STARSCOVIDClinicalCommunicationWorkingGroupUpdateTo:STARSOperationalCrew,Pilots,AMC,TP’s,ELCandEngineersDATE22ndMay2020

This COVID-19 communication is provided on behalf the COVID Working Group. It is continuing to provide recent updates and summaries of the key points, information, decisions and upcoming COVID-19 related changes for STARS Operational Staff.

 Pleasereview theseupdatesregularlyas theCOVID‐19pandemicresponsecontinuestoevolve.Updatesnowcomeoutevery2weeks.

We continue to work closely with our various Provincial Health services and partners. It is important that you familiarize yourself with your relevant Provincial recommendations (including EMS and Fixed Wing services) as they may differ from the STARS perspective. These operational communications can be referenced under the “Operations” section of http://stars.ca/covid-19. NEW and UPDATED files are available. Please ensure that you’re also talking about these at shift changes, and any operational meetings that may be occurring. Information is evolving quickly, and we want to ensure there are multiple forums for operational staff to remain current.

HIGHLIGHTS 1) BaseOutofService: We are now reverting back to the original process for duty crews to inform ELC for BOOS duration. Teams will now be pre-alerted for pending missions. 2) MissionProfiles:Mission volumes are increasing across all bases, particularly with increasing trauma. ILI volumes are reducing from 13% to 10.5%. 3) PPEUpdate: ongoing testing and fitting continues for reusable N95 masks for AMC.

4) EducationRe‐LaunchStrategy:The Education Team has been working hard on a re-launch strategy for STARS CME. Details for upcoming Educational events, courses, ASI and more below.

5) EducationRounds:Thanks to recent presentations by Dr. Chase Krook (Calgary TP) and Dr. Darren Hudson (Edmonton TP).

Next Educational Rounds from Calgary: Dr. Jamin Mulvey, incoming Medical Director Calgary base, "Working intheUrban Jungle:LondonAirAmbulanceandtheGoldenHour", Wednesday June 10th at 7pm. Zoom invite to follow.

6) UpdatedSTARSEducationResources:3 NEW and 2 UPDATED documents are now available http://stars.ca/covid-19. The New documents relate to our HCID/COVID SIM. This will be formally delivered by Base Educators shortly, however, please watch the video, review the resources and work through them while on shift. Thanks for the Education and Airway teams for all their work.

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OPERATIONALUPDATES

Theabovepoints1-4areexpandeduponbelow.

1)BaseOutofService(BOOS):

BasedonfeedbackfromAMCandpilots,andthereducednumberofpositiveCOVIDtransports,wearegoingtorevertbacktoouroriginalprocedureforpre-alerts.ELCwillnowpre-alertcrewsforpendingmissionsandthecrewwillneedtomakethedeterminationofserviceabilityandtimerequiredtodecontaminatetheaircraftinsteadofanautomaticBOOS.IfthecrewelectstoputtheBOOSfordecontaminationpurposes,ortobeuninterruptedwhilsttransportingapatientusingPPE,thedutycaptainshallbeaccountabletoensurethisiscommunicatedtotheELC. 2)MissionVolumeandProfiles:Whilevolumeisstillslightlylowerthanthepasttwoyears,wearebeginningtoseeournormalsummermissionvolumepickupaspeoplestarttoventureoutside.Requestsandpatienttransportsarebacktopre-COVIDvolumesandMaylongweekendsawourusualcasesoftraumarelatedtooffroadvehicles!TransportsrelatedtoILIarebeginningtotrenddownto10.5%overall,aligningwithlowerpositivecasereportingthroughoutourprovinces.

