#GMVEMSC: Communiques to Ohio EMS Personnel

OHIO EMERGENCY MEDICAL SERVICES Robert L. Wagoner, Executive Director www.ems.ohio.gov   Mike DeWine, Governor Thomas J. Stickrath, Director   Jon Husted, Lt. Governor Robert L. Wagoner, Executive Director     To:  Ohio EMS providers, EMS agencies, and EMS medical directors From:  Carol A. Cunningham, M.D., FAAEM, FAEMS   State Medical Director Date:  November 10, 2020 RE: The Surge in COVID-19 Cases The number of COVID-19 cases, hospitalizations, and deaths are rising nationwide, including within Ohio.  Numerous factors are contributing to these statistics and, regardless of the specific etiologies, the demand for EMS response will inherently increase.  As we navigate through this pandemic, it is imperative that we continue to provide compassionate patient care, exercise the recommended safety measures, and maximize the protection of our workforce.  The Centers for Disease Control and Prevention (CDC) issued a guidance for first responders (https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html) on July 15, 2020.   Although this guidance remains unchanged, I want to highlight a few of their recommendations in light of the fact that there are numerous counties in Ohio experiencing a statistically significant increase in COVID-19 cases.  Asymptomatic or pre-symptomatic persons who are infected with the COVID-19 virus are contagious and can spread the virus to others.   Due to this fact, every person encountered by an EMS provider, whether it is a patient or a co-worker, should be considered potentially infectious. Face coverings for source control (preferably a face mask), social distancing, and frequent hand washing are critical measures that prevent transmission of this disease. In areas with moderate to substantial community transmission, there is a higher incidence of patients with asymptomatic or pre-symptomatic COVID-19 infection.  If COVID-19 infection is not suspected based upon the patient’s symptoms and exposure history, EMS providers should follow standard and transmission-based precautions (e.g. gloves, gowns) and implement the following procedures: Wear eye protection and a face mask to ensure protection of the eyes, nose, and mouth from all splashes and sprays of infectious materials. Wear an N-95 or equivalent or higher-level respirator (instead of a face mask) when performing aerosol-generating procedures. Respirators with exhalation valves for placement on the patients are not recommended for source control. Within the sector of healthcare workers, the majority of COVID-19 cases have not been linked to contact with an infected patient when the appropriate personal protective equipment (PPE) is donned.   Instead, they occurred from transmission via community spread, including within the workplace from fellow employees.  During the entirety of the period of time while on duty, EMS providers should: Wear a facemask at all times while they are in service, including in breakrooms or other spaces where they might encounter co-workers. Emphasize the importance of source control and physical distancing when engaged in non-patient care activities. This includes designating areas for EMS personnel to take breaks, eat, and drink that allow them to remain at least 6 feet apart from each other, especially when they must be unmasked. Exercise frequent hand hygiene. The most effective method of disease prevention continues to be immunization against a pathogen through vaccination.  As the influenza season intersects with the ongoing COVID-19 pandemic, the State Board of Emergency Medical, Fire, and Transportation Services approved the Influenza Vaccinations by Ohio EMS Providers training module as an educational resource for Ohio’s EMS providers and EMS medical directors.  Although completion of this course is not mandatory, it is provided free of charge and is approved for Ohio EMS continuing education hours.  The training module will soon be available via the Public Safety Training Campus.  Efforts are currently underway to develop a safe and effective COVID-19 vaccine.  If and when it is approved by the Food and Drug Administration (FDA), the State Board of Emergency Medical, Fire, and Transportation Services and the Ohio Department of Public Safety, Division of EMS stand poised to provide a similar COVID-19 vaccine administration training module for Ohio EMS once the information regarding the dosing regimen, routes of administration, contraindications, and other parameters becomes available. The COVID-19 pandemic has created unprecedented challenges to our healthcare systems and other facets of our society.   Nevertheless, I am so proud of the dedicated service that all of you are unselfishly providing to your communities and to all of the residents and visitors of Ohio.  While we care for others, we cannot neglect the need to care for and maintain ourselves, both physically and mentally.  Don your PPE, wash your hands, get vaccinated, and take time to share a moment of laughter and tears with a good friend.  EMS is a team sport, and we are all in this together!   Ohio Department of Public Safety www.publicsafety.ohio.gov Mike DeWine, Governor Thomas J. Stickrath, Director

