In a previous, less serious blog on the topic of overcoming misgivings with giving first aid, I gave suggestions about factors that might make a person hesitant to act quickly (if at all) as an emergency first responder. In the current pandemic, we all will do well to gain awareness and knowledge of COVID (Coronavirus) risks and precautions.
RUN AND HELP, OR RUN AWAY?
The first aid provider is by definition running to an emergency and its risks instead of away from it. While we have all learned to deal carefully with blood and other body fluids, the risks posed by exposure to this virulent new pathogen are highly publicized and apparently greater than anything we have previously had to face, and may be enough to make even a well-trained and experienced first aider run away! However, it is important to know that the Red Cross, National Institute of Health, and the Centers for Disease Control all indicate that, while greater caution to prevent the spread of COVID should be used, those trained in First Aid should continue to act in case of emergencies. This alone should reassure and encourage the First Aider to act immediately. This includes cases in which the casualty is bleeding, needs CPR, or defibrillation with an AED.
IT'S NICE TO KNOW
There are some reassuring things to know when giving first aid during the pandemic.
- Again, having asked the question, “Should I be giving First Aid even though there is a COVID pandemic?”, we know that those in the business of guarding our health are saying that this can and should be done; they have considered the implications of going ahead with First Aid and have provided additional guidelines for us to follow.
- Another factor is that it is most likely that we lay responders would be providing aid to someone who shares our own household. Thus we have already been exposed to each other and there is virtually no additional risk of infection, if any, as we provide help to that relative or friend.
- Also, precautions such as wearing gloves, face masks and shields, and even sanitary breathers are already built into First Aid protocols; they are designed to protect all involved from the risk of unintentionally spreading disease.
- An AED may be our best friend in this situation. It is safer than giving compressions, which produces passive breaths from the victim. Now more than ever, it is best to keep an AED at hand, know where it is, and know when and how to use it.
- It is also good to remember that in giving First Aid, we are in the business of saving a life. We need not take on unnecessary risk to help someone, but we can decide to act with knowledge and, while taking all precautions, do our best to save a victim from dying.
SPECIAL PRECAUTIONS FOR FIRST AID DURING COVID 19
First, how is the Coronavirus spread? According to the Red Cross,
The SARS-CoV2 virus, which causes COVID-19, is thought to spread mainly from person-to-person, between people who are in close contact with one another (within about 6 feet) through respiratory droplets produced when an infected person coughs, sneezes or talks. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Some recent studies have suggested that COVID-19 may be spread by people who are not showing symptoms. Additionally, spread can occur when droplets contaminate nearby surfaces and when touched, can lead to self-inoculation when a person inadvertently touches their own mouth, nose or eyes. This is not thought to be the main way the virus spreads, but we are still learning more about this virus.
What does this mean when it comes to giving first aid?- As stated above, giving CPR compressions produces “passive breaths” from the victim, and thus may spread virus-infected respiratory droplets to the mouth or nose of the one giving first aid because of the direct contact with that victim. Thus it is best to use a respirator (e.g. N-95 mask) while giving aid, and to mask the victim as well. If there is only one mask available, it is best to place it on the victim! To protect from all body fluid exchange including blood, etc.,face shields, eye protection, disposable gloves and a disposable isolation gown should be worn whenever possible.
Following are specific guidelines regarding breathing emergencies, CPR emergencies, CPR for cardiac arrest, and AED use, directly from the Red Cross (emphasis and structure added by The AED Guy):
Guidance for Performing a Breathing Assessment and Rescue Breaths in Children or Adults
While CPR with breaths has been shown to be beneficial when compared to compression-only CPR, during the COVID-19 outbreak, it is currently recommended that no rescue breaths be performed for adult cardiac arrest patients with confirmed or suspected COVID-19, due to the risk of disease transmission. The following measures are recommended and may be associated with a decreased risk of transmitting the virus:
When assessing for normal breathing, we recommended that the CPR/first aid care provider looks for breathing but does not listen or feel for the victim’s breathing, as this will minimize potential exposure.
We recommend that adult victims of sudden cardiac arrest receive continuous compression-only CPR from their CPR/first aid care provider until emergency personnel arrive. Note: Compression-only CPR saves lives compared to no CPR.
Cardiac arrests that occur after a breathing problem (which is often the case in infants and young children), drowning and drug overdoses may benefit from standard CPR that includes compressions and rescue breaths. Note: It is recognized that in some of the cases, the victim may also have COVID-19. However, if a lay responder is unable or unwilling to provide rescue breathing with CPR, compression-only CPR should be initiated.
Guidance for chest compressions and use.
If an AED is available it is recommended for every cardiac arrest victim. Whether or not a cardiac arrest victim is suspected of having COVID-19, 9-1-1 should be called and, if available, an AED should be used.
Guidance for AED Application & Use
No studies to date have shown that defibrillation generates respiratory droplets or aerosols, and it is known that prompt use of AEDs save the lives of cardiac arrest victims. In addition, the current methods of automatic external defibrillation use hands-free methods via adhesive pads that allow performance without direct contact with the victim.
If an AED is available, it should be applied and used consistently with the manufacturer’s guidelines while waiting for emergency personnel to arrive.
- If gloves are available, they should be worn.
- The AED device should be cleaned with disinfectant after use.
Guidance for Cleaning & Disinfection After First Aid Care
While still wearing personal protective equipment, clean and disinfect items that touched the victim. After cleaning, dispose of your personal protective equipment and perform hand hygiene. Surfaces should be cleaned using a detergent or soap and water prior to disinfection.
For Hard Surfaces:
Diluted household bleach solutions, alcohol solutions with at least 70% alcohol and most common EPA-registered household disinfectants should be effective.
Products with EPA-approved emerging viral pathogens claims are expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.). In their absence, products with label claims against human coronaviruses or other viruses should be used according to label instructions.
For Soft or Porous Surfaces
For surfaces such as carpeted floor, rugs, and drapes; remove visible contamination if present, and clean with appropriate cleaners indicated for use on these surfaces.
After cleaning, wash items as appropriate in accordance with the manufacturer’s instructions. If possible, wash items using the warmest appropriate water setting and dry completely or use products with the EPA-approved emerging viral pathogens claims that are suitable for porous surfaces.
For Clothing:
Do not shake dirty laundry. This will minimize the possibility of dispersing virus through the air.
Launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely.
If clothing cannot be immediately laundered, store in a sealed disposable bag.
Alternatives to EPA-registered disinfectants include:
- Diluted household bleach: Mix 5 tablespoons (1/3 cup) bleach per gallon of water, or 4 teaspoons bleach per quart of water. Make sure you have proper ventilation and that the bleach is not expired.
- Alcohol solutions: Ensure your solution has at least 70% alcohol.
Providers with contact with persons known or suspected to have COVID-19 should monitor themselves for symptoms, including fever or respiratory symptoms, e.g., cough, shortness of breath, sore throat. If these symptoms occur, they should self-evaluate and immediately contact their healthcare provider.
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