The domestic epidemic has rebounded recently. How to take protective measures for pre-hospital first aid

The current domestic epidemic

Recently, the domestic epidemic situation has been rising continuously.

For more than two years, China has implemented measures such as city closure, nucleic acid for all staff, Fangcang shelter hospitals, and Huoyan laboratories to effectively control the domestic epidemic.

(Overview of the domestic epidemic situation)

Pre-hospital medical emergency prevention and control

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The new logo is characterized by "snake stick, six pillars, the Great Wall, and olive branch", and is the only visual identification mark of China's pre-hospital medical emergency system

The Star of Life in the middle is the international symbol of Emergency Medical Service (EMS), in which the snake stick means medical treatment, and the six columns represent the six key links of pre-hospital medical emergency: discovery, reporting, response, on-site treatment, On the way monitoring and transport to the hospital for treatment

Pre-hospital graded protection standards

Strictly abide by relevant regulations during work, implement standard precautions, conduct risk assessments according to patients admitted, and adjust the level of personal protection adopted

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hand hygiene

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Sterilization of carrier tools

According to the risk level of the region and epidemiological investigation, a comprehensive assessment is carried out.

1.
Working principle of negative pressure ambulance: In addition to the professional ambulance equipment of ordinary ambulances, negative pressure ambulances can also ensure the safety and hygiene of the medical cabin, with isolation, corrosion resistance, ventilation and bacteria resistance
.
Through the negative pressure device in the car, the air pressure in the car is lower than the outside atmospheric pressure (usually -20Pa or even lower), so that the air can only flow from the outside to the car when it flows freely, and the air in the car is harmless.
Discharge after processing
.
The gas extracted from the medical cabin will be discharged out of the car through the sterilization filter device, and the sterilization filter device can block and kill 99.
97% of the germs with a diameter of 0.
3 microns or more
.
Make a fixed air circulation area in the negative pressure chamber
.
The air flows from the clean area (medical staff area) to the infection source area (patient area), and the air pressure in the cabin is maintained between -10Pa and -30Pa, so as to minimize the dead angle and eddy current of the air flow
.

2.
Air circulation mode of negative pressure ambulance: The air circulation system of negative pressure ambulance ensures that clean air flows from top to bottom, so that fresh air first passes through medical staff, then to the patient lying flat, and finally passes near the patient's head The filter unit flows out of the vehicle
.
The more well-equipped negative pressure ambulances will also be equipped with a dedicated isolation cabin.
The patient lies flat in the isolation cabin and breathes through the fan in the isolation cabin
.

3.
Basic requirements for transferring patients

(1) When transporting suspected or confirmed cases of new coronary pneumonia, vehicles, emergency equipment, and stretchers should be used exclusively for transport.
It is recommended to use negative pressure ambulances or negative pressure isolation cabins for isolation and transfer
.
The cab and the medical cabin of the ambulance should be sealed and isolated
.
The medical cabin of the ambulance is a contaminated area, and the cab is a potential pollution area.
During the transfer, the pollution to the cockpit should be minimized to avoid cross-contamination
.
The cleaning and disinfection of the medical cabin and the cab should be managed in zones
.

(2) When transferring patients, the windows of the vehicle during and after the transfer should be strengthened for ventilation
.
When the negative pressure ambulance is transported, it should be kept in a closed state, the ultraviolet lamp of the high-efficiency filter device in the medical cabin should be turned on, the air conditioning system should be adjusted to the internal circulation, and the relative pressure in the cabin should be maintained at -30Pa to -10Pa to ensure the good operation of the negative pressure
.
A negative pressure of not less than 15pa should be established within 2 minutes of the operation of the negative pressure isolation chamber
.
During the transfer, if it is not necessary, the negative pressure isolation chamber shall not be opened
.
When an ambulance without a negative pressure system participates in the transfer, the side windows of the cab and the medical cabin can be opened at the same time when the vehicle is running, which can form a negative pressure area around the outside of the vehicle body and accelerate the air discharge from the cab and the medical cabin
.
The staff should try to be in the upper wind position when working
.
For ambulances without independent heating and air conditioning systems, the ventilation ducts of the air conditioning system in the cab and medical cabin should be strictly sealed and isolated, and the air conditioning system should not be turned on
.