OHIO EMERGENCY MEDICAL SERVICES Robert L. Wagoner, Executive Director www.ems.ohio.gov   FOR IMMEDIATE RELEASE:   MEDIA CONTACTS: November 9, 2020   Dan Tierney: 614-644-0957       Breann Almos: 614-799-6480   COVID-19 Update: Unprecedented Spike in Hospital Admissions (COLUMBUS, Ohio)— This afternoon, Governor DeWine was joined by incoming Ohio Department of Health Chief Medical Officer Dr. Bruce Vanderhoff and leaders of the Ohio Hospital Association to discuss the status of hospital capacity in Ohio as the number of COVID-19 cases continues to surge throughout the state. There are currently over 2,500 hospitalizations statewide, up from 2,000 hospitalizations on Thursday. A total of 154 hospitalizations were reported in the last 24 hours alone. "In Ohio, we are seeing an unprecedented spike in hospital utilization and it is impacting all areas of the state. While we are better prepared with personal protective equipment and physical capacity, what we are seeing now is an increasing demand on our staffing," said Dr. Vanderhoff. "If we don't control the spread of this virus, we won't be able to care for those who are acutely ill without postponing important, but less urgent, care. We anticipate that this kind of shift could happen in a matter of weeks if trends don't change." “The COVID-19 pandemic is becoming more dire for Ohio as hospitalizations have escalated 350 percent in the past 50 days to 2,533 COVID patients in Ohio hospitals today,” said Mike Abrams, president and CEO, Ohio Hospital Association. “Our hospitals are capable of managing capacity needs, but we must stem the spread now. This steep climb creates a severe strain on our caregivers who are braving the frontline of this pandemic. We can stop this spread, and we call on Ohioans to join hospitals and caregivers to take action now and do the right thing to slow the spread.” At the beginning of the pandemic, Governor DeWine worked with the Ohio Hospital Association to develop a comprehensive statewide public health system to ensure that all Ohioans have access to quality care during the pandemic. As part of this process, the state was divided into three healthcare zones. Leaders of each zone provided an update on hospital capacity in their regions.  ZONE 1 Of all hospitalizations in the state, more than 50 percent are in Zone 1, but there are currently enough hospital beds, personal protective equipment (PPE), medication, and ventilators. Total beds utilized and intensive care beds utilized in Zone 1 currently stands at 70 to 75 percent. This zone, however, is seeing many caregivers becoming ill with COVID-19.  At the Cleveland Clinic alone, there are currently 300 caregivers out due to the coronavirus.  "It's not because they're catching COVID in the hospital. What we're seeing is they're catching it in the community," said Robert Wyllie, MD, of the Cleveland Clinic. "What we're asking everyone to do is double down. Now is the time to wear a mask and socially distance - if not to protect your family and friends, do it to protect the caregivers who protect COVID patients and other hospitalized patients." ZONE 2 Last Monday, Zone 2 hit a milestone of 400 patients in the hospital, and by Friday, the number surpassed 500 patients. Today there are over 560 COVID-19 patients hospitalized with COVID-19 in Zone 2. Because patients are normally admitted 7 to 14 days after symptoms arise, hospitals are expecting to see hospitalizations continue to increase for at least two weeks after COVID-19 cases peak which could impact non-COVID care. "We need the citizens of Ohio do to the same things they did in the spring and summer - take seriously masking, distancing, washing hands, and especially avoiding large gatherings of people you don't live with where you can't control your environment and you can't protect yourself or loved ones from someone in that crowd who is asymptomatic positive," said Andrew Thomas, MD, MBA, of The Ohio State University Wexner Medical Center. ZONE 3 Zone 3 has had an unprecedented increase in COVID-19 hospitalizations since the beginning of October. There are over 670 patients hospitalized today, as compared to 300 patients at the peak of the previous surge in July. In the greater-Cincinnati area, the positivity rate had been approximately 3 percent but is now standing at approximately 8 percent.    In Zone 3, the growth of hospitalizations is doubling every three weeks. Right now, Zone 3 can accommodate the current capacity of patients, but if the doubling of cases continues to accelerate, this zone could exhaust resources and may have to defer non-COVID care.  "If we do what we did in the past - adhering to social distancing, wearing a mask, washing hands, and not expanding your personal bubble, we can bring the spread of this virus under control," said Richard Lofgren, MD, MPH, FACP, and president and CEO of UC Health. RURAL HOSPITALS Ronda Lehman, president of Mercy Health, Lima region, also discussed the hospital capacity in their hospital system, which encompasses many rural communities. There is currently adequate capacity of PPE, ventilators, and hospital beds, however, hospitalizations are increasing. On October 5, the hospital system had 17 COVID-19 patients, and today they are treating 75 patients who are COVID-19 positive. "This is a stark challenge for us because this is in addition to the normal fall flu and critical illness admissions, and it's not sustainable," said Lehman. "This is not a metro problem, this is a statewide and countrywide problem. Those in small communities should recognize that their behaviors do have a substantial impact to their neighbors, their local hospitals, the people they worship with, the people they go to school with, and the people they care about in their circles." CURRENT CASE DATA In total, there are 254,974 confirmed and probable cases of COVID-19 reported in Ohio and 5,524 confirmed and probable COVID-19 deaths. A total of 20,651 people have been hospitalized throughout the pandemic, including 4,047 admissions to intensive care units. In-depth data can be accessed by visiting coronavirus.ohio.gov.  