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COVID-19 Pre-Hospital/Emergency Medical Services (EMS) Resources
Topic Collection
November 14, 2023

Topic Collection: COVID-19 Pre-Hospital/Emergency Medical Services (EMS) Resources

This collection provides examples of promising practices, templates and other resources for addressing issues and challenges associated with the COVID-19 pandemic health emergency for two key decisionmakers in Emergency Medical Services (EMS): (1) EMS Administrators and Medical Directors and (2) the 911 System [911 Public Safety Answering Point (PSAP)/Emergency Communications Center (ECC) personnel].

This Resource Collection was reviewed in Fall 2023. Please refer to CDC’s Coronavirus Disease 2019 webpage for the most up-to-date clinical guidance on COVID-19 outbreak management.

If you have COVID-19 promising practices, plans, tools, or templates to share with your peers, please visit the ASPR TRACIE Information Exchange COVID-19 Information Sharing Page (registration required) and place your resources under the relevant topic area. Resources specific to pre-hospital and EMS can be placed under the COVID-19 Pre-Hospital/EMS Resources Topic.

NOTE: inclusion of any reference in this document does not constitute an endorsement, acknowledgment, or suggestion that the reference is the only or best example for that topic. References are included as examples which were provided as suggestions at the time the document was developed.

All guidance posted is accessible to the public, and non-federal resources are noted with an asterisk (*). Linking to a non-federal website does not constitute an endorsement by the U.S. government, or any of its employees, of the information and/or products presented on that site. 

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911 System- Caller Screening Resources

Association of Public-Safety Communications Officials-International (APCO). (2020). Recommendations Regarding Caller Interrogation *.
This guidance provides sample language 911 systems can use, in consultation with their local medical authorities, to screen for potentially positive viral illness.
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NENA The 9-1-1 Association (NENA). (2020). Coronavirus (COVID-19) Resources.
This list of Coronavirus (COVID-19) resources was compiled by NENA for the 9-1-1 community.
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911 System- Caller Triage & Referral to Non-Emergency Resources

Smith, W., Culley, L., Plorde, M., et al. (2001). Emergency Medical Services Telephone Referral Program: An Alternate Approach to Nonurgent 911 Calls *. Prehospital Emergency Care. 5(2): 174-180.
This study examines the effects of transferring nonurgent 911 calls to a telephone consulting nurse. Transferring 911 calls to a nurse line resulted in fewer BLS responses and no adverse patient outcomes, while maintaining high patient satisfaction.
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911 System- Continuity of Operations Plan (COOP)

Centers for Disease Control and Prevention. (2009). Coordinating Call Centers for Responding to Pandemic Influenza and Other Public Health Emergencies.
This workbook provides guidance for coordinating call centers’ response to pandemic influenza and other public health emergencies.
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Federal Communications Commission. (2016). Emergency Planning: Public Safety Answering Points.
This webpage provides guidelines to help Public Safety Answering Points ensure their continuity of operations and manage the security and operability of their communications systems and networks during emergencies.
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Federal Emergency Management Agency. (n.d.). Continuity of Operations: An Overview of Continuity Planning for Pandemic Influenza. (Accessed 8/20/2020.)
This one-page brochure provides an overview of continuity of operations planning for pandemic influenza.
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Federal Emergency Management Agency. (n.d.). Pandemic Influenza Continuity of Operations Annex Template Instructions. (Accessed 8/20/2020).
This template can help organizations develop their Pandemic Influenza Continuity of Operations Plan and/or Annex.
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National Emergency Number Association. (2020). Customizable Influenza COOP Outline *.
This outline can help 911 Public Safety Answering Point (PSAP)/Emergency Communications Center (ECC) managers/911 agencies in the preparation of a COVID-19 continuity of operations plan.
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911 System- General Resources

NENA: The 911 Association. (n.d.). Sample Pandemic Influenza EMS Dispatch Protocol *. (Accessed 5/5/2020.)
This sample pandemic influenza EMS dispatch protocol illustrates how resources can be reallocated during a pandemic.
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NENA: The 911 Association (NENA). (2020). Initial Impacts of COVID-19 on 9-1-1 Centers *.
This report summarizes trends in call volume and nature during the COVID-19 pandemic.
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911 System- Managing Expectations