(3) Confirmed cases, asymptomatic infections, suspected cases excluded from diagnosis, and cured patients with positive symptoms can be transported in multiple cases in one car.
Suspected cases, close contacts, fever patients, and cases that meet the discharge criteria need to be transported in one car
.

(4) After the transfer of confirmed or suspected cases of new coronary pneumonia, ambulances, in-vehicle equipment, and contaminated emergency medical supplies must be cleaned and disinfected before being used for other patients
.
After the transfer vehicle returns to the station, it will be parked in the polluted parking space for terminal disinfection, and can only drive into the clean parking space after cleaning and disinfection
.

(5) During the epidemic period, strictly implement the disinfection of ambulances at any time and after transfer, and transfer and disinfect them without affecting the outpatient service
.
Surfaces that are frequently touched and easily contaminated, such as door handles and handrails in the ambulance, should be disinfected more frequently
.
The disinfection sequence of ambulances shall refer to the provisions of the "General Rules for Disinfection of Foci of Foci" (GB19193-2015), and spray disinfection shall be carried out in the order of first outside, then inside, and then up and down
.
When blood, vomit, sputum and other pollutants are splashed and polluted, the stains should be cleaned and disinfected at any time, and the pollutants should be removed first, and then cleaned and disinfected
.

(6) For high-frequency contact, easily contaminated and difficult to clean and sterilized surfaces, shielding protection measures can be adopted, and the coverings used for shielding protection (such as plastic films, aluminum foils, etc.
) should be replaced one by one; When cleaning and disinfecting, you should refer to the instruction manual of the instrument and equipment, pay attention to the compatibility of cleaning agents and disinfectants, and select appropriate cleaning and disinfection products
.

(7) The protective equipment should be worn in the clean area, and the personal hygiene treatment should be carried out in the designated area.
Follow the order from dirty to clean to take off the protective equipment in turn by area.
The action of removing the protective equipment should be gentle, and the contaminated surface and the clean surface should be distinguished Clearly, pay attention to hand hygiene, and remove the mask at the end
.

(8) The disinfection products used should be approved by the health and health administrative department or comply with the corresponding standard technical specifications, and follow the approved scope, methods and precautions
.

4.
Negative pressure ambulance transfer process:

(1) Wear and wear protective equipment during the transfer process → go out to the medical institution to pick up the patient → the patient wears a surgical mask → place the patient in an ambulance → transfer the patient to the receiving medical institution → disinfect the vehicle and equipment → transfer the next patient
.

(2) The procedure of putting on and taking off protective articles The procedure of wearing protective articles: washing hands or hand disinfection → wearing a hat → wearing a medical protective mask → wearing work clothes → wearing isolation clothing → wearing gloves
.
The procedure of removing protective items: removing gloves → washing hands or hand disinfection → removing isolation gown → washing hands or hand disinfection → removing masks and hats → washing hands or hand disinfection
.

(3) Medical staff and drivers should perform hand hygiene → shower and change before leaving work
.

(4) Cleaning and disinfection of ambulances:

1.
Air: Open windows for ventilation
.

2.
The carriage and its surfaces: wipe and disinfect with hydrogen peroxide spray or chlorine-containing disinfectant
.

5.
Ambulance disinfection measures

Because ambulances contain many metal parts, the selection of disinfection methods and disinfectants should be adapted to local conditions and used reasonably
.

(1) Ventilation: In the case of patient tolerance, non-negative pressure ambulances should strengthen window ventilation and/or mechanical ventilation during and after transfer
.

(2) Ultraviolet irradiation: Use mobile or vehicle-mounted ultraviolet lamps to irradiate and disinfect (installed at not less than 1.
5W/m3), because ultraviolet irradiation disinfection is easily affected by temperature, humidity and environmental cleanliness, and the irradiation and disinfection time can be appropriately extended for more than 1 hour.

.

