Virginia EMS Initial Certification Process Changes During COVID-19

In response to the Governor's Executive Orders 51, 53, & 55, the Virginia Office of EMS in conjunction with the National Registry of Emergency Medical Technicians have developed the following temporary changes to the EMS Initial Certification process.

BLS Certification Testing:

BLS Psychomotor Examination:

The Virginia Office of EMS has cancelled all Consolidating Testing at the BLS level through December 31, 2020.

A Candidate who needs to retest a station/skill will be contacted directly by OEMS or his/her Course Coordinator for assistance.

BLS Cognitive Examination:

The National Registry of Emergency Technicians (NREMT) has reopened several PearsonVUE testing locations, but is now also offering Pearson OnVUE- a remotely proctored cognitive exams for BLS candidates beginning May 12th, 2020. More information can be found at: 

https://home.pearsonvue.com/nremt/onvue

Once a BLS candidates passes the National Registry Cognitive Exam, he/she will be issued full National Registry and Virginia certifications.

ALS Certification Testing:

ALS Psychomotor Examination:

Currently, all ALS Psychomotor Examinations have been postponed. The Office of EMS is working with ALS programs and the NREMT to provide psychomotor testing. The ALS Testing Calendar can be found on the VA OEMS website at:

https://www.vdh.virginia.gov/emergency-medical-services/virginia-national-registry-psychomotor-examination-schedule/

ALS Cognitive Examination:

Advanced EMT Candidates may take the cognitive test at a location or remotely. More information may be found at: 

https://home.pearsonvue.com/nremt/onvue

 Paramedic Candidates must take the cognitive test at a PearsonVue location. Remote proctoring for this examination is not available.

Once an Advanced EMT or Paramedic Candidate successfully completes the respective cognitive examination, he/she will receive a provisional certification that must be converted to full certification once the COVID-19 threat is mitigated and the Candidate passes the required NREMT psychomotor examination.

VDH/OEMS Authorizes EMS to Transport to Alternate Sites

The Virginia Office of EMS (OEMS) has released a White Paper on “Transportation of Patients to Alternate Sites” to provide agencies with guidance in response to the March 30, 2020 Centers for Medicare and Medicaid Services (CMS) released notification of issuance of temporary regulatory waivers for EMS to have maximum flexibility when responding to the COVID-19 pandemic.  The guidance identifies the manner in which this option is to be employed and places the responsibility on EMS leadership including the OMDs to determine which patients can be adequately treated by these facilities versus being transported elsewhere for more definitive care, as well as for the development of protocols to properly outline that process.

Those protocols should take into account the facilities capabilities, hours of operations as well as  time and distance to other facilities with more definitive care. 

In their rollout of the White Paper, the OEMS Medical Director and the Regulation and Compliance Division Manager emphasized the need for agencies to work with the identified alternate facilities to establish the necessary processes for such protocols to be successful.

PEMS suggests the following things be considered: 

  • Identify the patients that can be appropriately treated at the alternate facility 
  • Identify the triage process 
  • Establish a pre-arrival communications process for the facility
  • Establish a patient reception and handoff process for the facility
  • Establish a waste/PPE/contaminated waste disposal process
  • Establish a unit decon process/in the event decon is needed
  • Establish a medication kit exchange process (involve PEMS) if necessary
  • Establish processes for reporting of positive test results on patients transported by EMS

Also, OEMS told the Regional Council directors to advise their agencies that refusals were only to be used when the EMS agency recommended  a treatment or transport and the patient refused one or both.  Refusals ARE NOT APPROPRIATE AND SHOULD NOT BE USED to document a treat and release by protocol disposition.  If the non-transport decision is provider initiated or initiated by telemedicine consult, it should be documented as such in the PPCR narrative and the disposition should be – Treated and Released by Protocol.

To assist agencies and facilities in the region, the Peninsulas EMS Council Protocol Task Force is currently developing:

1. PEMS COVID-19 Establishing Alternative Destinations Procedure to assist EMS Leadership and OMDs in creating a partnership with alternate sites.

2. PEMS COVID-19 Expanded Services Protocol to guide EMS Providers in determining where to transport patients during the COVID-19 Pandemic

Agencies will be notified when these documents have been finalized.

  Click Here to Download the VDH/OEMS White Paper "Transportation of Patients to Alternate Sites"

CDC Publishes Updates to COVID-19 Infection Control Guidance for Healthcare

  • CDC has updated the current national COVID-19 infection control guidance for healthcare to include the recommendation all U.S. healthcare facilities put policies into place requiring everyone entering the facility to practice source control, regardless of symptoms. This recommendation is intended to protect healthcare personnel by reducing their risk for exposure as we continue to learn how COVID-19 spreads, particularly from asymptomatic and pre-symptomatic people.

