Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West Room HSC-2C1, Hamilton, ON L8S 4K1, Canada.
Int J Environ Res Public Health. 2022 Mar 4;19(5):3004. doi: 10.3390/ijerph19053004.
Patients with COVID-19 who require aerosol-generating medical procedures (such as endotracheal intubation) are challenging for paramedic services. Although potentially lifesaving for patients, aerosolizing procedures carry an increased risk of infection for paramedics, owing to the resource limitations and complexities of the pre-hospital setting. In this paper, we describe the development, implementation, and evaluation of a novel pre-hospital COVID-19 High-Risk Response Team (HRRT) in Peel Region in Ontario, Canada. The mandate of the HRRT was to attend calls for patients likely to require aerosolizing procedures, with the twofold goal of mitigating against COVID-19 infections in the service while continuing to provide skilled resuscitative care to patients. Modelled after in-hospital 'protected code blue' teams, operationalizing the HRRT required several significant changes to standard paramedic practice, including the use of a three-person crew configuration, dedicated safety officer, call-response checklists, multiple redundant safety procedures, and enhanced personal protective equipment. Less than three weeks after the mandate was given, the HRRT was operational for a 12-week period during the first wave of COVID-19 in Ontario. HRRT members attended ~70% of calls requiring high risk procedures and were associated with improved quality of care indicators. No paramedics in the service contracted COVID-19 during the program.
需要进行气溶胶生成医疗程序（如气管插管）的 COVID-19 患者对护理人员来说极具挑战性。尽管这些程序对患者有潜在的救生作用，但由于院前环境资源有限且复杂，对护理人员来说，气溶胶化程序会增加感染的风险。在本文中，我们描述了在加拿大安大略省皮尔地区开发、实施和评估新型院前 COVID-19 高风险反应小组 (HRRT) 的情况。HRRT 的任务是接听可能需要进行气溶胶生成程序的患者的电话，其双重目标是减轻服务中 COVID-19 感染的风险，同时继续为患者提供熟练的复苏护理。该小组仿效医院内的“受保护的蓝色代码”团队，要使其投入运行，需要对标准护理人员的做法进行多项重大更改，包括使用三人机组配置、专职安全官、电话响应核对清单、多个冗余安全程序以及增强个人防护设备。在接到任务不到三周后，HRRT 在安大略省 COVID-19 第一波期间的 12 周内开始运作。HRRT 成员参加了约 70%需要高风险程序的电话，并与改善的护理质量指标相关。在该计划期间，服务中的护理人员均未感染 COVID-19。