Centers for Disease Control and Prevention. (2020). 10 Things You Can do to Manage Your COVID-19 Symptoms at Home.
This fact sheet dated 5/11/2020 provides guidance for managing symptoms at home.
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911 System- Telehealth Resources

Centers for Medicare & Medicaid Services. (2020). General Provider Telehealth and Telemedicine Toolkit.
This document contains links to reliable sources of information regarding telehealth and telemedicine, including specific documents that will be useful in choosing telemedicine vendors, initiating a telemedicine program, monitoring patients remotely, and developing documentation tools. Information is also included for providers who wish to care for patients through the virtual services that may be temporarily used during the COVID-19 situation.
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U.S. Department of Health & Human Services. (2020). Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency.
This webpage describes how the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered healthcare providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency.
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U.S. Department of Health and Human Services, Office for Civil Rights. (2020). Disclosures to Law Enforcement, Paramedics, Other First Responders and Public Health Authorities.
This notice from the Office for Civil Rights answers questions about how law enforcement, paramedics, other first responders, and other public health authorities can receive information about an individual who has been infected with or exposed to the coronavirus without an individual’s authorization under the HIPAA Privacy Rule.
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Clinical Rounds

Office of the Assistant Secretary for Preparedness and Response. (2020). National COVID-19 Clinical Rounds: Emergency Department - Interfacility Transfers (6/4/2020). U.S. Department of Health and Human Services.
This webinar is part of the National COVID-19 Clinical Rounds hosted by ASPR, Project ECHO, NETEC, and other public-private partners. This emergency department session focused on interfacility transfers and featured speakers from Air Methods Corporation and Vidant EastCare.
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Office of the Assistant Secretary for Preparedness and Response. (2020). National COVID-19 Clinical Rounds: EMS - Response to COVID-19 and Protests (6/8/2020). U.S. Department of Health and Human Services.
This webinar is part of the National COVID-19 Clinical Rounds hosted by ASPR, Project ECHO, NETEC, and other public-private partners. This session focused on the EMS response to COVID-19 and protest activity and featured presentations from Hennepin EMS and Seattle and King County EMS.
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Office of the Assistant Secretary for Preparedness and Response. (2020). National COVID-19 Clinical Rounds: EMS (5/11/2020). U.S. Department of Health and Human Services.
This webinar is part of the National COVID-19 Clinical Rounds hosted by ASPR, Project ECHO, NETEC, and other public-private partners. This session focused on emergency medical services from the Memphis Fire Department and Hennepin EMS.
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Office of the Assistant Secretary for Preparedness and Response. (2020). National COVID-19 Clinical Rounds: EMS (5/18/2020). U.S. Department of Health and Human Services.
This webinar is part of the National COVID-19 Clinical Rounds hosted by ASPR, Project ECHO, NETEC, and other public-private partners. This session focused on emergency medical services featured speakers from the State of Alaska Emergency Programs and Pagosa Springs Medical Center.
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Office of the Assistant Secretary for Preparedness and Response. (2020). National COVID-19 Clinical Rounds: EMS Resources (4/10/2020). U.S. Department of Health and Human Services.
This webinar is part of the National COVID-19 Clinical Rounds hosted by ASPR, Project ECHO, NETEC, and other public-private partners. This webinar focused on emergency medical services. Speakers from Seattle and King County EMS and Global Medical Response shared their observations and lessons learned.
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Office of the Assistant Secretary for Preparedness and Response. (2020). National COVID-19 Clinical Rounds: EMS Resources (4/20/2020.). U.S. Department of Health and Human Services.
This webinar is part of the National COVID-19 Clinical Rounds hosted by ASPR, Project ECHO, NETEC, and other public-private partners. Speakers from the Detroit Fire Department/Wayne State University and Emory University School of Medicine shared their observations and lessons learned from the emergency medical services perspective.
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Office of the Assistant Secretary for Preparedness and Response. (2020). National COVID-19 Clinical Rounds: EMS Resources (4/27/2020.). (Added 5/12/2020.) U.S. Department of Health and Human Services.
This webinar is part of the National COVID-19 Clinical Rounds hosted by ASPR, Project ECHO, NETEC, and other public-private partners. This webinar focused on emergency medical services featured presenters from Boston Emergency Medical Services and Wichita/Sedgwick County Kansas Division of Public Safety.
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Office of the Assistant Secretary for Preparedness and Response. (2020). National COVID-19 Clinical Rounds: EMS Resources (5/4/2020.). (Added 5/12/2020.) U.S. Department of Health and Human Services.
This webinar is part of the National COVID-19 Clinical Rounds hosted by ASPR, Project ECHO, NETEC, and other public-private partners. This webinar focused on emergency medical services featured presenters from the Dayton Fire Department and Ohio Department of Public Safety, Division of EMS.
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Office of the Assistant Secretary for Preparedness and Response. (2020). National COVID-19 Clinical Rounds: EMS Resources (6/1/2020). U.S. Department of Health and Human Services.
This webinar is part of the National COVID-19 Clinical Rounds hosted by ASPR, Project ECHO, NETEC, and other public-private partners. This session focused on emergency medical services featured speakers from Grady EMS and New Orleans EMS.
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EMS Administrators/Medical Directors - Crisis Standards of Care

