Pan American Health Organization · Version 2.3, 2020
An instructive checklist for verifying pre-hospital emergency medical system readiness to respond to COVID-19 across all operational components.
- Issuer
- Pan American Health Organization
- Edition
- Version 2.3, 2020
- Audience
- Managers of emergency call centres, dispatch centres, ambulance services, first responder programmes; ministries of health pre-hospital care offices
- Evidence
- Expert consensus based on SARS, MERS and influenza outbreak experiences
- Reviewed
- 19 Oct 2026 · GMJ
What this guideline says
GMJ summary
This instructive checklist, developed by the Pan American Health Organization, provides a comprehensive readiness verification tool for pre-hospital emergency medical services (EMS) responding to COVID-19. Drawing on experiences from SARS, MERS and influenza outbreaks, it addresses the interface between preparedness actions and immediate emergency response.
The checklist is structured across four core components: access to emergency call numbers and dispatch services; first responder programmes; patient transfer including basic and advanced life support; and administration including medical direction, human resources and training. Each component contains specific objectives with dichotomous verification items rated as complete, incomplete or in process.
The tool emphasises the Detect–Isolate–Report (D.I.R.) approach, ensuring appropriate personal protective equipment use, establishing pre-arrival protocols for suspected cases, implementing hospital pre-notification procedures, and maintaining coordination with health authorities and integrated health service networks throughout the COVID-19 response.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Call protocols must include up-to-date questionnaires covering COVID-19 symptoms and risk factors (e.g. history of travel to affected areas) based on current case definitions
- Pre-arrival information protocols (post-dispatch) must inform responding units to ensure appropriate personal protective measures before arrival at scene
- Ambulances should have compartmentalised separation between driver's cabin and treatment area and/or HEPA filters in ventilation circuits
- Manual ventilation devices must be equipped with HEPA filters capable of filtering 99.97% of airborne particles as small as 0.3 µm in diameter
- Hospital pre-arrival notification procedures must be established with the integrated health service network to confirm reception and facilitate emergency department preparation
- All ambulance staff must be trained in the Detect–Isolate–Report (D.I.R.) conduct, use of personal protective equipment, and COVID-19 transmission mechanisms
- Protocols must be established for risk exposure assessment and management of professionals exposed to COVID-19, including medical leave for quarantined emergency personnel
- Designated areas must be identified in ambulance stations and/or referral hospitals for decontamination and disinfection of materials and ambulances
Readiness verification criteria for prehospital EMS COVID-19 response
Table extracted from the guideline
| Verification level | Criteria |
|---|---|
| Complete | The EMS has developed, validated, and implemented the procedure/protocol. It has the recommended equipment. |
| In process | The EMS has developed a procedure/protocol but has not yet implemented or validated it. The equipment is being purchased but has not yet been received. |
| Incomplete | The EMS does not have the procedure/protocol and/or recommended equipment. |
Source: Pan American Health Organization, Prehospital Emergency Medical Services Readiness Checklist for COVID-19. Reproduced in summary form.
From the guideline
Verbatim
“Readiness is basically the interface between preparedness actions and the immediate response to any emergency, i.e., the action and effect of being ready or prepared and/or being ready to respond.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Georgia strengthens its emergency medical services following the 2013 universal health coverage reforms, this checklist provides an essential framework for COVID-19 readiness that extends beyond the current pandemic. The emphasis on the Detect–Isolate–Report protocol and integrated coordination with health service networks aligns well with Georgia's ongoing efforts to modernise emergency response systems. I would stress to Georgian EMS managers the critical importance of establishing robust hospital pre-arrival notification procedures—this single measure can dramatically reduce nosocomial transmission risk whilst improving patient outcomes. The primary implementation challenge for Georgia will be ensuring HEPA filtration capacity across the ambulance fleet, particularly in rural and mountainous regions where resource constraints are most acute and where retrofitting older vehicles may require phased investment aligned with national procurement cycles.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 19 Oct 2026
Applicability
Georgia and the South Caucasus
This checklist is directly applicable to Georgia’s emergency medical services system, which operates through the Emergency Medical Centre and regional ambulance services. Georgian EMS would need to verify readiness across all four components, with particular attention to establishing COVID-19-specific call protocols that can be integrated with existing 112 emergency dispatch systems. The checklist’s emphasis on coordination with integrated health service networks aligns with Georgia’s ongoing health system reforms and universal health coverage programme. Implementation would require assessment of current HEPA filtration capacity in the ambulance fleet, development of standardised pre-arrival notification protocols with receiving hospitals, and comprehensive training of EMS personnel in D.I.R. procedures—all adapted to Georgia’s specific health system structure and resource availability.
Questions this guideline answers
Quick answers
What are pre-arrival instructions and when should they be provided?
Pre-arrival instructions are guidance that emergency dispatch workers provide to callers (witnesses, family members, first responders) whilst waiting for ambulance services. They can include general safety advice or specific instructions on controlling bleeding, choking, CPR or assisting with childbirth. For COVID-19, these must not delay immediate advice on life-threatening situations.
What personal protective equipment requirements are specified for ambulance staff?
The checklist requires all ambulance staff to be trained in the use of personal protective equipment (PPE) and aware of COVID-19 transmission mechanisms. Specific equipment standards include HEPA filters for manual ventilation devices and ambulance ventilation circuits, adequate hand hygiene resources in ambulances, and clearly indicated areas for disposal of biological/infectious waste.
How should ambulances manage suspected COVID-19 cases during transport?
A care protocol must be available for management and transportation of suspected and confirmed cases. This includes hospital pre-arrival notification to confirm reception and prepare the emergency department, airway management protocols covering all aerosol-producing techniques, use of HEPA-filtered ventilation devices, and established procedures for ambulance worker hygiene and treatment area cleanliness after patient transport.
What coordination mechanisms are needed with health authorities?
Identified and established mechanisms must be in place for communication and coordination with health authorities at health services and points of entry for case reporting and patient transportation. This includes reporting ambulances en route, patient transfers, and maintaining operative systems for communication with 911, points of entry, integrated health service networks, and health authorities throughout case management.
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Quality & accreditation
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- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Edition
- Version 2.3, 2020
- Status
- Current
- Published
- 2020-01-01
- Scope
- Pre-hospital emergency medical services readiness verification for COVID-19 response
- Audience
- Managers of emergency call centres, dispatch centres, ambulance services, first responder programmes; ministries of health pre-hospital care offices
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus based on SARS, MERS and influenza outbreak experiences
- Record history
- Created 19 Oct 2026 · updated 19 Oct 2026 · next check Apr 2027
Pan American Health Organization. Prehospital Emergency Medical Services Readiness Checklist for COVID-19. Instructive. Draft document, Version 2.3. Washington, D.C.: PAHO; 2020.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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