Summary of Recent Changes
Significant changes to this guidance include the following:
2-23-23
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 State and Local Health Officer Orders regarding health care worker vaccination requirements and CA Dept of Public Health AFL for return to work for exposed and infected EMS personnel: *
They are also 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.
CDC, CDPH, and LAC DPH urge everyone to remain up to date with COVID-19 vaccination, including the most recent booster dose to protect themselves and reduce the spread of the virus. See CDC Stay Up to Date with COVID-19 Vaccines Including Boosters for more information. Visit LAC DPH Vaccine Schedule website for easy-to-read color schedules in English and Spanish.
Health care worker vaccine requirementAll persons who work in Emergency Services Provider Agencies must complete a primary COVID-19 vaccine series and receive a single booster dose as required by the LA County Public Health Officer.
Workers who are already in compliance with the vaccine requirement (i.e., completed a primary series and received a single booster) are not required to stay up to date with recommended COVID-19 boosters. The bivalent booster is, however, strongly recommended.
Workers who are newly coming into compliance with the LA County healthcare worker vaccine requirements must receive their booster dose within 15 days after becoming eligible. Workers who have completed their primary series who provide proof of subsequent COVID-19 infection may defer this booster administration for up to 90 days after infection. The 90 days are from the onset of the initial COVID-19 symptoms. If they never had symptoms, then the 90 days are from the date of collection of the first positive viral COVID-19 test.
Workers may be exempt from the vaccination requirements based on either a) Religious Beliefs or b) a Qualifying Medical Reason.
For details, please refer to the LA County Healthcare Worker Vaccination Requirement Order
EMS personnel with higher risk occupational exposures and those with close contact exposures outside of work (community exposures) may continue to work, regardless of vaccination status, as long as they do not develop symptoms or test positive for SARS-CoV-2. Serial post-exposure testing is required. EMS personnel should follow the table below to guide the management of asymptomatic EMS personnel with exposures based upon the facility staffing level.
All EMS personnel with exposures should wear an N95 respirator at all times while in the field until they have a negative test result on Day 5.
Table 1. Management of Asymptomatic EMS Personnel with Exposures| Vaccination Status | Routine | Critical Staffing Shortage |
|---|---|---|
| All EMS personnel, regardless of vaccination status | No work restriction with negative diagnostic test† upon identification (but not earlier than 24 hours after exposure) and if negative, test at days 3 and 5. | No work restriction with diagnostic test† upon identification (but not earlier than 24 hours after exposure) and at days 3 and 5.^ |
†Either an antigen test or nucleic acid amplification test (NAAT) can be used. In general, post exposure testing of asymptomatic EMS personnel who have recovered from SARS-CoV-2 infection in the prior 30 days is not recommended. If the exposed EMS personnel’s first positive prior test was 31-90 days ago, then antigen testing is recommended.
^ If most recent test is positive, see Table 2 Work Restrictions for EMS with SARS-CoV-2 Infection.
Higher-risk occupational exposure
In the EMS setting, the following exposures to a confirmed infectious COVID-19 case* are considered high-risk:
*COVID-19 cases are considered to be infectious beginning 2 days prior to symptom onset (or initial positive viral test if case is asymptomatic) until the time they meet criteria for discontinuing isolation.
Community Exposure
EMS personnel who are close contacts in the community are considered higher risk. This is because at work, EMS must follow infection control prevention and control procedures and they use personal protective equipment (PPE) per strict standards. To see the definition of a close contact in the community, see CDPH Guidance on Isolation and Quarantine of the General Public.
For more information, see the following CDPH AFL guidance:
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.
EMS personnel with SARS-CoV-2 infection Under routine staffing, it is recommended that infected staff be tested in order to return to work early (prior to completing the 10-day isolation) unless under crisis staffing shortages. See Table 2 Work Restrictions for EMS personnel with SARS-CoV-2 Infection (Isolation).
Post-exposure Testing is recommended* for asymptomatic EMS personnel after a high-risk occupational or community close-contact exposure to SARS-CoV-2 as outlined in Table 1 Management of Asymptomatic EMS Personnel with Exposures unless under crisis staffing shortages. Testing should also be performed as part of an outbreak investigation.
Screening of asymptomatic workers is no longer routinely recommended except in outbreak investigations. During, though during periods of high community transmission of COVID-19, the LAC DPH may recommend this practice.
EMS personnel with symptoms of COVID-19 should be excluded from work pending SARS-CoV-2 diagnostic testing.
For personnel who were initially suspected of having COVID-19 but, following evaluation, another diagnosis is suspected or confirmed, return-to-work decisions should be based on their other suspected or confirmed diagnoses.
See CDC Interim Guidance for Managing HCP with SARS-CoV-2 Infection.
| Vaccination Status | Routine | Critical Staffing Shortage |
|---|---|---|
| All EMS personnel, regardless of vaccination status | 5 days* with
at least one negative diagnostic test† same day or within 24 hours prior to return OR
10 days without a viral test |
No work restrictions, with prioritization considerations (e.g., asymptomatic or mildly symptomatic)‡ |
*Asymptomatic or mildly symptomatic with improving symptoms and meeting negative test criteria; facilities should refer to CDC guidance for HCP with severe to critical illness or moderately to severely immunocompromised.
† Either an antigen test or nucleic acid amplification test (NAAT) can be used. Some people may be beyond the period of expected infectiousness but remain NAAT positive for an extended period. Antigen tests typically have a more rapid turnaround time but are often less sensitive than NAAT. Antigen testing is preferred for discontinuation of isolation and return-to-work for SARS-CoV-2 infected HCP and for HCP who have recovered from SARS-CoV-2 infection in the prior 90 days; NAAT is also acceptable if done and negative within 48h of return.
‡ If most recent test is positive, then EMS personnel may provide direct care only for patients with confirmed SARS-CoV-2 infection. This may not apply for all staff types or in settings where practically infeasible (eg., Emergency Departments where patient COVID-19 status is unknown) or where doing so would disrupt safe nurse to patient ratios, and for staff who do not have direct patient care roles. Infected EMS personnel should maintain separation from other EMS personnel as much as possible (for example, use a separate breakroom and restroom) and wear a N95 respirator for source control at all times while working until at least 10 days from symptoms onset or positive test (for EMS personnel who remain asymptomatic throughout their infection).
EMS personnel returning to work between days 5-9 after meeting routine criteria should wear a fit-tested N95 for source control through at least Day 10 from symptoms onset or positive test (for EMS personnel who remain asymptomatic throughout their infection).
In addition, EMS provider agencies should make N95 respirators available to any EMS personnel who wishes to wear one when not otherwise required for the care of patients or residents with suspected or confirmed COVID-19.
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Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.