COVID-19 Healthcare Resilience Working Group. (2020). COVID-19: Considerations, Strategies, and Resources for Emergency Medical Services Crisis Standards of Care.
This document provides an overview of general considerations, potential strategies, and existing resources that emergency medical services (EMS) agencies may use to inform changes to their operations and standards of care to preserve and effectively allocate EMS during the COVID-19 pandemic.
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* Edelson, D., Sasson, C., Chan, P., et al. (2020). Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19*.
This Consensus Report from the Emergency Cardiovascular Care Committee and Get With the Guidelines - Resuscitation Adult and Pediatric Task Forces of the American Heart Association in collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, American Society of Anesthesiologists, American Association of Critical Care Nurses, and National EMS Physicians provides guidelines for treatment of cardiac arrest in patients with suspected or confirmed COVID-19.
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Hanfling, D., Hick, J., and Stroud, C. (2013). Crisis Standards of Care: A Toolkit for Indicators and Triggers – Table 7.1. (Free registration required.) Institute of Medicine, Washington, DC: National Academies Press.
Table 7.1 provides specific indicators, triggers, and tactics for EMS to use along the continuum of care during the COVID-19 pandemic.
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Hanfling, D., Hick, J., and Stroud, C. (2013). Crisis Standards of Care: A Toolkit for Indicators and Triggers *. (Free registration required.) Institute of Medicine: National Academies Press.
This toolkit contains key concepts, guidance, and practical resources to help individuals across the emergency response system develop plans for crisis standards of care. Chapter 7 includes sample indicators, triggers, and sample tactics for use in the transition from conventional surge to contingency surge to crisis surge, and a return from crisis response to conventional response (detailed specifically for emergency medical services using slow-onset and no-notice scenarios).
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Minnesota Metro Region EMS System. (2020). Crisis Contingency Strategies *.
This flow chart from 3/12/2020 depicts real-time and shift adaptations to allow EMS systems to transition among conventional, contingency, and crisis strategies while responding to the COVID-19 pandemic.
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National Highway Traffic Safety Administration (NHTSA) Office of EMS. (2007). EMS Influenza Pandemic Guidelines for Statewide Adoption.
This document provides broad-based pandemic influenza guidelines for consideration by state and local emergency medical services agencies, including the basic planning assumptions underpinnings those recommended guidelines.
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National Highway Traffic Safety Administration, Office of EMS. (2020). Crisis Standards of Care and COVID-19: What EMS Needs to Know.
This webinar posted 3/26/2020 provides an overview of why crisis standards of care (CSC) planning is critical in the pre-hospital setting, implications for leaders who implement CSC in their communities, and an example of one state's preparedness for emergency medical services surge.
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EMS Administrators/Medical Directors - Employer’s Responsibility Regarding Personal Protective Equipment

