First Aid/CPR/AED Care During COVID-19

The emergence of COVID-19 has raised questions among those who may need or choose to give care in an emergency. This page is meant to inform those who may perform CPR/First Aid care and are not healthcare professionals.

How Does COVID-19 Spread?

The SARS-CoV2 virus, which causes COVID-19, is thought to spread mainly from person-to-person, between people who are in close contact with one another (within about 6 feet) through respiratory droplets produced when an infected person coughs, sneezes or talks. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Some recent studies have suggested that COVID-19 may be spread by people who are not showing symptoms.  Additionally, spread can occur when droplets contaminate nearby surfaces and when touched, can lead to self-inoculation when a person inadvertently touches their own mouth, nose or eyes. This is not thought to be the main way the virus spreads, but we are still learning more about this virus.

General Guidance for Preventing COVID-19 Transmission During CPR and First Aid

While there is currently no specific data on COVID-19 transmission while performing CPR or giving first aid, it is reasonable to conclude that chest compressions have the potential to generate respiratory droplets or aerosols and close contact needed for some aspects of first aid may have risk of transmission.

Guidance for PPE

For lay responders and those who may need to provide care to someone suspected to have COVID-19. We recommend wearing PPE as recommended by CDC, this would be wearing respiratory protection using a respirator (e.g. N-95 mask), eye protection, disposable gloves and a disposable isolation gown if possible. Per CDC guidance facemasks are an acceptable alternative when there is shortage of N-95. During the COVID-19 pandemic, for all persons requiring CPR, personal protective equipment (PPE) such as gloves and face mask should be worn, if available. We recognize that for lay responders, CPR and first aid is often performed for household members where there would have already been close contact and exposure. 

We recommend placing a face mask or face covering over the mouth and nose of the victim. If only 1 mask is available and it is simple face mask or face covering, we recommend placing it on the victim.

Guidance for Performing a Breathing Assessment and Rescue Breaths in Children or Adults

While CPR with breaths has been shown to be beneficial when compared to compression-only CPR, during the COVID-19 outbreak, it is currently recommended that no rescue breaths be performed for adult cardiac arrest patients with confirmed or suspected COVID-19, due to the risk of disease transmission. The following measures are recommended and may be associated with a decreased risk of transmitting the virus:

·       When assessing for normal breathing, we recommended that the CPR/first aid care provider looks for breathing but does not listen or feel for the victim’s breathing, as this will minimize potential exposure.

·       We recommend that adult victims of sudden cardiac arrest receive continuous compression-only CPR from their CPR/first aid care provider until emergency personnel arrive. Note: Compression-only CPR saves lives compared to no CPR.

·       Cardiac arrests that occur after a breathing problem (which is often the case in infants and young children), drowning and drug overdoses may benefit from standard CPR that includes compressions and rescue breaths. Note: It is recognized that in some of the cases, the victim may also have COVID-19. However, if a lay responder is unable or unwilling to provide rescue breathing with CPR, compression-only CPR should be initiated.

Guidance for Compressions

Chest compressions and use if an AED is available is recommended for every cardiac arrest victim.  Whether or not a cardiac arrest victim is suspected of having COVID-19, 9-1-1 should be called and, if available, an AED should be used.

Guidance for AED Application & Use

No studies to date have shown that defibrillation generates respiratory droplets or aerosols, and it is known that prompt use of AEDs save the lives of cardiac arrest victims. In addition, the current methods of automatic external defibrillation use hands-free methods via adhesive pads that allow performance without direct contact with the victim.

·       If an AED is available, it should be applied and used consistently with the manufacturer’s guidelines while waiting for emergency personnel to arrive.

·       If gloves are available, they should be worn.

·       The AED device should be cleaned with disinfectant after use.

Guidance for Protecting those at Home and in your Community

Most COVID-19 patients do not require hospitalization and can be cared for at home.  The following guidance can help provide care for someone at home. Keep in mind that many people have mild illness and are able to recover at home.

If a person has symptoms consistent with COVID-19, Stay Home and Call a Health Care Provider

·       Stay at home and call their doctor for medical advice. Older adults and people of any age with serious underlying medical conditions should call a health care provider as soon as symptoms start.

·       Avoid public transportation, ridesharing and taxis.

·       Separate from other people in the home. As much as possible, stay in a specific “sick room.” Use a separate bathroom, if available. Visitors, other than caregivers, are not recommended. 

·       Limit contact with pets and animals. 

·       To protect others, wear a cloth face covering if they are around other people (e.g., sharing a room or vehicle) and before entering  a health care provider’s office. If they are unable to wear a cloth face covering, caregivers entering your room should wear one.

·       Continue to follow good hygiene practices. 

·       Do not share dishes, drinking glasses, cups, eating utensils, towels or bedding with other people in your home. After use, wash items thoroughly with soap and water or put them in the dishwasher. 

·       In the sick room and designated bathroom:  clean and disinfect all surfaces daily. Surfaces that are touched frequently and by multiple people (such as doorknobs, light switches, phones, remotes, sink faucets and toys) should be cleaned and disinfected throughout the day.

·       In the rest of the house: Have a healthy household member clean and disinfect all other surfaces daily and high-touch surfaces frequently throughout the day. 

If symptoms are severe, call to get medical attention immediately.

Emergency warning signs include:

·       Trouble breathing

·       Persistent pain or pressure in the chest

·       Confusion or inability to respond

·       Bluish lips or face

This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.

Guidance for Cleaning & Disinfection After First Aid Care

While still wearing personal protective equipment, clean and disinfect items that touched the victim. After cleaning, dispose of your personal protective equipment and perform hand hygiene. Surfaces should be cleaned using a detergent or soap and water prior to disinfection.

·       For Hard Surfaces:

·       Diluted household bleach solutions, alcohol solutions with at least 70% alcohol and most common EPA-registered household disinfectants should be effective.

·       Products with EPA-approved emerging viral pathogens claims are expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.). In their absence, products with label claims against human coronaviruses or other viruses should be used according to label instructions.

·       For Soft or Porous Surfaces

·       For surfaces such as carpeted floor, rugs, and drapes; remove visible contamination if present, and clean with appropriate cleaners indicated for use on these surfaces.

·       After cleaning, wash items as appropriate in accordance with the manufacturer’s instructions. If possible, wash items using the warmest appropriate water setting and dry completely or use products with the EPA-approved emerging viral pathogens claims that are suitable for porous surfaces.

·       For Clothing:

·       Do not shake dirty laundry. This will minimize the possibility of dispersing virus through the air.

·       Launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely.

·       If clothing cannot be immediately laundered, store in a sealed disposable bag.

·       Alternatives to EPA-registered disinfectants include:

·       Diluted household bleach: Mix 5 tablespoons (1/3 cup) bleach per gallon of water, or 4 teaspoons bleach per quart of water. Make sure you have proper ventilation and that the bleach is not expired.

·       Alcohol solutions: Ensure your solution has at least 70% alcohol.

Guidance for Providers After Caring for Someone Suspected Positive for COVID-19

Providers with contact with persons known or suspected to have COVID-19 should monitor themselves for symptoms, including fever or respiratory symptoms, e.g., cough, shortness of breath, sore throat. If these symptoms occur, they should self-evaluate and immediately contact their healthcare provider.

Info from American Red Cross:

https://www.redcross.org/take-a-class/coronavirus-information/first-aid-cpr-aed-care-during-covid-19