High risk mask protocol

This protocol is under review, and has not been accepted.

We are currently gathering feedback and editing this protocol, and there may be errors or bad wording. Please only use this protocol with caution, and if other organisations have definitive protocol, use that instead.

Please see #protocols on Slack to discuss this protocol further.

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More documents in need of medical review can be found here.

This page describes protocol for using PPE. Please read the PPE principles and remember that appropriate PPE, not simply the most PPE is the correct solution. PPE is not a magical talisman or substitute for good practice and a scene survey

Note regarding COVID: This page is not specifically relating to the COVID-19 pandemic pandemic, but includes information that will be useful for dealing with the pandemic.

This is the protocol for using masks in high risk situations, such as:

• When you're in confined spaces with someone who has a confirmed or suspected infection that's spread through droplets (such as COVID-19) for a long period of time (e.g. a long car ride with a known case)
• When you're close to actions which are likely to generate aerosols, such as CPR or intubation

For such situations, respirator masks should be used if available. If there is no alternative, you can use surgical masks. Cloth masks should only be used as a last resort.

When using masks, it is essential to remember the following principles:

• Masks are an addition to other infection control measures (hand hygiene, use of tissues, not touching the face), not a substitute.
• Maintain distancing whenever possible - use masks for additional protection and in situations where this is impossible, not as an excuse to ignore distancing principles.

About Respirator Masks

• Designed to protect the wearer from becoming infected
• Blocks tiny aerosol particles: in Europe, FFP2 masks block 94% of 3 micrometre particles (the N95 is the US equivalent).
• Must fit tightly to achieve this effect.

In current circumstances, highest priority must be given to healthcare workers carrying out procedures such as intubation which are known to produce quantities of aerosol particles.

When supplies permit, they can also be worn by others who are caring for infected people in close contact and enclosed spaces. Healthcare workers and others who are caring for multiple patients, or doing care which requires prolonged close contact should be prioritised, since these people are exposed to a greater viral dose which may (though this is still unclear) increase the severity of any illness they do contract.

Although respirators are far superior to surgical masks in laboratory tests, studies suggest that in many real-life situations they may not provide any greater benefit. If used, it is essential that they are correctly fitted, and that people wear them as instructed regardless of the discomfort.

Even when widely available, respirators should not be worn by people with symptoms of COVID-19, since they make it more difficult to breathe.

How to wear a respirator mask

Putting on a mask

1. You should make sure you have the right size of mask.
   • You may need to try several different sizes until you find one that fits securely
2. Wash your hands first.
3. Check there are no defects, such as holes or tears.
4. Cup the face of the mask in your hand.
   • Position the nose of the mask at your fingertips
   • Allow the headbands to hang below your hand
   • If you can, touch only the edges of the mask
5. Hold the mask up to your face.
6. Use your other hand to position the straps behind your head.
   • The top strap goes behind your head, above your ears
   • The bottom strap goes below your ears
   • Do not criss-cross the straps
7. If there is a metal clip at the nose, slide your fingers down both sides to mould it to the shape of your nose.
8. Make sure the mask is secure, with a tight seal around your nose, and covers your mouth, nose and chin.
9. Check the seal by placing both hands over the respirator and breathing in and out.
   • The mask should cling to your face as you inhale and no air should leak when you exhale
   • If air leaks, you may need to adjust the position of the straps and the nose clip, or try another size or model
10. Wash your hands again before putting on your gloves.

Wearing a mask

• The mask must cover your nose and mouth.
• Don’t touch your face, or touch the face of the mask while wearing it. If you do, sanitise or wash your hands before touching your surroundings.
• Don’t take it off when talking, using the phone etc.
• Wear for as short a time as possible - put it on immediately before entering the situation. Moisture spreading from your mouth will decrease the effectiveness.

Taking off a mask

1. Remove your gloves, to avoid transferring virus from your hands to your face.
2. Wash your hands
3. Do not touch the front of the respirator, as it may be contaminated.
   • You should hold the mask by the straps
4. Remove by pulling the bottom strap over the top of your head, and then the top strap
5. Dispose of the mask as soon as you can
   • If you can't dispose of it immediately, place it in a sealed bag until you can
6. Wash your hands again

Sterilising masks

• Respirators should be single-use, but in the current severe supply shortage, clean undamaged respirators can be set aside in a breathable paper bag for 72 hours before reuse.

Don’t use a plastic bag, as this may prevent them from drying.

Never share masks.

• Never use bleach to clean masks.