Baxter, C. and Stull, J. (2020). Balancing the Risk - Strategies for Respiratory Protection During a Pandemic *. The Interagency Board for Emergency Preparedness and Response.
This document from 4/10/2020 describes a phased approach to risk management for first responders based on the availability of respiratory personal protective equipment during the COVID-19 pandemic.
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Centers for Disease Control and Prevention. (2020). Use Personal Protective Equipment (PPE) When Caring for Patients with Confirmed or Suspected COVID-19.
This fact sheet dated 6/3/2020 from the Centers for Disease Control and Prevention highlights the need for and importance of healthcare personnel training and competency on the donning, doffing, care, maintenance and disposal of personal protective equipment. Access a poster for this resource at https://www.cdc.gov/coronavirus/2019-ncov/downloads/A_FS_HCP_COVID19_PPE_11x17.pdf. An illustration of the correct PPE requirement is available for download at https://www.cdc.gov/coronavirus/2019-ncov/downloads/COVID-19_PPE_illustrations-p.pdf
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National Institute of Environmental Health Sciences (NIEHS). (2020). Protecting Yourself from COVID-19 in the Workplace.
This training dated 4/2020 provides health and safety awareness for responders and workers with potential COVID-19 exposure.
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EMS Administrators/Medical Directors - Health Monitoring- Caregiver Well Being (Including Mental Health)

COVID-19 Health Care Resilience Taskforce. (2020). Managing Patient and Family Distress Associated with COVID-19.
These strategies can help healthcare providers in hospitals and alternate care settings ease stress and anxiety experienced by patients during infectious disease outbreaks.
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COVID-19 Health Care Resilience Taskforce. (2020). Mitigate Absenteeism by Protecting Emergency Medical Service (EMS) Clinicians' Psychological Health and Well-being during the COVID-19 Pandemic.
This document contains general concepts to prepare and take action to help EMS/911 agencies protect the psychological health and wellbeing of workers.
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EMS Administrators/Medical Directors - Health Monitoring- Sample Employee Occupational Health Surveillance Protocol

Global Medical Response (GMR). (2020). COVID-19 Guidelines for GMR Call Intake Centers *.
This document provides guidance in preparation for and response to COVID-19 for Global Medical Response Call, Billing, Membership, Communication, Operation and Maintenance Control Centers.
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EMS Administrators/Medical Directors - Organizational Infection Control

Centers for Disease Control and Prevention. (2020). Strategies for Optimizing the Supply of N95 Respirators.
This webpage updated 6/28/2020 provides strategies for optimizing the supply of N95 respirators.
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Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH). (2020). NIOSH-Approved N95 Particulate Filtering Facepiece Respirators.
This webpage updated 6/19/2020 provides a list of NIOSH-approved N95 respirators, alphabetically by manufacturer.
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World Health Organization. (2020). Preventing Infection of COVID-19 During Healthcare *.
This interim guidance from 3/19/2020 is intended for healthcare workers, healthcare managers and infection prevention and control teams and includes strategies for use when a COVID-19 infection is suspected.
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EMS Administrators/Medical Directors - Personal Protective Equipment Decontamination

N95DECON. (2020). N95 Decontamination *.
This website contains quantitative studies on N95 filtering facepiece respirator decontamination.
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The Interagency Board for Emergency Preparedness and Response. (2020). Minimum Recommended Guidance on Protection and Decontamination for First Responders Involved in COVID-19 Cases - Detailed Reaction Guide.
This document from 4/10/2020 details personal protective equipment (PPE) considerations for first responders to protect against inhalation, ocular, and dermal exposures to SARS-CoV-2; donning, use, and doffing considerations; cleaning, sanitizing, and disinfecting considerations; decontamination and disinfection procedures and considerations for vehicles, apparatus, and fire stations; and waste management considerations.
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U.S. Food & Drug Administration. (2020). Letter Permitting Medical Use of all NIOSH Approved N95.
This letter dated 3/28/2020 from the U.S. Food & Drug Administration authorizes emergency use of (1) all disposable filtering facepiece respirators (FFR) approved by the National Institute for Occupational Safety and Health (NIOSH) in accordance with 42 CFR Part 84, as non-powered air-purifying particulate FFRs, and (2) FFRs that were NIOSH-approved but have since passed the manufacturers’ recommended shelf-life, for use in healthcare settings by healthcare personnel (HCP)2 to prevent wearer exposure to pathogenic biological airborne particulates during FFR shortages resulting from the Coronavirus Disease 2019 (COVID-19).
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EMS Administrators/Medical Directors - Sustainability of Operations Through a Pandemic

