UPDATE #014

Posted 04/01/2020

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The following info shall be utilized when transporting a patient to the USNS MERCY ship:

 

This map that illustrates the entrance for ambulances and the location of the ship. 

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You will enter at the USS Iowa parking lot. You need to check in at the first gate with license plate number and patient MAC Order Number. You will then follow to the right and follow along the route. Be advised, there are stop signs about every 50 feet. 

 

After you follow this route you will come to a narrow path that the mod barely fits in. You will be greeted by another set of LA Port Police and USMC. They will confirm the MAC Order number and then direct you up a narrow ramp. Take it nice and slow. There is no rush and you must avoid ambulance contact in this narrow passage. At the top of the ramp you will find a large parking lot containing a pop up tent at the end. You will pull up to it and back up with the back doors to the tent. 

 

You will then be greeted by USN and USMC. They will ask you to exit the ambulance to be screened for crew temperature and ask if you have had Cough, SOB, N/V or fever.

 

Offload the patient out of the ambulance and wheel them into the building you see on the map listed as Los Angeles WORLD CRUISE CENTER. Once inside you will give a report and transfer care to the USN team. They will sheet patients onto their hospital gurney. 

 

They will ask for paperwork and MAC order number quite often to confirm at all steps. 

 

Make sure you are getting destination signatures. For IFTS destination is listed under call informations. Not under the signature boxes

 

After transferring care they will ask you to step back outside to the rig and ask that you wait until it is confirmed that the patient has been admitted to the ship. Do not leave until you have confirmation!

 

Additional Information:

They are not accepting certain types of patients. They will not take geriatrics, pediatrics, or anyone who needs ICU level care as of now. They are taking middle aged patients that are basically MED SURG level only. They have capability to take TELEMETRY(cardiac monitoring 24s hours a day) but at this time they are only taking MED SURG patients. 

 

If you are interested you can see photos of the inside on google. Type in USNS MERCY interior. It is pretty interesting. We do not enter the ship but the inside is built exactly like a hospital. Instead of your standard USNS steel there is drywall painted, rails on the walls, drop ceilings, full monitors, IV pumps, everything to make the patient feel like they're in a hospital and not a ship.

 

If you have any questions during or prior to transporting to the ship, contact your Supervisor.

 

Be advised that the Supervisors will not be allowed to enter the lot with the transporting crew.

The LA Port police are pretty strict at the site.

 

The mod ambulance fits. You just have to roll slow. It maybe allows 3-4inches of space at the wheels on either side as there is a high curb on the ramp up to the lot. 

 

Please be advised that the security both locally and federally for the ship and its current mission is very tight for a number of reasons.

 

Access to the ship will not be granted to our crews as it requires a thorough background check.

 

While there have been plenty of pictures and videos of the ship made public, you are NOT authorized to take any photos/videos as it is an ACTIVE MILITARY installation. This means that while we have minimal access, it is more than public access and we will be held to Federal laws and regulations. Photos are definitely prohibited. Failure to comply may result in disciplinary action.

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OPERATIONAL UPDATES:

1) PPE/N95 REUSE

Please continue to be safe. Please don and dof according to standards. 

 

Respirator Reuse Recommendations

Safe N95 reuse is affected by a number of variables that impact respirator function and contamination over time. However, manufacturers of N95 respirators may have specific guidance regarding reuse of their product. The recommendations below are designed to provide practical advice so that N95 respirators are discarded before they become a significant risk for contact transmission or their functionality is reduced:

· Discard N95 respirators following use during aerosol generating procedures.

· Discard N95 respirators contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients.

· Discard N95 respirators following close contact with any patient co-infected with an infectious disease requiring contact precautions.

· Hang used respirators in a designated storage area or keep them in a clean, breathable container such as a paper bag between uses. To minimize potential cross-contamination, store respirators so that they do not touch each other and the person using the respirator is clearly identified. Paper bags should be disposed of after the N95 is no longer re-usable. (Please see supervisor if you need a paper bag)

· Clean hands with soap and water or an alcohol-based hand sanitizer before and after touching or adjusting the respirator (if necessary for comfort or to maintain fit).

· Avoid touching the inside of the respirator.