(3) Ultra-low volume aerosol spray disinfection: After the transfer of fever or confirmed or suspected cases of new coronary pneumonia, it is necessary to carry out combined space-surface disinfection of the interior environment and surfaces of the transfer vehicle
.
Use an ultra-low volume aerosol sprayer, use a disinfectant such as hydrogen peroxide, first surface and then space, and proceed sequentially
.
When disinfecting air and surfaces, it is required to form a dense fog in a confined space and pay attention to the dosage of the drug, and spray until it is evenly moistened
.

(4) Steam (gas)ization/dry mist hydrogen peroxide disinfection: enhanced terminal disinfection measures taken after the transfer of fever or confirmed or suspected cases of new coronary pneumonia
.
Use 5%-8% hydrogen peroxide spray for disinfection, the dosage is 5-8ml/m3, the airtight effect is 1 hour to 1.
5 hours, and the water is wiped after sufficient ventilation
.

(5) Disinfection of the ground and surfaces in the car: After transferring common patients (non-febrile and infectious patients), use a chlorine-containing disinfectant with effective chlorine of 500 mg/L to wipe or spray to disinfect the environment and surfaces of the ambulance
.
If there are contaminants visible to the naked eye, the contaminants should be completely removed before disinfection
.
After transferring cases with fever, epidemiological history, confirmed or suspected new coronary pneumonia, etc.
, use 1000mg/L chlorine-containing disinfectant with effective chlorine or 500mg/L chlorine dioxide disinfectant to wipe or spray to disinfect the environment and surfaces inside the ambulance , dechlorination cleaning after at least 30 minutes
.
The cab and medical cabin disinfection and cleaning appliances should be strictly used separately
.

Wiping disinfection is mainly used for the disinfection of irregular, polyhedral and smooth surfaces such as doors and windows, door handles, handrails, stretchers, etc.
in the car
.
The ground should be wet mopped with disinfectant
.
Wiping and disinfection needs to be performed at least twice, and 75% ethanol disinfectant can be used for small surfaces to be wiped for more than 3 minutes
.
Spraying disinfection is to use a small watering can to spray disinfectant, which is used to disinfect the inner wall, doors and windows, ground and object surfaces of the medical cabin.
It should be carried out in the order of top, bottom, left and right.
The liquid should be evenly covered on the surface of the object and the ground
.
Wipe and mop the floor with disinfectant while spraying, so that the disinfectant evenly covers the surfaces and floors to be disinfected
.

(6) Disinfection of blood, secretions, vomitus, and excrement in confirmed and suspected cases of new coronary pneumonia: a small amount of pollutants can be dipped in disposable water-absorbing materials (such as gauze, rags, etc.
) with effective chlorine 5000mg/L-10000mg/L (or disinfectant wipes/dry wipes capable of high level disinfection) carefully removed
.
To deal with a large amount of pollutants, it should be completely covered with disinfectant powder or bleaching powder containing water-absorbing components, or fully covered with disposable water-absorbing materials, and then pour a sufficient amount of effective 5000mg/L-10000mg/L chlorine-containing disinfectant on the water-absorbing material.
For more than 30 minutes (or a disinfectant dry towel that can achieve high-level disinfection), carefully remove it
.
Avoid contact with pollutants during the removal process, and the cleaned pollutants are disposed of in a centralized manner as medical waste
.
The patient's secretions, vomitus, etc.
should be collected in a special container, and the chlorine-containing disinfectant with effective chlorine of 20,000 mg/L should be soaked and disinfected for 2 hours according to the ratio of 1:2 of substance and medicine
.
After removal of contaminants, the surfaces of contaminated environmental objects should be disinfected
.
Containers containing pollutants can be disinfected by soaking in a chlorine-containing disinfectant solution containing 5000 mg/L of effective chlorine for 30 minutes, and then dechlorinated for cleaning
.

(7) Disinfection of vehicle-mounted equipment and first aid supplies: Disposable medical consumables are recommended for supplies such as oxygen humidification devices, ventilator pipes, and negative pressure suction pipes
.
Visiting boxes, car stretchers, etc.
are wiped and disinfected with chlorine-containing disinfectant with effective chlorine of 1000mg/L
.
Ear thermometers, stethoscopes, defibrillators, electrocardiographs, etc.
can be wiped and disinfected with 75% ethanol or disinfectant wipes with the same effect, and should be wiped twice
.
Supplies (mobile phones, precision instruments, etc.
) that cannot be disinfected by the above methods are sealed with transparent plastic films and bags, and replaced each time
.
The disinfection and sterilization of other medical devices shall be carried out in accordance with national regulations
.