Federal Emergency Management Agency. (2020). FEMA Administrator March 27, 2020, Letter to Emergency Managers Requesting Action on Critical Steps.
This letter from the FEMA Administrator includes specific guidance for emergency managers.
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United States Fire Administration (USFA). (2020). Information for First Responders on Maintaining Operational Capabilities During a Pandemic.
This document revised 3/20/2020 can support first responders’ efforts to provide the best possible service to their team and their community. Information is provided under three main categories: adjusting operations to maintain readiness and response, planning at the local level (a tool is included), and innovative planning and operations concepts. Reference sheets that list action steps are also included.
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EMS Administrators/Medical Directors - Workforce Expansion Resources

Global Medical Response (GMR). (2020). Interim Guidance on Card Extensions during COVID19 Outbreak *.
This guidance document from 3/31/2020 provides additional flexibility for providers, American Heart Association instructors, and instructor candidates during the COVID-19 pandemic.
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National Registry of Emergency Medical Technicians (NREMT). (2020). NREMT Extends Certification and Waives Distributive Learning Limit *.
The National Registry's Board of Directors approved a motion extending the current recertification deadline from March 31, 2020 to September 30, 2020. Additionally, for registrants due to recertify March 31, 2020 Distributive Education limitations will be removed. This allows all continuing education to be accomplished outside of classrooms.
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State of Maine, Department of Public Safety. (2020). Extension of Maine EMS Service Licenses *.
This notification is specific to Maine emergency medical service (EMS) licenses and states that all EMS services whose license expires in March, April, or May 2020, and are not able to meet all requirements for service re-licensure by their current expiration date deadline, will have their deadlines for re-licensure extended to June 30, 2020.
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EMS Administrators/Medical Directors - Workforce Expansion Strategies

National Registry of Emergency Medical Technicians (NREMT). (2020). FAQs about Provisional Certification *.
This document from 3/26/2020 provides responses to frequently asked questions about provisional certification.
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Plans, Tools, and Templates

