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Providing Services During a Pandemic

Published:August 14, 2020DOI:https://doi.org/10.1016/j.amj.2020.07.004
      The year 2020 has been challenging for all of us, especially for health care providers. The news about widespread and local outbreaks of coronavirus disease 2019 (COVID-19) changes daily depending on where you are. Dealing with the unanticipated consequences of a pandemic requires careful and creative steps because most of us were unprepared for this type of crisis, including the Commission on Accreditation of Medical Transport Systems (CAMTS).
      In the first part of the year, the CAMTS office received many calls and e-mails about our official position on transporting patients with suspected or diagnosed COVID-19. We made it clear on our website and through letters to accredited services that it is not the position of the CAMTS to dictate whether a patient with suspected or known coronavirus should be transported. Medical transport is an integral part of health care, and transport is the conduit to get the patient to the most appropriate and definitive care.
      Medical transport services have unique opportunities to address the challenges of transporting patients while keeping staff healthy and able to function with diminishing resources and higher needs. Accredited services have met these challenges with new processes that were never anticipated. We share the many resources our accredited service developed, from educational videos to practices. Few serious illnesses among the crewmembers who care for suspected and known COVID-19 patients have been reported.
      The CAMTS Board of Directors, like many other groups who meet regularly, meet by videoconferencing and continue to conduct the business of accrediting services by creating innovative practices. In one case, an international service was prepared for a CAMTS Global site visit, but the country closed to international visitors. Recognizing all the work involved in submitting the information before a site visit, the CAMTS Global Board reviewed the information and awarded a conditional accreditation. This is a one-year accreditation that recognizes the policies and practices in place meet CAMTS Global standards and allows the program to apply for full accreditation in one year.
      The CAMTS and CAMTS Global Board of Directors also recognize that accredited services may not be able to meet predetermined timelines, such as when an application or a progress report are due. Site surveys were delayed until June 2020 so the services with expired tenure of accreditation dates were given an “approved extension” as listed on the website.
      Policies were created to address conducting site visits during the pandemic as well. CAMTS does not penalize programs who need to make temporary changes in staffing or currencies not available in the expected time frame. As Winston Churchill once said, “It's not enough that we do our best; sometimes, we have to do what is required.”
      The following practices were put into place to address site visits.

      Scheduling Site Visits

      Site surveyors who routinely care for patients in their daily careers will not be scheduled unless they have a window of time free from direct patient care before and after a site visit.
      The CAMTS staff will monitor counties and states that have reported widespread coronavirus transmission and avoid those areas in arranging travel.
      • Site surveyors who are within driving distance of a site visit and free from conflicts are given preference.
      • Direct flights are preferable, avoiding hot spot areas for connecting flights if a direct flight is not possible.
      • Before traveling for a site visit, site surveyors shall provide an attestation that the site surveyor has not tested positive with COVID-19 or had possible exposure to someone with COVID-19 in the previous thirty days. This attestation shall be signed and provided for our internal record keeping. Site surveyors may also be required to and shall comply with COVID-19 screening in place at the service, which is the subject of the site visits.
      • Site surveyors shall provide a negative COVID-19 test result within seven days before travel, if available and possible. If such testing is not available, site surveyors shall complete our screening requirements (following Centers for Disease Control and Prevention recommendations) before travel.

      On-Site Expectations

      • Site visits will be limited to those that are new accreditation applicants and new base locations for reaccreditation visits. All satellite bases will be monitored for COVID-19 risks at the time of the visit to minimize exposures, and we may plan to do a Skype or video record of a base that is in a hot spot at the time of the visit.
      • For reaccreditations, only one site surveyor may be scheduled for single-site programs at the discretion of CAMTS executive staff.
      • Site surveyors shall wear masks and gloves during site visits, when checking aircraft or ambulances, and when in contact with any patient care areas. Masks and social distancing are required throughout the visit and interview process. Site surveyors will bring their own masks, gloves, and hand sanitizer for use during travel but will use the program's personal protective equipment once they are on-site to prevent any cross contamination.
      • Site surveyors shall follow on-site protocols, such as checking visitor temperatures before entry and personal protective equipment requirements.
      • To minimize exposures, we will also ask for a private area to station the site surveyor with computer access to conduct online interviews with key personnel. This will minimize travel and exposure between locations for the site surveyor and the staff.
      The CAMTS office closely monitors Centers for Disease Control and Prevention recommendations and the many public webinars that bring new information on a weekly basis. Any new information or changes to our practices are on the website, and we are available for questions and concerns.
      Eileen Frazer, RN, CMTE, is the CAMTS executive director. She can be reached at [email protected] and (864) 287-4177.