Video of today's full update, including versions with foreign language translation, can be viewed on the Ohio Channel's YouTube page.  For more information on Ohio's response to COVID-19, visit coronavirus.ohio.gov or call 1-833-4-ASK-ODH. Ohio Department of Public Safety www.publicsafety.ohio.gov Mike DeWine, Governor Thomas J. Stickrath, Director

 

OHIO EMERGENCY MEDICAL SERVICES Robert L. Wagoner, Executive Director www.ems.ohio.gov   FOR IMMEDIATE RELEASE:   MEDIA CONTACTS: November 11, 2020   Dan Tierney: 614-644-0957       Breann Almos: 614-799-6480   Governor DeWine Calls on Ohioans to Recommit to Safety Practices, Announces New Mask, Social Distancing Orders (COLUMBUS, Ohio)— In a statewide address to Ohioans Wednesday evening, Ohio Governor Mike DeWine called on citizens to recommit to their individual efforts to prevent coronavirus spread as Ohio moves through its most intense, widespread, and dangerous surge of cases to date. Ohio is currently facing a record number of coronavirus-related hospitalizations and intensive care admissions, with nearly 3,000 people in the hospital, including more than 700 people in the ICU. During the first week of November alone, 104 Ohioans infected with the coronavirus died. “With this new wave of COVID-19, the onset of flu season, and an already-exhausted group of healthcare workers, there are serious concerns that there won’t be enough people to fully staff our healthcare facilities in the next few weeks,” said Governor DeWine. “If we don’t change this, Ohio won’t be able to provide appropriate care for COVID patients or for Ohioans who require other emergency care for things like accidents, strokes, and heart attacks. Hospitals will again be forced to postpone important, but less urgent, care.” Although testing capacity in Ohio has nearly doubled, the number of people testing positive for the coronavirus has increased almost four times. At the end of September, Ohio averaged under 1,000 new cases per day; this week, Ohio hit a record high of more than 6,500 new cases reported in a single 24-hour period. “As we wait for the vaccine, which could come as soon as December, we have so much to protect,” said Governor DeWine. “What each Ohioan does in his or her own life impacts every citizen and every place we desperately want and need to keep open– our schools, nursing homes, hospitals, and businesses.” To reinforce the necessity of wearing masks and slowing virus spread, Governor DeWine announced two forthcoming orders: Revised Mask Order Although most people and businesses have properly followed COVID-19 safety guidelines issued in Ohio’s July 23, 2020, mask order, others are not following the order. To protect frontline workers and customers, the Ohio Department of Health will reissue Ohio’s mask order and add the following provisions: Each store will be required to post a sign outlining face-covering requirements at all public entrances to the store; Each store will be responsible for ensuring that customers and employees are wearing masks; and A new Retail Compliance Unit, comprised of agents led by the Ohio Bureau of Workers’ Compensation, will inspect to ensure compliance. A first violation will result in a written warning and a second violation will result in closure of the store for up to 24 hours. New Social Gathering Order Ohio’s April order that limits public events and private gatherings of more than 10 people is still in effect, however, there has been rampant spread of the virus as a result of banquets, wedding receptions, and social gatherings following funerals. To address the tragedies that have resulted from such events, the Ohio Department of Health will issue an order that will place significant new restrictions on these social activities. Specifically, open congregate areas will no longer be permitted to open, and everyone will be required to be seated and masked unless they are actively consuming food or drinks. Bars, restaurants, and fitness centers may remain open, but this will be reassessed one week from tomorrow for potential closure.  “If the current trend continues and cases keep increasing, we will be forced to make these closures,” said Governor DeWine. “I am very well aware of the burden this will place on employees and owners, but these are places where it is difficult or impossible to maintain mask-wearing, which we know now is the chief way of slowing this virus.” For Governor DeWine’s entire address, visit ohiochannel.org or read his prepared remarks at coronavirus.ohio.gov. Ohio Department of Public Safety www.publicsafety.ohio.gov Mike DeWine, Governor Thomas J. Stickrath, Director