Emergency & disaster management
Health and wellness
Trainer’s Corner: Don and doff with care
By Ed Brouwer
I was about to submit my column for this issue’s Trainer’s Corner ironically entitled “Situational Awareness”, but it felt irrelevant considering the current state of affairs in our country.
On March 18, the total confirmed cases of COVID-19 was recorded as 216,480. This number represents 123,177 active cases: 84,409 recovered cases and 8,894 fatal cases.
On that same day the total confirmed cases in Canada was recorded as 644. This includes 623 active cases, 12 recovered cases and nine fatal cases.
This information will have changed several times by the time you read this. In fact, just as of March 23 the total confirmed cases are recorded as 351,705 worldwide, and Canada recorded a rise to 1,472.
The thing to remember is that this “updated” information is compiled from stats a week old. And that is somewhat disconcerting in this rapidly evolving situation.
I feel this article will be deemed a bit like closing the barn doors after the horses have run out. However, having said that, I encourage you to look back and record what worked and what didn’t work during this pandemic. Certainly, we should learn from our history. What PPE didn’t you have? What SOGs need to be revamped?
One disturbing observation for me as a first responder is the number of Canadians who were, at this time, not taking this serious enough. The Vancouver Sun reported, that according to a new poll, Canadians still thought it was OK to gather in groups despite warnings from health officials to stay home. The Research Co. survey they quoted found that while most Canadians agree they must do their part to stop the COVID-19 outbreak, 30 per cent still think it’s “reasonable” to hold a gathering of up to 10 people.
We have been informed by the World Health Organization that the level of infectiousness, or ease of transmission, is still unclear. The coronavirus appears to spread via close contact (two meters) with infected people and/or spreads through exposure to the large droplets created from coughing or sneezing.
It is important to note that all viruses have an incubation period. The incubation period is the period between the exposure of an individual to a pathogen (virus) and the beginning of the illness or disease it causes.
Despite best efforts to contain COVID-19, cases continued to rise worldwide. That was the reason first responders were asking patients whether they had traveled outside of Canada, and or whether they had attended a mass gathering event with international attendees within Canada in the 14 days before onset of illness. They were also asked if they had been in close contact with a confirmed/probable case of COVID-19, or had they been in close contact with a person with acute respiratory illness who has travelled outside of the Canada, or attended a mass gathering event with international attendees within 14 days prior to their illness onset.
If the answer was yes to the above, first responders were to immediately implement droplet and contact precautions and mask the patient. Far too many of our first responder fire departments were not ready for the level of response required. We found ourselves facing a new enemy with too little information, not enough PPE, a lack of medical supplies and equipment, changing protocols every single day and no “do overs”.
Firefighters are responding to increasingly infectious environments: COVID-19 has caused the quarantine of many firefighters. That itself puts a great strain on our resources. Without proper PPE for these types of incidents, we send our first responders in wearing coveralls or bunker gear, and that sets us up for cross contamination. Not every department had gowns, or proper eye protection. This must be addressed for future events.
At the very least our members must take donning (putting on) and doffing (taking off) of PPE much more seriously. It is important they understand that they are at greatest risk to contaminate themselves when removing PPE.
Please note the order of the following safety protocols:
- Removing gloves
- Clean hands with alcohol-based hand rub (ABHR) unless visibly soiled
- Remove gown
- Clean hands with ABHR unless visibly soiled
- Remove eye protection
- Remove mask
- Clean your hands with ABHR unless visibly soiled
If your hands are visibly soiled, proper handwashing with soap and water must be performed. Reusable PPE such as goggles must be properly cleaned, decontaminated, and maintained after and between uses. Goggles should be cleaned according to manufacturer’s directions.
The cornerstone of infection control is handwashing using soap and water or the prepared alcohol-based gels. The Centers for Disease Control and Prevention (CDC) recommends everyday preventive actions to help prevent the spread of respiratory diseases: avoid close contact with people who are sick, avoid touching your eyes, nose, and mouth, stay home when you are sick, and cover your cough or sneeze with a tissue, then throw the tissue in the trash. Clean and disinfect frequently touched objects and surfaces. Get into these habits not only for yourself, but for your family and fellow firefighters.
The CDC also recommends that you adhere to your SOGs and SOPs for your department when responding to a known or unknown infection hazard occupancy, keeping in mind airborne precautions including the use of eye and respiratory protection.
Just as we instruct our firefighters that there is no such thing as a routine fire, we need to teach them to assume that every person is potentially infected or colonized with a pathogen that could be transmitted to them as a first responder
I cannot express how important it is to pay strict attention to training on the correct use, proper donning (putting on) and doffing (taking off), and cleaning or disposal of any PPE.
The last thing we need is for our fire halls to become incubators for infectious or contagious diseases. Be sure to diligently clean your station and your apparatus after each response.
Unfortunately, during the initial response firefighters may not know they have been exposed to COVID-19 until later. That is why it is extremely important for responders to follow recommended infection control procedures.
Properly handle, clean, and disinfect individual care equipment, instruments, and devices. Non-disposable items that come into contact with an individual who potentially may be infected must be cleaned / disinfected. This includes things you may not usually think of, such as clipboards, pens, pencils, etc. All disposables must be disposed of properly. Package, transport, and store clean textiles or uniforms so they are protected during transport and unloading so they’re clean for future usage.
No, I’m not saying you need to respond in a full-blown Hazmat suit, but you must take this seriously.
Our members need to be diligent about following these recommendations and procedures to minimize exposure to respiratory diseases. Whatever the state of the COVID-19 pandemic may be at the time this article goes to press, these critical safety protocols stand for all infectious diseases — now and for the future.
Please, stay safe out there and remember to train like lives depend on it, because as we are witnessing, they do.
Ed Brouwer is the chief instructor for Canwest Fire in Osoyoos, B.C., deputy chief training officer for Greenwood Fire and Rescue, a fire warden, wildland urban interface fire-suppression instructor and ordained disaster-response chaplain. Contact Ed at email@example.com.