Transporting High-risk Populations Guidance

This guidance provides recommendations for emergency medical services (EMS) and transport agencies providing high-risk population groups with transport to routine treatments.

Those at high-risk for severe illness from COVID-19 include:

• People aged 65 years and older.
• People who live in a nursing home or long-term care facility.
• People of any age with certain underlying conditions, including:
  
  • Cancer
  • Chronic kidney disease
  • Chronic obstructive pulmonary disease
  • Immunocompromised (weakened immune system) from solid organ transplant
  • Obesity (body mass index [BMI] of 30 or higher
  • Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
  • Sickle cell disease
  • Type 2 diabetes mellitus
• Currently, there are limited data and information about the impact of other underlying medical conditions and whether they increase the risk for severe illness from COVID-19.  Based on what is known at this time, people with the following conditions might be at an increased risk for severe illness from COVID-19:
  
  • Asthma (moderate to severe)
  • Cerebrovascular diseases (Affects blood vessels and blood supply to the brain)
  • Cystic fibrosis
  • Hypertension or high blood pressure
  • Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
  • Neurologic conditions, such as dementia
  • Liver disease
  • Pregnancy
  • Pulmonary fibrosis (have damaged or scarred lung tissues)
  • Smoking
  • Thalassemia (a type of blood disorder)
  • Type 1 diabetes mellitus

• Check the patient for fever, difficulty breathing, and respiratory symptoms.
• Ask the patient if they have had contact with someone diagnosed with or being checked for COVID-19.
  
  • Updated personal protective equipment (PPE) recommendations for the care of patients with known or suspected COVID-19:
    • Face masks are an acceptable alternative until the supply chain is restored. Respirators should be prioritized for procedures likely to generate respiratory aerosols, which would pose the highest exposure risk to health care personnel (HCPs).
    • Eye protection, gown, and gloves continue to be recommended.
      • If there are shortages of gowns, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of HCPs.
    • When the supply chain is restored, fit-tested EMS clinicians should return to using respirators for patients with known or suspected COVID-19.
• Provide a face mask to any patient with respiratory symptoms and ensure they apply it correctly.
• Wear recommended PPE when transporting patients with possible COVID-19.
• On arrival to the facility/home, EMS/transport personnel should remove and discard PPE and perform hand hygiene. Used PPE should be discarded in accordance with routine procedures.
• Persons in the transport vehicle should avoid touching their face, mouth, nose, and eyes.
• Perform hand hygiene often, including before and after each patient contact.
• When transporting a patient to an appointment ( e.g., to dialysis center or medical office), ensure patients have contact information for their primary care provider/specialist and they have called ahead of their appointment to report fever or respiratory symptoms so the facility can be prepared for their arrival or triage them to an appropriate setting.
• Inform staff of the patient’s fever or respiratory symptoms immediately upon arrival to the facility.
• Use cleaning procedures appropriate for SARS-CoV-2 (the virus that causes COVID-19), along with all routine cleaning and disinfection procedures. Refer to List N on the U.S. Environmental Protection Agency (EPA) website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2.
• After transporting the patient, leave the rear doors of the transport vehicle open to allow for sufficient air exchange to remove potentially infectious particles.
  
  • The time to complete transfer of the patient to the receiving facility and complete all documentation should provide sufficient air exchange. When possible, use vehicles that have isolated driver and patient compartments that can provide separate ventilation to each area.
  • Close the door/window between these compartments before bringing the patient on board.
  • During transport, vehicle ventilation in both compartments should be on nonrecirculated mode to maximize air exchanges that reduce potentially infectious particles in the vehicle.
  • If the vehicle has a rear exhaust fan, use it to draw air away from the cab, toward the patient-care area, and out the back end of the vehicle.
  • Some vehicles are equipped with a supplemental recirculating ventilation unit that passes air through HEPA filters before returning it to the vehicle. Such a unit can be used to increase the number of air changes per hour (ACH) (https://www.cdc.gov/niosh/hhe/reports/pdfs/1995-0031-2601.pdf).
• If a vehicle does not have an isolated driver compartment, ventilation must be used, open the outside air vents in the driver area and turn on the rear exhaust ventilation fans to the highest setting. This will create a negative pressure gradient in the patient area.

• Follow EMS system site management organization (SMO’s)/guidelines, which may change based on evolving COVID-19 guidance.
• Understand many patients need to continue their medical and procedure appointments in order to maintain their health, e.g., dialysis treatment. Postponing or canceling their visits may be detrimental to their health.

Last Updated:  7/27/2020

Guidance Document: 

Transporting High Risk Populations Guidance