First aid protocols and considerations for an ill or injured person during COVID-19

***Considerations provided on behalf of the Red Cross***

Providing first aid during the COVID-19 pandemic can raise questions around safety and infectious disease transmission. Outlined below are the first aid protocols that should be followed when attending to an ill or injured person.

According to the Public Health Agency of Canada, the COVID-19 situation continues to rapidly evolve, and an individual’s risk is variable depending on the level of COVID-19 activity on a local community level.

General considerations

The current COVID-19 pandemic brings an additional layer of risk, which each individual must consider and act accordingly. As always, it is up to the First Aid responder to evaluate the situation and decide how much (if any) risk they are willing to take on behalf of another.

Proper use of personal protective equipment (PPE) is extremely important; improper use could potentially increase risk of infection especially when providing first aid care.

• For general first aid care provided to an ill or injured person, it is recommended that First Aiders wear a medical-grade face mask, eye protection, and gloves. It is important to conduct proper hand hygiene after each interaction.
• It is recommended that First Aiders take training on prevention of disease transmission that includes how and when to use PPE, donning and doffing PPE, and disposing of all PPE. The Red Cross Preventing Disease Transmission Course is available online at learn.redcross.ca.
• All contaminated PPE must be properly disposed of after providing care.
• Hand hygiene should be performed regularly and when contaminated, including before donning and after doffing PPE.
• Where appropriate, apply additional measures of risk mitigation during first aid, including primary and secondary surveys.
• If the injured person is able to self-treat, they should be instructed in how to do so, and the First Aider should remain on standby to treat the injured person should it become necessary.
• Offer a face covering to those receiving care.
• Screen for COVID-19 as part of the individual’s history by completing a health questionnaire with them prior to providing care, such as:
  • Do you have any of the following: fever, cough, shortness of breath, sore throat, runny nose, or any other COVID-19 symptoms?
  • Have you been in close contact with someone who is sick or has confirmed COVID-19 in the past 14 days?
  • Have you returned from travel outside Canada in the past 14 days?
• Maintain a physical distance of two metres, unless it is medically necessary to be near the person.
• Use a buddy system for donning and doffing PPE, where First Aiders supervise each other to ensure best practices for applying PPE are followed, while maintaining physical distancing.

Considerations for resuscitation

If someone’s heart stops, and the First Aider is concerned they may have had respiratory symptoms, it is at the individual’s discretion to perform or not perform mouth-to-mouth breaths based on personal risk threshold. It’s still important to call emergency medical services and find an AED. If the individual chooses to perform breaths, they should  use a barrier device, such as a pocket mask. Performing the breaths/ventilations always creates the potential for personal infection/contamination, which can be mitigated with the use of a pocket mask with a one-way valve to help protect themselves.

CPR with breaths is recommended for people who have been trained in CPR, but as an alternative, hands-only CPR can be performed until help arrives if the First Aider does not have a proper pocket mask, or has concerns the person may have COVID-19. They should perform hands-only CPR, by first calling 9-1-1, laying a cloth, a towel, or clothing over the person’s mouth and nose to prevent potentially contagious particulates from escaping into the air during compressions, and then pushing hard and fast in the centre of the person’s chest until advanced help arrives. If the First Aider believes the person may have COVID-19, they should state their concerns to the emergency response telecommunicator so everyone who responds can be aware of the potential for COVID-19 transmission.

For a First Aider to be effective you need to:

• Be aware of the risks to yourself and others
• Keep yourself safe
• Provide aid when it is safe to do so
• Keep yourself informed and updated on first aid/CPR skills and evolving protocols as we move through the pandemic
• Remember your own needs