02 Jun Decontamination challenges in a pandemic
Firstly, I wish to pass on my personal thanks to all front-line responders during this period. It is often forgotten by the wider populace but you are literally on the front-line and literally run into the burning buildings whilst we evacuate. Your continued efforts and professionalism are the best of what humanity can be. It is often a thankless task and considering this though you commit to doing this every day. In this time of a global pandemic this is more than obvious.
This article is designed to lend my thoughts and opinions on the protection of front line firefighters – essential employees – in the work that they do for us every day… Saving lives. Thank you, writes Toby Hayward, FME’s international Health & Safety expert.
One of the first conversations that a situation like this brings to the fore is this “what is essential?”. This covers both products, staff and services. Much of the world continues to debate this and I will not spend too long on it as I do not wish to enter into any form of political discourse. In short, we have all had to change our approaches to what “essential” means. Some are newer to being realized than previously. PPE supply for example, or the internet! I have been guilty of telling my 14 year olds “you don’t need to be connected all the time!” – today it is essential. Or pivotal of what is essential has, for me, personally changed.
Others however, have always been the core of how we function. Power, fresh water, medical care, refuse collectors, farmers, food distribution etc. and emergency services. It is obviously the latter that we shall be focusing on in this article.
“Essential service personnel are still part of the population. Fires and accidents still occur”
The simple fact is that the fire services around the world are made of up people. They are those of us that put themselves on the line every day but they remain part of the population. They are not immune to pandemics. Also, just because the population of the planet has stayed at home, or if you prefer, moved to a lower risk environment, accidents and fires still occur and the essential work of the fire services remain.
Therefore, this portion of our population has to go to work. They cannot social distance (all the time!); they have to interact with the public; they have to work in close proximity. These are unassailable facts. They are at managed accepted risk every day anyway. During a pandemic however, they are essentially operating in a hazardous atmosphere – consistently.
“Isolation of fire personnel is impossible”
In a utopia it would be ideal to fully test and isolate all essential personnel throughout the tenure of the pandemic. However, this is just not a reality. Because they are people, not robots. They suffer from fatigue and worry just like the rest of us and hence need time to recharge and relax like us all. In fact, fatigue in the essential services can lead to the most devastating of consequences, both for the service personnel as well as the public as a whole. We struggle to manage this at the best of times, let alone now.
It should also be understood clearly, that an essential service should deserve the protection that they need to be able to operate. The sad loss of those within a pandemic not surprisingly includes essential service members. This is tragic but also reflects a direct loss to operability. So the management of the pandemic within the essential services is a clear cut requirement to maintain this operability.
So now we have agreed that we need to focus on the management of the pandemic within the essential service population, how is this achieved?
The above is stated in a circular from the Fire Brigades Union which is also provided in the reference section for those that need more advice. However, this will remain the core source document for advice going forward.
When fire brigade personnel are required to provide assistance to those who are symptomatic and may have COVID-19, wherever possible, place the person in a place away from others. If there is no physically separate room, ask others who are not involved in providing assistance to stay at least 2 metres away from the individual. If barriers or screens are available, these may be used.
In reference to the use of personal protective equipment (PPE). Use and disposal should be in line with the manufacturers instructions and training that has been provided. Disposable gloves and fluid repellent surgical face mask is recommended and, if available, disposable plastic apron and disposable eye protection (such as face visor or goggles) should be worn. Was your hands thoroughly with soap and water before putting on and after taking off PPE.
One of the interactions that requires management is that of cardiopulmonary resuscitation (CPR). If you are required to perform CPR a dynamic risk assessment should be conducted and appropriate precautions taken for infection control implemented.
Where possible, it is recommended that you do not perform rescue breaths or mouth-to mouth ventilation; perform chest compressions only. Resuscitation Council Guidelines 2010 for Basic Life Support state that studies have shown that compression-only CPR may be as effective as combined ventilation and compression in the first few minutes after non-asphyxial arrest (cardiac arrest due to lack of oxygen).
If a decision is made to perform mouth-to-mouth ventilation in asphyxial arrest, use a resuscitation face shield where available.
Should you have given mouth-to-mouth ventilation there are no additional actions to be taken other than to monitor yourself for symptoms of possible symptoms of possible COVID-19 over the following 14 days. Obviously if you do develop such symptoms you should follow the advice of your health authority.
After contact with the individual, wash your hands thoroughly with soap and water or alcohol hand rub at the earliest opportunity. Avoid touching your mouth, eyes and/or nose, unless you have recently cleaned your hands after having contact with the individual.
There are no additional precautions to be taken in relation to cleaning your clothing/uniform other than what is normal practice.
Cleaning and decontamination of areas where symptomatic individuals have passed through, including public areas, and spent minimal time (such as corridors) but which are not visibly contaminated with bodily fluids can be cleaned in the usual way. However, all surfaces that the symptomatic individual has come into contact with must be cleaned and disinfected. This obviously includes any equipment or vehicles.
If there has been a blood or bodily fluid spill then keep people away from the area. Use a spill kit if available, using the PPE in the kit or PPE provided by your employer/organization and following the instructions provided with the spill kit. If no spill kit is available, place paper towels/roll onto the spill, and seek further advice from medical emergency services when they arrive.
It is often a fact that firefighting personnel will have to handle the deceased. If a person has died at home and COVID 19 is suspected, disposable gloves should be worn when handling the body or articles in the home. Avoid touching your face or mouth with your gloved hands. Dispose of the gloves and perform hand hygiene, as described previously.
Conclusion – what’s been learnt and changed?
It is clear that the world has changed but the risks of fire remain. In fact, with the global population under lockdown, the increase in cooking fires, house fires etc. may well be seen to have increased during this period. Our service members have to interact with the public during times of great pain, loss and risk. They will continue to do so. When they do, the practical guidelines above will assist in keeping them safe whilst they carry out this essential work.
The need for disinfection routines and the focus on hand washing and basic hygiene has a great effect when coupled with social distancing. As mentioned above our essential workers have to continue to interact with both each other, their families and the public. As such the importance of these basic measures exponentially increases. Discipline cannot be understated. Yes, these measures can be difficult at the beginning, as can any change, but if managed correctly then it not only has a great effect on managing the spread of the virus, it also becomes the “way that we do things”. It becomes our new social norm – part of our culture.
When we discuss the lessons learnt from this time I am positive that preparation for future events will be a focus. From business continuity to the strategic implementation of supply lines, the focus will be on what we failed to prepare for. I sincerely hope that there will also be a focus on ourselves. Who we were before and who we needed to become to flatten the curve of transmission. The culture of who we are has changed. This pandemic is a global issue, as such our support for essential workers and their protection in the high risk environments in which they work, is also a global issue.
We, the human race, must work together, to share ideas and to assist where we can, our fellow professionals.
On a final note I would like to wish all the readers well. Whether you are still in lockdown, starting to venture out as government restrictions are lifted or are part of the emergency services, keep safe, keep well and carry on your essential work. We need you.
FBU, 2020 – Fire Brigades Union Circular 2020HOC0202AD, 31st March 2020 which itself refers to https://www.gov.uk/government/publications/novel-coronavirus-2019-ncov-interim-guidance-forfirst-responders/interim-guidance-for-first-responders-and-others-in-close-contact-withsymptomatic-people-with-potential-2019-ncov