· Use a pair of clean (non-sterile) gloves when donning a used N95 respirator and performing a user seal check. Discard gloves after the N95 respirator is donned and any adjustments are made to ensure the respirator is sitting comfortably on your face with a good seal.

 

 

2) PCRS

All caregivers (drivers/attendants/trainees) are required to login in daily to look for pcrs that are either parked and or not transmitted. If you have one or more in your profile they must be completed immediately. All pcr's by policy should be completed shortly after a call but always prior to shifts end. If you have a device issue or some other question please contact your field supervisor.

 

3) SUCCESS FACTORS

Some of you may be receiving emails from Erin about outstanding online training. Please login in today utilizing your toughbook and complete any courses that have a due date. There are some other optional courses assigned to everyone with some important information. Please utilize your downtime and or hospital wait times to complete these modules.

 

4) TELESTAFF

You must punch in and out for every shift. This includes if you are on 48's.  You have to clock out and then back in between the 48s. You must check your online time card for accuracy. If you are missing a punch or made a wrong punch out must send an email to laurel.hickcox@gmr.net with your correct punch in order for the correction to be made. Please set reminders for yourselves. It creates a tremendous amount of work to compensate for a missed punch. Both on your side and ours. Please, please, please punch in and out on time. Thanks

 

5)UNIFORMS

Please remember to bring spare uniforms in case you need to shower and or wash them during shift. We have multiple washing stations to assist you.

 

6)OVERTIME

I know this is a topic of conversation. As you all are probably feeling, this epidemic has created a significant volume change in our operation. Call transport volume is down significantly. This as an organization is how we create the revenue needed to succeed. When volume is high and hospital wait times are long we as an industry have had to increase the number of units we have on the road to compensate. With the sudden drop of transport volume and the reduction in wall times the need for additional units is not currently necessary. Because we had those additional units currently staffed, we are using any openings as an opportunity to pair up single caregivers.  We are doing this to make sure everyone scheduled still works on those days. As openings occur on our master schedule we will be able to pair up the partners in advance on a permanent basis and eliminate any last minute changes hopefully. We do have a significant number of driver trainees right now and hopefully once they clear that will reduce the number of splits. We thank you for your patience in this time and appreciate your understanding of how we have to navigate through these changes.

 

7)CREW CHIEF OPENINGS

Currently Stations 8,9,14 and 18 have openings

 

 

 

UPDATE #013

Posted 03/31/2020

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McCormick COVID-19 Monitoring for EMS Personnel

 

1. Personnel should be wearing goggles, n95’s and gloves on all patient contacts. Regardless of call type and cad notes

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2. All McCormick personnel should self-monitor twice daily, once at the start of shift and the second, ideally timed approximately 12 hours later for possible symptoms of COVID-19 (i.e., elevated temperature >100.0 and/or cough or shortness of breath). Station thermometers should be utilized, and results should be reported to your on-duty supervisor after you have obtained your results.

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3. If any personnel have symptoms before coming to work, they should contact their on-duty supervisor immediately for further instruction and stay home from work.

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4. Personnel who develop a fever will be sent home and NOT allowed to work.

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5. Personnel with mild respiratory symptoms without fever may continue to work once it has been more than 3 days without medication and improvement of symptoms if the onset was 7 days or more. If direct patient care is required, personnel should wear surgical masks and follow hand hygiene and infection control guidance.

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6. EMS personnel who are in the same room and have NOT donned appropriate PPE while performing a high hazard, aerosol-generating procedure (e.g., intubation [King or direct laryngoscopy], bag mask ventilation, CPR, or nebulized treatments) on a confirmed or suspected COVID-19 patient should quarantine at home for 14 days and perform active monitoring as described by the CDC. They can return to work after 14 days if they never developed symptoms.

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7. Testing is not recommended for asymptomatic persons, even if exposed during a high hazard procedure. Home quarantine is recommended as per above.

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8. First responders with other healthcare exposures may work and follow self-monitoring guidelines.

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9. Any EMS personnel with a fever should be presumed to have COVID-19. They can discontinue home isolation and return to work after they have met both of the following conditions:

• At least 3 days have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and, • At least 7 days have passed since symptoms first appeared. Upon returning to work, they should follow the recommended return to work practices, wear a mask and follow hand hygiene and infection control guidance.

