Suspected or confirmed COVID-19 ONLY​​


​Ensure you know the goals of care for your patient.

Wear PPE according to local facility and current NSW COVID-19 guidance.

Start BLS immediately using combined contact and droplet precautions.​
 

D
↓​

Dangers?​​​​​

Limit the number of BLS responders in the patient zone at all times.​

R

​Responsive?

Important
Additional responders begin donning airborne PPE

S

​Send for help

CALL 2222 or local​ emergency number

A

​Open airway

​Apply O2 mask
Opening the airway is not an aerosol generating procedure (AGP) ** 



​Normal breathing?

​Warning 
Bag-valve-mask ventilation is an AGP**
Airborne precautions are required​

C

​Start CPR

​Warning
Chest compression is a potential AGP**
Airborne precautions are required​

D

​Attach defibrillator (AED)

​Important
This is NOT an AGP.**  Do not delay.
Defibrillation can precede compressions using contact and droplet precautions

** Aerosol generating procedures (AGP) must not be performed until all responders within the patient zone are wearing PPE for airborne​ precautions.

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Avoid exposure to potentially infectious aerosol

  •  limit the number of BLS responders in the patient zone at all times
  • if not in a single room, consider moving the patient, if practical
  • evacuate the area of other patients, visitors and non-responding staff, if possible
  • signs of life, including breathing, can be determined visually from a distance. 

Oxygen therapy and masks during BLS

  • O2 therapy using a mask is not an AGP and may provide benefit
  • a Hudson mask (6L/min) or non-rebreather mask (10L/min) are both suitable and can be applied over the top of a surgical mask. 

​Personal protective equipment (PPE)

  •  a responder using combined contact and droplet precautions should commence resuscitation immediately
  • all BLS interventions that are not AGP should be performed without delay
  • do not delay early defibrillation of shockable rhythms
  • responders that arrive and are not wearing PPE, should use contact, droplet and airborne precautions (P2/N95 mask) so that all resuscitation interventions can proceed as soon as possible
  • AGPs that occur commonly during resuscitation are listed below.​​​​​​​​ ​
Known or potential AGPs
  • high flow O2 therapy nebuliser therapy
  • manual ventilation using a bag-valve-mask (BVM)
  • open airway suctioning
  • chest compressions
  • ​​intubation​​​.​​​

Developed by

Agency for Clinical Innovation (ACI) Intensive Care NSW.

Consultation 

Senior clinicians, both medical and nursing, from NSW intensive care units through the:

Endorsed by

Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning, NSW Ministry of Health. 

Reviewed by

Reviewed and discussed at the ICCOP, discussion initiated by Dr Marino Festa and Dr Matt O’Meara.​

For use by

To support adult intensive care and ward staff with surge in COVID-19 pandemic​.​​​​​​​​​​​​​

​​​​​
Current as at: Thursday 6 August 2020
Contact page owner: Health Protection NSW