Figure1.PercentageofMissionType,Aprilvs.May2020

Figure2.VolumeofRequests/Missions/PatientsoverMay2020

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3)PPEUpdate:

WearestillcontinuingtofittestAMContheMSAnon-disposableN95mask.Todate,Winnipeg,GrandePrairieandSaskatchewanAMChavebeentestedandfittedtothesemasks.Theprimaryguidingprincipletomovingtothesemasksistoallowustobeself-sustainableandnotrelyonprovincialN95stock.Wehavealreadybeenaskedtofittesttootherdisposablemasksandwebelievethatchangeswillcontinueasthepandemicpersistsandsupplychainsareimpacted.Wealsohopethatthesemaskswilldiminishthefoggingissue.ThePortacountmachineiscurrentlyisCalgaryandwillheadnorthsoon.WearestillreceivingfeedbackrelatedtocommunicationchallengeswiththemasksassomeAMCarereportingpositivecommsinthebackandothersreportingpoororinconsistentcomms.Wecontinuetotroubleshoottheseissuesincludingensuringthebi-directionalmicrophonesareplacedcorrectlyagainstthemask,microphoneboomlength,radioVOXtoliveandothertips.DecontaminationprocedureswillfollowshortlythroughthePPEWorkinggroupsandyourCOM’s.Standby.Wewillcontinuetoworkthroughthesechallenges.Weappreciateyourwillingnesstocomeinonshortnoticefortestingandhelpinguswithtroubleshooting!4)EducationRe-LaunchStrategy:

InresponsetotheCOVID-19Pandemic,allface-to-faceContinuingMedicalEducation(CME)waspaused.Sincethen,theclinicaleducationteamhasbeenworkinghardandpreparingforwhatthefuturemightlooklikeoverthenextyear,aswecontinuetoworkthroughsocialdistancingguidelines.Firstandforemost,wewanttocontinuetoensurecrewsafetyduringthesetimesandwewillcontinuetodoso.TheeducationteamranaverysuccessfulfinalweekofAcademyvirtuallyforourinternalAMCinApril.Whiletheteamexperiencedsomeminortechnicalglitches,thefeedbackoverallwasverypositivefrombothlearnerandeducatorperspectives.BasedonthissuccessweareexcitedtoannounceourCMEre-launchplanfortheremainderofthefiscalyear(untilMarch31,2021):ASI’s,AirwayCourse,VentilatorCourse:ThesecourseswillbedeliveredvirtuallythroughMoodleandZOOM.WeareplanningtoholdtheMedicalASI’saspreviouslyscheduled.Asthesecoursesarenowbeingheldvirtually,weareexcitedbythepotentialthatAMCfromallbasescanparticipatetogether.AnybasethathasmissedanASIduringtheeducationpausewillbere-scheduled.MonthlySimulationSessions:WewillresumeHPSagainstartinginJunewiththefollowingrestrictions:

• SocialDistancingisstillrequired.Groupsizesshouldnotexceed4people.• Masksshouldbewornwheresocialdistancingcannotbeachieved.• Thesamepre-shiftmedicalscreeningshalloccur.

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• Frequenthandwashingwithhandsanitizer/soapandwaterisrequired.• Disinfectantofmedicalequipment,suppliesandmannequinsbeforeand

aftereachsimulationisrequired.• Sessionscanbecancelledorpostponeddependingoncaseloadandriskof

transmission.• AMCdonothavetoparticipateiftheydonotfeelcomfortabledoingso.