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10. COVID-19 testing of symptomatic staff is generally not recommended as it is not sufficient to discontinue isolation recommendations but may be obtained through EMS Provider Agency protocol.

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Latest GMR Update for 03/31/2020

 

UPDATE #012

Posted 03/30/2020

 

USE YOUR PPE

Do not come in contact with patients without the proper ppe. N95, goggles and glove are a must. If you have a patient receiving aerosolized procedures make sure you have all of this and a gown on! With the amount of community transmission of Covid-19 it should be assumed all patients are carriers, even if they are asymptomatic.

 

PARKED PCRS

Login daily and make sure you check for any parked PCRS. You must clear them out daily, no exceptions please

 

TMH/TMMC update

TMMC is going to start checking temperatures on everyone entering our building including staff and EMS. TMMC staff will be getting a color coded sticker for each day to show that they have been screened for that shift already. I am trying to figure out a way to do this without backing up the Providers coming in, especially with critical patients. Just wondering if or what agencies are already monitoring the personnel temps prior to their shift? If the PM and EMT’s are already being checked at their stations, then maybe we can forgo checking them. I don’t know. Just trying to work this out the easiest and fastest way possible while making sure everyone is safe.

 

RESTOCK

please do not stock ambulances from stations other than your home base. If you need supplies please contact your on duty supervisor. Also, if you do not have what you need please take your unit out of service pending supervisor restock. Do NOT run any calls if you are missing any items. This is the crews responsibility to know whats on board their unit.

 

UPDATE #011

Posted 03/27/2020

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Effective today 03/27/2020 responses with Compton Fire Department at time of dispatch will be as follows:

 

Code 3 response:

Full Arrest or Difficulty Breathing

 

Code 2 response:

All other responses.

               

 

The on scene Captain or Paramedic has the ability to upgrade a response. If this occurs dispatch will notify you of the change

 

UPDATE #010

Posted 03/26/2020

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GMR COVID-19 Security Guidelines 

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Do not put your unit in service if you are short supplies. Please contact your supervisor if you need an item. You have access to restock through your supervisor. 

 

 

UPDATE #009

Posted 03/25/2020

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1. We have fogger machines we are using to supplement your ambulance cleaning on some very specific call types. It is not a replacement for your traditional, it is in addition. Please note the solution is hard to get so we will do it while we can. The recommendation for fogging comes from your field supervisor

2. Please make sure you are following Lukes/GMR’s recommendation on reusing masks when they have not been compromised and or exposed. It is critical that we keep good inventory .

3. Open Crew chief spots. Please submit your request Stations 9,14 and 18

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Latest COVID-19 Update from GMR

 

 

UPDATE #008

 

Posted 03/24/2020

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GMR updated pay practice policy

 

Posted 03/24/2020

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1. Under no circumstance should your vehicle be in service if you are short equipment, this includes ppe. Advise dispatch immediately if you were to ever run out of something. If you respond to a call without equipment that is a violation of your responsibilities. 

2. Crews should have ppe with them available to put on for all calls. You never know when it is needed, this includes a surgical mask for the patient.

3. Make sure you always have spare uniforms with you. We do have washing stations for exposed clothes at multiple stations. Contact your sup if you have a uniform exposure that requires immediate washing, showering and changing

4. Compton is looking at changing their response approach. We are looking at the request and will advise of any changes.

 

 

UPDATE #007

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Posted 03/23/2020

This is a guide as to the care and transport of the suspected COVID-19 patient coming to Cedars- Sinai.

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Prior to entry to the ED, the provider should doff the PPE and follow the plan for hand-off with the nurse triaging the patient.

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Los Angeles County is experiencing an outbreak of the severe acute respiratory syndrome (SARS) – 2 coronavirus known as COVID-19. Based on the current outbreak, most infected persons experience mild illness and fully recover. Those at high risk for severe illness and/or complications are patients who are elderly or have underlying medical conditions. The Centers for Disease Control and Prevention recommends that low risk patients potentially infected with COVID-19 experiencing mild disease self-isolate at home unless symptoms worsen.

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Current EMS Policy is:

A. Low-risk patients with mild symptoms of respiratory infection (e.g., fever, cough, upper

respiratory illness) should be advised that their current condition does not require transport to

the emergency department.

