Summary of Recent Changes
Significant changes to this guidance include the following:
EMS personnel may be exposed to COVID-19 in the community or at home and increase the risk of transmission to patients or other co-workers, especially if they are not fully vaccinated against COVID-19. Exposures encountered by EMS personnel at work are unlike those that might occur in the community because EMS agencies follow infection control prevention and control procedures and EMS personnel use personal protective equipment (PPE) per strict standards. Due to their often extensive and close contact with vulnerable individuals, EMS personnel with symptoms of possible COVID-19 illness and those with community or high-risk occupational exposures who are not fully vaccinated or have not recently recovered from COVID-19 should be managed more conservatively.
These guidelines have evolved as a result of greater experience, the availability of published data on COVID-19, continued evidence of community transmission of COVID-19 including asymptomatic and pre-symptomatic transmission of more infectious variants, established infection control principles, and the availability of effective COVID-19 vaccines.
In addition to following these guidelines, EMS provider agencies are expected to follow the CDC and Cal/OSHA COVID-19 infection prevention guidance and requirements, including universal use of PPE for patient care, use of N95 respirators for the care of suspect or confirmed COVID-19 cases, and routine respirator fit testing.
Employers and facilities can have policies that are stricter than those required by the LA County Health Officer Orders and Cal/OSHA or recommended by the CDC.
Currently licensed and authorized vaccines in the United States are highly effective at protecting vaccinated people from severe disease and death from COVID-19. Fully vaccinated people are less likely to become infected and, if infected, to develop symptoms of COVID-19. Per the CDC, there is preliminary evidence that suggests that fully vaccinated people who do become infected can be infectious and can spread the virus to others. For this reason, infection prevention measures continue to be necessary for all staff even if fully vaccinated.
All persons who work in Emergency Services Provider Agencies must be vaccinated against COVID-19 as required by the LA County Public Health Officer and further explained in associated FAQs. Workers must receive the final dose of a COVID-19 vaccine series by September 30, 2021. Workers may be exempt from the vaccination requirements based on either a) Religious Beliefs or b) a Qualifying Medical Reason. (See the CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines for clinical guidance.)
Note: CDC suggests that facilities consider continuing work restrictions for fully vaccinated healthcare workers who have had a high-risk exposure if they have an underlying immunocompromising condition (e.g., organ transplant, cancer treatment).
High-Risk Occupational Exposure
The following healthcare exposures to a confirmed infectious COVID-19 case* are considered high-risk if the personnel are not fully vaccinated:
In the community, a close contact is any of the following persons who were exposed to a laboratory-confirmed COVID-19 case while they were infectious:
Symptomatic persons Regardless of vaccination status, EMS personnel with any signs or symptoms of COVID-19 should be prioritized for SARS-CoV-2 viral testing (and other respiratory viral testing, such as influenza as indicated), even if the symptoms are mild. Positive viral tests (NAAT or antigen tests) in vaccinated personnel should not be attributed to the COVID-19 vaccine as vaccination does not affect the results of these tests.
Post-exposure Testing is recommended for asymptomatic EMS personnel after a high-risk occupational or after a community close-contact exposure to SARS-CoV-2, regardless of vaccination status. Testing also should be performed as part of an outbreak investigation.
Timing of post-exposure testing
Screening EMS Provider Agencies are required to ensure routine testing of unvaccinated employees that have been granted a vaccine exemption and those who are incompletely vaccinated against COVID-19, pursuant to the LA County Order. Note that employees cannot opt to regularly test instead of getting vaccinated.
EMS personnel that are unvaccinated or incompletely vaccinated are required to be tested at least once a week. Note: Unvaccinated workers who previously tested positive with a viral COVID-19 test are exempted from this testing only for 90 days from their initial positive test. After 90 days have passed, they must restart testing.
Fully vaccinated EMS personnel
Re-testing for return-to-work clearance is not recommended, see EMS Personnel with Confirmed COVID-19 Return-To-Work Protocol below.
Recently recovered from COVID-19 Recently infected persons are known to shed non-infectious viral particles for at least 90 days after recovery and reinfection is unlikely to occur during this period. EMS personnel who previously tested positive and are asymptomatic should not be retested for 90 days since the date of symptom onset or date of collection of the first positive viral test. For EMS personnel that develop new symptoms consistent with COVID-19 within 90 days from their prior infection, if an alternative etiology cannot be identified, it is recommended that retesting be done in consultation with infectious disease or infection control experts.
EMS Provider Agencies should have a plan to evaluate EMS personnel with symptoms of possible COVID-19 illness. It is recommended that symptomatic personnel be evaluated by a clinician. Symptomatic personnel with compatible symptoms and no clear alternate diagnosis should be told to isolate at home pending clinical evaluation and testing.
For EMS personnel who had symptoms of possible COVID-19 and had it ruled out, either with negative test(s) and/or with a clinical assessment that COVID-19 is not suspected (e.g., clear alternate diagnosis), then return to work decisions should be based on their other suspected or confirmed diagnoses.
See CDC Return to Work: https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html
EMS personnel with mild to moderate illness who are not severely immunocompromised can return to work:
Asymptomatic EMS personnel who are not severely immunocompromised should be excluded from work until 10 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have not subsequently developed symptoms. If they develop symptoms, follow above guidance.
Symptomatic EMS personnel with severe or critical illness or who are severely immunocompromised can return to work:
Note: Asymptomatic personnel who are severely immunocompromised, should wait to return to work until 20 days since first positive viral diagnostic test.
For current definitions of COVID-19 illness severity and severely immunocompromised see CDC Return to Work for Healthcare Personnel with SARS-CoV-2 Infection
Return to Work Practices and Work Restrictions
EMS personnel with confirmed COVID-19 do not need medical or LAC DPH clearance to return to work. Testing of laboratory-confirmed cases is not recommended for return to work due to the prolonged detection of SARS-CoV-2 RNA without direct correlation to viral culture. Refer to the CDC Return to Work for Healthcare Personnel with SARS-CoV-2 Infection for more information on the limitations of using a test-based strategy.
EMS Provider agencies must be prepared for staffing shortages and have plans and processes in place to mitigate them. Every effort should be made to limit exposure to both patients and co-workers. Refer to the CDC Strategies to Mitigate Healthcare Personnel Staffing Shortages for protocols on contingency and crisis strategies for mitigating staffing shortages.
EMS Provider agencies experiencing critical staffing shortages of essential EMS personnel may allow personnel in quarantine to return to work using the following shortened quarantine as long as they remain asymptomatic:
These personnel must observe strict infection control procedures including source control at all times (facemask or respirator required) while working. They must adhere to full home quarantine when not doing their essential work (unless fully vaccinated). They must continue regular daily symptom monitoring and if symptoms occur within 14 days of the exposure, they must be immediately excluded from work and told to isolate at home pending clinical evaluation and testing.
See CDC Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing and CDPH Guidance on Isolation and Quarantine for COVID-19 Contact Tracing for more information.
Personnel who are infected with SARS-CoV-2 should be excluded from work until they meet all return-to-work criteria (as outlined above in EMS Personnel with Confirmed Covid-19 Return-To-Work Protocol). If extreme shortages continue despite all other mitigation strategies, facilities may consider following CDC crisis capacity strategies to mitigate severe staffing shortages. See CDC Strategies to Mitigate Healthcare Personnel Staffing Shortages.
Report EMS personnel testing positive to COVID-19 to
or call at 213-240-7941 during regular business hours.