Key points of information (provided by CDC's Division of Healthcare Quality Promotion group)

    • When supplies are available, facemasks are generally preferred for healthcare providers to wear while they are in a healthcare facility as it offers both source control and protection for the wearer against exposure to splashes and sprays of infectious material from others.
    • Cloth face coverings should not be considered PPE and should NOT be worn instead of a respirator or facemask if more than source control is required.
    • Healthcare providers should consider continuing to wear their respirator or facemask (extended use) while in the healthcare facility instead of intermittently switching back to their cloth face covering, which could cause self-contamination. Healthcare providers should remove their respirator or facemask and put on their cloth face covering when leaving the facility at the end of their shift.
    • Visitors and patients should be wearing their own cloth face covering upon arrival to the facility per CDC recommendations to the general public. If they are not, they should be offered a facemask or cloth face covering, as supplies allow, and instructed to wear it while in the facility.
    • This recommendation does not change CDC’s guidance to use N-95 or equivalent respirators when providing care for patients with suspected or known COVID-19.
      • Facilities that do not have sufficient supplies of N-95s and equivalent respirators for all patient care should prioritize their use for activities and procedures that pose high risks of generating infectious aerosols, using facemasks for care that does not involve those activities or procedures. Once availability of supplies is reestablished, N-95s and equivalent respirators use should resume for all workers caring for these patients.
      • Facilities should consider utilizing CDC’s PPE optimization guidance and PPE Burn Rate Calculator in order to preserve PPE supplies and keep workers safe.
    • To see additional guidance, materials or othe national updates, go to the CDC's website: https://www.cdc.gov/coronavirus/2019-ncov/whats-new-all.html
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An Important Announcement from the Virginia State Health Commissioner

As COVID-19 continues to rapidly evolve, please visit the VDH website for updated epidemiological information and clinical guidance. 

COVID-19 in Virginia 

● As community transmission increases in Virginia, healthcare facilities should consider additional actions to reduce the risk of their employees introducing COVID-19 into their facilities. 

● There is growing evidence of asymptomatic and presymptomatic spread. CDC recently changed the start of the infectious period to 48 hours before symptom onset. 

● For people who must leave their home for essential needs (e.g., grocery shopping and picking up pharmacy medications), CDC recommends that people wear cloth face coverings where other social distancing measures are difficult to maintain, especially in areas of significant community-based transmission. N95 respirators and surgical masks are not recommended in these situations so that they can be reserved for HCP and first responders 

● Mildly ill patients may not need to be tested and can be managed at home. Clinical diagnoses of COVID-19 are reportable; given the volume, reporting through the VDH Online Morbidity Report Portal is preferred. Please continue to call your local health department about suspected outbreaks of COVID-19. 

● For COVID-19 patients, please provide this patient handout about home isolation and encourage them to notify their contacts. 

● A COVID-19 Flag Alert has been added to Virginia’s Emergency Department Care Coordination Program. COVID-19 alerts will automatically become inactive after six weeks. 

● VDH has updated work restriction recommendations to allow asymptomatic healthcare personnel who have had an exposure to a COVID-19 patient to continue to work after options to improve staffing have been exhausted and in consultation with their occupational health program. More information can be found on the VDH COVID-19 Healthcare Personnel Risk Assessment Tool

Testing 

VDH criteria for COVID-19 public health testing at DCLS have been updated to remove requirements for influenza testing. Until testing is widely available, prioritizing testing at private labs for high risk groups should also be considered. 

Personal Protective Equipment (PPE) 

● Virginia continues to experience a critical shortage of PPE. CDC has defined acceptable alternative PPE for caring for patients with confirmed or suspected COVID-19. Additional shipments from the Strategic National Stockpile are not expected in the near future. For questions, individual practices, home health and CHCs/FQHCs should check with their local health districts. Hospitals and nursing homes should contact their regional healthcare coalition. 

Congregate Settings 

● As of April 3, 31 confirmed outbreaks (defined as having two or more COVID-19 cases) have been reported and 12 (39%) are in skilled nursing and assisted living facilities. Answers to frequently asked questions are available on the VDH website and guidance is on the CDC website

● Other congregate settings, such as jails, prisons, and behavioral health residential facilities also face the threat of COVID-19 introduction and spread. To date, two (7%) confirmed outbreaks have been reported in correctional facilities. CDC guidance and resources are available for correctional facilities and detention centers. 

Thank you for all your efforts on the front line of combat against the COVID-19 pandemic. You are an essential part of the public health campaign to protect the health of the people of the Commonwealth. 

M. Norman Oliver, MD, MA - State Health Commissioner

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