PPE use when attempting prehospital resuscitation during COVID-19: conflicts between science and ethics?

Dear Editor,

Conflicting guidance continues to be issued by the Resuscitation Council (UK) (2020), Public Health England (PHE) (2020), College of Paramedics (2020) and the Association of Ambulance Chief Executives (AACE) (2020) on the level of personal protective equipment (PPE) to be used when attempting resuscitation in the prehospital settings.

As discussed in our previous article (Tang et al, 2020), the rationale to use of level 3 PPE should be based on whether the procedure(s) could generate airborne particles contaminated by known infectious substances (known as aerosols). The most up-to-date New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) (2020) consensus statement concluded that there is insufficient evidence to support chest compressions or defibrillation being procedures that are associated with a significantly increased risk of transmission of acute respiratory infections. However, it also discussed the limitation of the review ‘… evidence base is extremely weak and heavily confounded by an inability to separate out specific procedures performed as part of CPR, e.g. chest compression, defibrillation, manual ventilation and intubation…’.

With the inconclusive scientific evidence in this topic area, ethical principles should be considered during the decision-making process to help organisations address the following questions:

  • How should we go about doing this?
  • What are the values that we are trying produce or increase? (Duncan and Cribb, 2012).

In terms of PPE used when attempting prehospital resuscitation during COVID-19, ethical principles including beneficence (the duty of care to the patients); non-maleficence (the duty of care to protect staff); and justice (the fair distribution of limited supplies of PPE) should be considered by organisations when producing guidance on PPE.

Organisations should be transparent on the ethical framework used in their decision-making processes. This would help to maintain trust and reduce anxiety of frontline clinicians, ensuring appropriate guidelines are being followed.

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