 

B. If the patient or the patient’s legal representative requests that the patient be transported after

assurance that the transport is not needed, EMS personnel should honor the request and

transport to the Most Accessible Receiving Facility (MAR) for adults and to the closest

Emergency Department Approved for Pediatrics (EDAP) for children.

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1. EMS personnel transporting patients with suspected COVID-19 shall notify the receiving

facility in advance prior to arrival and may be directed to a screening area other than the

emergency department.

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2. EMS personnel who are assessing, treating or transporting a patient with suspected

COVID-19 shall use appropriate PPE at all times to include a N95 mask, gown, gloves

and eye protection. Additionally, place a surgical mask on the patient.

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3. On arrival at the hospital and after the transfer of care, doff your PPE and most

importantly wash your hands using soap and water.

 

We are expecting a significant number of respiratory infection patients over next few weeks. In order to reduce the spread of contamination through the ED, we are requesting that EMS personnel doff their PPE outside of the ambulance bay doors, transfer the more symptomatic patients to a clean gurney and notify the charge nurse of their arrival. Based on their symptoms, the charge nurse will designate the patients accordingly to:

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A. Transport mildly symptomatic (walkable) patients to the Tent for triage and assessment.

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B. Those that more symptomatic will wait outside of the ambulance bay until the bed is

clean so that they may proceed directly to their bed. Patients who are getting nebulizers

(even though they are trying to push for MDI in mildly symptomatic patients), they will

be required to discontinue this prior to entering the ED.

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If the patient did use an MDI via paramedics, please make sure you get them from the paramedics. Studies show that MDI via spacers is just as efficacious as nebulizers. We expect to see an increase in shortage of MDIs going forward. If a patient is getting oxygen, it is recommended that a surgical mask be placed over the mouth and nose to prevent transmission.

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Many patients in severe respiratory distress will likely only have a king airway or no intubation at all. It is imperative that the MICN ask the paramedics the type of airway the patient has before ED arrival so we can be prepared beforehand. Once the patient is intubated in the ED, it is recommended that hole be placed in the surgical mask and have the ET tube go through it. This will also help prevent transmission.

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Although this policy may increase the “wall time” of the paramedics, it is imperative that these measures be taken in order to prevent the transmission of this disease.

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Amar Shah MD, MPH, FACEP

Base Hospital Medical Director

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Sam Torbati, MD, FACEP, FAEEM

Co-Chair and Medical Director

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Claude Stang RN BSN MA CEN

Executive Director, Emergency Department

 

 

Posted 03/23/2020

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1)This is the last week for the overtime raffle. All pickups this week are eligible. Program ends Saturday 3/28/20

 

2) County Public Health, County EMS  and CDC are reevaluating Health Care Provider home isolation times. We will send an update as soon as we have a finalized document from County personnel.

 

3) Please only use the N95 brand and size you were fitted for. Moldex is our provider unless you were specifically given stock as an individual because of a failed seal test with Moldex brand.

 

4) Please continue to decon thoroughly after ever call. Please continue to clean your stations thoroughly. Clean high contact points more frequently. Please make sure you are still doing your 30 minute ambulance deep clean.

 

5) DO NOT COME TO WORK SICK.

 

6) If you are a trainee, please contact Cristina before coming to HQ to be processed. More details to follow.

 

7)EMS sent an email to anyone licensed in LA County on how to renew your EMT card this year.

 

Any questions please contact your divisional field supervisor

 

Hawthorne M41 310-863-6337

Valley M51 818-968-0373

Carson M61 626-945-0244

 

 

Thanks everyone

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UPDATE #006

Posted 03/20/2020

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Latest PPE Guide from LACoFD

Field Guide for Management of Suspected COVID-19

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Return to Work Criteria for HCP with Confirmed or Suspected COVID-19

 

Return-to-Work Criteria for Healthcare Workers | CDC

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GMR is announcing the following guidelines for the temporary implementation of the Child Care Assistance Program for frontline caregivers and support personnel essential to continuing the operational mission of GMR during the Coronavirus Disease (COVID-19) pandemic.

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Click HERE for details

 

UPDATE #005

Posted 03/19/2020

COVID-19 Potential Exposure Reporting Procedure

In an effort to streamline the reporting process for potential or suspected exposure to COVID-19, GMR Medicine and GMR Clinical Informatics have developed an online screening tool.