6.
Ambulance disinfection process

①After completing the task, the non-negative pressure ambulance can open windows for ventilation and/or mechanical ventilation according to the conditions on the way back.
The negative pressure ambulance should keep the doors and windows closed, and the negative pressure will continue to open
.
If the negative pressure vehicle is equipped with an on-board steam (gas)/dry mist hydrogen peroxide sterilizer, it can be operated by the driver in the cab, the negative pressure is turned off, the disinfection device is turned on and timed (when the medical cabin is unmanned)
.

② When the vehicle returns to the decontamination site, the car keys, communication mobile phone, mobile terminal equipment and other items in the cab should be placed in the designated place for disinfection, and it is strictly prohibited to bring them into the personal hygiene disposal area; 75% ethanol disinfectant or chlorine-containing disinfectant with effective chlorine of 1000mg/L is sprayed, wiped and disinfected, and then dechlorinated and cleaned
.

③The cab is disinfected
.
Refer to the disinfection method of the medical cabin.
It is advisable to use wipe disinfection or steam (gas)/dry mist hydrogen peroxide sterilizer for disinfection
.
Pay attention to the protection of the cab instrument panel, GPS display screen and other devices, it is recommended to use 75% ethanol disinfectant to wipe and disinfect
.

④Disinfection of medical cabin
.
Use effective chlorine 1000mg/L chlorine-containing disinfectant or 500mg/L chlorine dioxide disinfectant to spray, wipe and disinfect the interior environment and surface of the car, remove chlorine after 30 minutes of action, and cooperate with ultraviolet radiation equipment to irradiate the air for ≥ 1 hour , to achieve the final disinfection effect
.
If conditions permit, you can use an ultra-low volume electric aerosol sprayer or a steam (gas)/dry mist hydrogen peroxide sterilizer for spray disinfection, and then ventilate and clean after the standing and airtight time is reached
.
Note that vehicle-mounted precision instruments and equipment that cannot be disinfected with disinfectant spray should be covered with a disposable isolation sheet
.
After removing the isolation sheet, wipe and disinfect with less corrosive and effective disinfectant such as 75% ethanol disinfectant
.
Disposable isolation sheets are disposed of in accordance with medical waste regulations
.

⑤ Wash the outside of the car
.

⑥ After the ambulance has been disinfected and cleaned, drive into the clean parking area (enhanced ventilation)
.

Respiratory Occupational Exposure Handling Process

1.
Respiratory exposure

Lack of respiratory protection measures, when the respiratory protection measures are damaged (such as the mask is loose, falling off, etc.
), and the use of ineffective respiratory protection measures (such as the use of masks that do not meet the requirements of the specification) is in close contact with patients diagnosed with new coronary pneumonia; contact with hands contaminated by the new coronavirus nose,
etc.

2.
Disposal process

1.
When medical personnel are exposed to respiratory tract occupations, they should immediately take measures to protect the respiratory tract (cover the masks with their hands after standard hand hygiene or urgently add a layer of masks, etc.
), and evacuate the contaminated area according to the prescribed procedures
.

2.
Emergency through the removal area and remove the protective equipment according to the specifications
.

3.
According to the situation, clean and disinfect the oral cavity or/and nasal cavity with water, 0.
1% hydrogen peroxide solution, iodophor, etc.
, and leave after wearing a medical surgical mask
.

4.
Report to the director of the department concerned, the head nurse and the competent department of the medical institution in a timely manner
.

5.
Medical institutions should organize experts to conduct risk assessment as soon as possible, including confirming whether isolation medical observation, preventive medication, psychological counseling, etc.
are necessary
.

6.
High-risk exposures are managed as close contacts and quarantined for 14 days for medical observation
.

7.
Fill out the occupational exposure record form of medical staff with new coronary pneumonia in time, especially the reasons for exposure, and carefully summarize and analyze to prevent the occurrence of similar incidents
.