EducationalRounds/AMCQuarterlyMeetings:RoundswillcontinuetobeofferedvirtuallythroughZOOMorTeams.Thereisnochangetomonthlyonlineeducation,skillchecklistsandintubationrequirements.ASI,ventilationandairwaycourseschedulesarebeingdecidedandwillbesentoutshortlybyyourbaseeducator.Weappreciateandunderstandtherichnessandbenefitsofface-to-faceeducationbutweareexcitedtobeabletodeliverourhighlyrespectedtrainingvirtually.Wewillcontinuetoaskforyourfeedbackasweevaluateandlooktoimproveforeachcourse.BurdenofStress:MessagefromDr.DennisNesdoly(AssociateChiefMedicalOfficer)ThecurrentCOVID-19Pandemichascreatedatleastthreeparallelcrises,withimpactsonglobalhealth,internationaleconomies,andcommunitypsychologicalwellbeing.Wemaynowbeconfrontingasurgeofphysicalandemotionalharmwithintheclinicalworkforceduetotheburdenofstress.Thisharmmayincludeanxiety,depression,orreducedsleepquality.Theanxietyandgriefassociatedwith‘lossoftheoldway’arepotentialtriggersforpost-traumaticstressdisorder.ThementalhealthoffrontlineteammemberswhoarecaringforpatientsduringanoutbreakofaHighlyContagiousInfectiousDisease[HCID]suchasCOVID-19mustnotbeoverlooked.Therecentinformalsurveyofoperationalfrontlineteamscollectedmorethan200viewsofperceivedhazardsthatwerecategorizedintothemes.ThemostprevalentitemsfocusedonExposure,PPE,CrewFatigue,andAircraftdecontaminationprocedures.AsignificantproportionofrespondentsratedtheirabilitytoworkeffectivelyduringthePandemicresponseasespeciallydifficult.Researchconductedduringpastinfectiousoutbreaksdocumentedgreaterlevelsofbothacuteorpost-traumaticstressandpsychologicaldistressforstaffindirectcontactwithaffectedpatients.Riskfactorsforpsychologicaldistressincludedyoungerage,morejuniorinprofession,parentsofdependentchildren,underquarantine,havinganinfectedfamilymember,lackofpracticalsupport,andstigma.

Interventionstooptimizetheresilienceofcliniciansworkingduringaviraloutbreakincludeclearcommunication,provisionoftrainingandeducationfocusedoninfectiousdiseases,accesstoappropriatesuppliesofprotectiveequipment,adequaterest,andbothpracticalandpsychologicalsupports.

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Psychologicalfirstaidincludestheassessmentofneedsandconcerns;practicalcareandsupport;dealingwithbasicneeds(food,water,information);empathiclistening;accesstoinformation,services,andsocialsupports;andprotectionfromfurtherharm.

Bycontrast,psychologicaldebriefingfocusingontraumaticexperiencesisnotusuallyhelpfulandcouldinterferewiththenaturalrecoveryprocess.

WorkingathomeduringCOVID-19restrictionsmayamplifystressorsrelatedtoconcernsforfamilymembers,‘virtual-schooling’challenges,orfinancialuncertainties.Ifyou’reworkingfromhome,takingrestorativemicro-breakshelpsencourageproductivity,improveperformanceandreduceerrors.Researchhasshownthatabreakthatincorporatesnatureprovidesthebestrestorativeeffect.Studiesdemonstratethatlimitingsocialmediatimeprovidestheessentialdisengagementtopromotecognitiverest.Theattachedgraphic‘FogofCOVID’mayoffersucha‘non-operational’distraction.

Thanksagainforallyourworkteam.

Besafe.Lookoutforeachother.Haveagreatweek.

Dr.JNArmstrong,Dr.DennisNesdoly,DaveEvansandDr.JaminMulvey

Progress Notes: The Fog of COVIDMichael Natter, MD

Ann Intern Med. 2020;172:W124-W125. doi:10.7326/G20-0030

ANNALS GRAPHIC MEDICINE Annals of Internal Medicine

W124 © 2020 American College of Physicians

To be of use   The people I love the best jump into work head first without dallying in the shallows and swim off with sure strokes almost out of sight. They seem to become natives of that element, the black sleek heads of seals bouncing like half-submerged balls.   I love people who harness themselves, an ox to a heavy cart, who pull like water buffalo, with massive patience, who strain in the mud and the muck to move things forward, who do what has to be done, again and again.   I want to be with people who submerge in the task, who go into the fields to harvest and work in a row and pass the bags along, who are not parlor generals and field deserters but move in a common rhythm when the food must come in or the fire be put out.   The work of the world is common as mud. Botched, it smears the hands, crumbles to dust. But the thing worth doing well done has a shape that satisfies, clean and evident. Greek amphoras for wine or oil, Hopi vases that held corn, are put in museums but you know they were made to be used. The pitcher cries for water to carry and a person for work that is real.   [Source: Circles on the Water: Selected Poems of Marge Piercy (Alfred A. Knopf, 1982)]

AdaptedfromAnnInternMed.2020;172:HO2-HO3.doi:10.7326/M20-1897