to get food and other needed items.
 
Summit said:
do you have any advice on processing plastic gowns? We are being told to be "creative" in reuse. Someone suggested "wiping them off" and I just laughed.
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i'd suggest raiding the overalls discarded from surgery along with the discards and cramming the whole pile into a tub filled with around 200 ppm chlorine for 24 hours. Call it a 99% get by. They should hold up to the bath.
Or if you have a hospital connection, depending on workload in CS, when they aren't looking stuff the EO or flasher to the eyeballs and look really innocent. CS may just be willing to allocate sterilizer time during slow hours. Not sure how that plastic would hold up in the steam though. EO is your best bet but it would prob need to ride for 48 hours. If path lab uses an autoclave for discards that's another sterilizer you might be able to commandeer.
Just take a chunk from a plastic gown and ask CS or whoever runs the sterilizers to wrap and bake in a flasher. If it doesn't do a melt down you're golden. A normal sized flasher could cook up around 40-50 gowns at a time. Just don't leave melted plastic all over the insides. The surg sup will have you for breakfast.
 
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@Summit CORRECTION! 2500 ppm chlorine or >160cc household bleach per gallon of water.
 
I'm just glad that here disposable masks and gowns still means just that, use 'em then dispose of 'em...
 
Things are bad at several hospitals, where staff are not only reusing masks, they’re SHARING them.

Our current policy, based on the CDC guidelines, is N95 respirators may be reused up to 5 times. The complete guideline set is below.

This Page is No Longer Available

This document recommends practices for extended use and limited reuse of NIOSH-certified N95 filtering facepiece respirators (commonly called “N95 respirators”).
www.cdc.gov www.cdc.gov
 
Medic511 said:
I agree with you whole-heartedly. The suggestion of reusing N95s and gowns is just plain irresponsible. The better solution for gowns is buying launder-able cloth long-sleeve scrubs, chef coats and aprons, or rain gear. Did the mental midgets who made those suggestion never hear of Universal Precautions and learn that not assuring a safe scene is a critical fail. Any scene with a potental SARS-CoV-2 patient is NOT safe UNLESS you are using the appropriate PPE. That includes at an absolute minimum Mask, eye protection, gown, and gloves. Anything less is just playing cards against the house -- do it often enough and you WILL go broke.
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Of course it's irresponsible, but if the choice is between no protection and recycled/re-used protection, then it changes things..

That's where some folks are at right now.
 
SandpitMedic said:
This is a counter to the Imperial study and other data out there indicating mass die off. Great read, and I tend to agree while continuing to believe caution is the best exercise these days.

www.statnews.com

A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

A fiasco in the making? As the #coronavirus pandemic takes hold, we are making decisions without reliable data.
www.statnews.com www.statnews.com
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Good read. I’ve been thinking similarly all along. It may be my epidemiological and infectious disease ignorance, or it may just be wishful thinking, but I suspect the AAR will show that this thing was not, statistically speaking, nearly as bad as the doomsday predictions foretold.

Which doesn’t mean we shouldn’t be taking lots of precautions, of course. But I think the economic impact of these decisions will be massive and will be felt for a long time and many will rightly question whether economic suicide was necessary - or worth it.

We were so unprepared for this in so many ways, even though we’ve known for a long time that something like this was an eventuality. This thing didn’t surprise us - we knew it was coming someday. That we simply couldn’t be bothered to invest in surge capacity and financial preparation on the macro, micro, and individual levels does not surprise me, but further reinforces my lack of confidence in and disdain for our major institutions.
 
NomadicMedic said:
You can also open the window or turn on vents in front and turn on the exhaust fan in the back to create a negative pressure gradient.
(Or so the CDC says)
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Oh, I’m aware. I’m just venting at the culture that says protective measures are “unnecessary”. Before this is over, American EMS is going to have a few tragedies brought on by complacency.
 
Remi said:
Some good analysis here:

www.enkiops.org

COVID19 vs Influenza: why it’s worse, why it’s not.

OOPS: these are per 10,000, not 1000. You’re seeing lots of graphs and tables on COVID 19. In a disgusting display of fear mongering, networks are now keeping running counts of the cases a…
www.enkiops.org
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Excellent, this hits it right on the nose.

"If these trends hold, the US can expect about 30 to 35 million people to be “symptomatic” (most mild), 400,000 to 500,000 need hospitalization, and 30-40 thousand deaths. Compare to the 2017 influenza season: 45 million symptomatic, 810,000 hospitalized, 61,000 died. HOWEVER, rather than coming over 20 weeks or so, those cases will come over maybe 4 weeks -five times faster. The US health care system can’t really keep up with a normal flu season; there is no way it can handle this flood.
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Medic511 said:
I guess I am so old that I remember when Universal Precautions were, well, universal. That has kept me well for almost 20 years through hep-C, AIDS/HIV, Swine Flu, and ebola. Now "my" current service is all upset that I say, no, reusing gowns and much more so N95 masks is not an acceptable process. When did assuring that the scene was safe before entering cease to be a critical fail? These request are folly and appear to say that ou employers just do not give two cents about our wellbing if it costs them money. By the way, the problem is not that no gowns are available but that gown substitutes are more costly and require washing with adequate bleach. That's the real complaint, otherwise these managers would be on line and on the phone placing orders to chef's coats and aprons, long-sleeve scrub, and raingear.

I hope others will post their take on this sudden safety-no-longer-important stuff.
Click to expand...
I don't think anyone thinks that safety is not an issue here. But we can't just put our heads in the sand and say that we don't have a shortage and to operate business as usual. We have a problem, the solutions require both creativity and frankly time.
 
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