• IPC guidance covers staff waiting outside A&E
  • Growing concern about impact of handover delays
  • But guidance unchanged on PPE for ambulance staff

Rotating clinicians and keeping ventilation running are among Public Health England’s recommendations for how to avoid spreading covid while looking after patients in the back of ambulances outside emergency departments.

The suggestions are made in unprecedented new guidance issued by PHE amid sky-high rates of very long ambulance handovers outside hospitals.

This is because EDs are struggling with attempts to maintain distancing for infection control, along with high occupancy and severe operational pressures elsewhere in hospitals. It has led over the past two months to large numbers of patients being looked after in ambulances for extended times while they wait for space in ED.

In the first full week of January, there were 5,513 delays of more than an hour – the highest for at least three winters — and crews in the South East have run out of oxygen supplies while waiting to hand over patients.

The PHE guidance, added last week to existing covid guidance for ambulance services, says it should only happen in “exceptional circumstances”.

But it says staff in this situation should adopt infection prevention and control procedures including:

  • if more than one clinician is available, rotating them regularly, so allowing them time to change PPE and have a drink; 
  • keeping ventilation systems running which may require the engine to be kept running;
  • ensuring patients and any essential escorts wear surgical masks, as long as patient care is not compromised;
  • minimising the number of people within the patient compartment and avoiding sitting face-to-face with patients; and
  • decontaminating contact surfaces more frequently and during the delay if possible.

But the guidance adds there is no need to automatically increase the level of PPE worn by ambulance staff. Some staff have argued for higher level protection in cases where crew members are spending a long time with potentially infectious patients.

Deputy managing director of the Association of Ambulance Chief Executives Anna Parry said the ambulance sector was concerned about hospital handover delays and the guidance was aimed at allowing staff to safely treat and manage patients while protecting themselves from infection,

“However, we reiterate in the strongest possible terms that it remains unacceptable for patients to be held outside in the back of ambulances, a practice that puts those patients at significant risk of harm and ties our resources up at hospitals making them unavailable to attend other potentially life-threatened patients in the community,” she added. 

UNISON national ambulance officer Colm Porter said: “Ambulance crews must have access to the highest-quality PPE available. The risks they face are increasing. They’re spending longer in vehicles with infected patients, and the new covid strains are easier to catch.  

“The guidance is there to support ambulance staff. But crews should assess the level of safety kit they’ll need for each situation.“Employers should continue to listen to crews and ensure all levels of protective equipment are available for staff to use.”

 The measures seem primarily intended to reduce the risk for ambulance staff from virus particles in the air and on surfaces. Ambulances are routinely cleaned between patients and the guidance also gives details of what decontamination should be carried out.

In the past, ambulance staff would often look after patients within ED until they were handed over to hospital staff, and would sometimes “cohort” patients with one crew member looking after several patients, so others can go back on the road. The need to socially distance in EDs has meant this has largely stopped and more patients are being looked after in ambulances – in some cases for several hours. The knock-on effect of this is that people are waiting longer for ambulances.


Updated 17.25 25 January with comment from Unison.