ASPR TRACIE. (2023). EMS Infectious Disease Playbook.
This playbook (updated in 2023) synthesizes multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for emergency medical services (EMS) agencies developing their service policies. The information can be incorporated into agency standard operating procedures and reviewed by the EMS medical director.
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  • Bridget Kanawati Thank you for your interest in this resource. Unfortunately, funding restrictions preclude our being able to provide printed versions of our resources so all of our products, including this one, are only available electronically. ASPR TRACIE Team
    3/26/2020 2:12:41 PM
  • Frances Thorpe I agree with Tracy, is there a way to order this publication in hard copy format? The information contained in this publication highlights agency infection control policies and is a great resource to have in the department library.
    3/26/2020 12:21:36 PM
  • Tracy Miller Is there any way to order a printed and bound version?
    8/9/2018 5:16:09 PM
Healthcare Resilience Working Group. (2021). EMS Supplement for the Medical Operations Coordination Cells (MOCC) Tool Kit. National Highway Traffic Safety Administration, Office of EMS.
This supplement to the Medical Operations Coordination Cells (MOCC) Toolkit (https://files.asprtracie.hhs.gov/documents/fema-mocc-toolkit.pdf) provides information on emergency medical services (EMS) and transportation issues. It includes information on coordination and planning with partners before, during, and after transport; medical oversight; standard operating procedures; personnel; infection control; ambulance preparation and configuration; and patient preparation.
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Massachusetts Department of Public Health. (2020). Emergency Measures Relating to EMS Due to COVID-19 Outbreak *.
This memo from 3/20/2020 is an example of statewide emergency measures to protect EMS personnel and first responders during the COVID-19 response. It updates statewide treatment protocols, allows ambulance transport to designated alternate sites on hospital grounds, clarifies the unprotected exposure protocol, updates the PSAP response, provides considerations for ambulance services, outlines post-transport cleaning, and addresses scene management, initial assessment, transport, treatment, and PPE for patients with a risk of COVID-19 infection.
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Minnesota Metro Region EMS System. (2020). COVID-19 Response Matrix *.
This table from 3/12/2020 summarizes conventional, contingency, and crisis strategies for EMS systems related to dispatch, staffing, personal protective equipment, and supplies as well as decisions about which responders to send, patient destination, and lefts.
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Minnesota Metro Region EMS System. (2020). Pandemic Response Matrix.
This document from 3/12/2020 outlines the standing orders that EMS directors may implement during crisis conditions to provide the best pre-hospital care and transport guidance to the most people. It outlines the following options for 22 different scenarios: transport by EMS, transport by law enforcement, referral to use alternate transportation to a medical facility, referral to a clinic or other medical facility, and provision of home care information.
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National Association of State EMS Officials. (2020). COOP - Planning Outline Guidance.
This template guides the development of a continuity of operations plan during COVID-19 for public safety access points or emergency medical services agencies. A Word version is also available for customization at https://nasemso.org/nasemso-document/coop-plan-outline-for-ems-and-psap/.
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Northwest Community Emergency Medical Services System. (2020). Corona Virus Disease (COVID-19) EMS Playbook. (Added 12/15/2020.)
This document compiles information relevant for emergency medical service professionals during the COVID-19 pandemic and will be updated over time.
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Office of the Assistant Secretary for Preparedness and Office of EMS. (2021). EMS Template Protocol for COVID-19 Monoclonal Antibody Administration. U.S. Department of Health and Human Services and U.S. Department of Transportation.
This template protocol is intended to assist state emergency medical services (EMS) offices and EMS medical directors planning for their personnel to assist in the administration of monoclonal antibodies for the treatment or post-exposure prophylaxis of COVID-19.
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Resources for First Responders

ACLS Training Center. (2020). Resuscitation of COVID-19 Patients. (Added 12/10/2020.)
This article provides an illustrated narrative about resuscitating patients with confirmed or suspected COVID-19, without risking contamination of healthcare providers or other patients.
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American Heart Association. (2020). Coronavirus (COVID-19) Resources for CPR Training and Resuscitation *.
This page includes several resources including guidance on basic and advanced life support, infographics, resuscitation algorithms, training courses, and podcasts.
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* Edelson, D., Sasson, C., Chan, P., et al. (2020). Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19*.
This Consensus Report from the Emergency Cardiovascular Care Committee and Get With the Guidelines - Resuscitation Adult and Pediatric Task Forces of the American Heart Association in collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, American Society of Anesthesiologists, American Association of Critical Care Nurses, and National EMS Physicians provides guidelines for treatment of cardiac arrest in patients with suspected or confirmed COVID-19.
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Federal Healthcare Resilience Task Force, EMS/Prehospital Team. (2020). Interim Guidance: SARS-CoV-2 (COVID-19) and Field Trauma Triage Principles.
This document provides a brief overview of the impact of COVID-19 on trauma triage for first responders, including emergency medical service, fire and rescue, and law enforcement.
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Washington State Department of Health. (2020). COVID-19 Interim Infection Control Guidance for Prehospital Emergency Medical Services (EMS) *.
This document from 3/6/2020 provides links to current CDC guidance applicable to EMS providers and systems. It provides general considerations followed by action steps under the following categories: assessment criteria, patient transport, PPE, safe work practices, documentation, post-transport management of the contaminated vehicle, and follow-up of EMS personnel.
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Agencies and Organizations

EMS Online. COVID-19 - Infectious Disease Safety Information *.
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National Association of Emergency Medical Technicians. Coronavirus (COVID-19) *.
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National Association of EMS Physicians. COVID-19 Resources *.
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National Association of State EMS Officials. COVID-19 Resources.
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National Highway Traffic Safety Administration, Office of EMS. Coronavirus/COVID-19 Resources for EMS.
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