Updated May 27, 2020

AmeriClerkships is proud to be the first U.S. Medical Education Services institution to provide PPEs to its independent medical students, graduates and hospitals in need.

Since March 15, 2020, the multi-phase AmeriClerkships COVID-19 Relief Fund for the 2021 Match has been instrumental in keeping AmeriClerkships Members who are planning on participating in the 2021 Main Residency Match on track by offering free Loyalty Memberships, free clinical rotations and needs-based financial relief. We are thrilled to announce the Phase 3 expansion of AmeriClerkships COVID-19 Relief Fund for the 2021 Match with focus on healthcare worker’s safety, by securing PPEs for our in-need Members and affiliated hospitals.

The Problem of PPE Shortage & U.S. Clinical Rotations

Soon after AmeriClerkships’ 3/17/20 recommendation to all of its members to bring their own PPEs to each clinical rotation, stories of PPE bidding wars, PPE thefts, global shortage of PPEs and increasing popularity of homemade PPEs made us realize that not only will our Members have a hard time securing any PPEs prior to their rotations, but also our key affiliated healthcare facilities and residency programs may be having a growing unmet need for PPEs which they may not want to publicize. One residency program reported that they are in dire need of any type of face masks, since a local hospital finally donated 300 surgical masks after begging them, and they’re down to only 32 N95s for their 18 residents and many more nursing staff. AmeriClerkships Members were naturally worried about their safety, and some hospitals even warned of cancelling clinical rotations due to PPE shortages; so we AmeriClerkships got to work!

The Solution to PPE Shortage for AmeriClerkships Members & Affiliated Hospitals

With the unwavering help of committed AmeriClerkships staff, and lots and lots of research, we vetted over 50 PPE vendors, cross referenced their product classifications and performance standards to NIOSH, and narrowed our results to a handful of vendors from whom we’ve purchased thousands of (and even returned thousands of questionable) PPEs, with a lazer sharp focus on securing N95, KN95 and FFP2/3 face masks. The first shipment of 3,000 KN95 with FFP2 product classifications arrived on 4/23/2020, which were donated to a primary care clinic in Atlanta serving the underserved, and sent to AmeriClerkships Members who pre-purchased PPE Packages with clinical block starts in <14 days on 4/24/2020 using FedEx 2-3 day shipping.

Additional shipments of PPEs are expected to come into and leave AmeriClerkships over the next several weeks.  Our plan is to sell at cost 40% of these PPEs to our Members with upcoming U.S. clinical starts in the months of May, June and July, and donate 60% to our affiliated U.S. hospitals and primary care centers so they can distribute them amongst their care providers.

The Actual Cost of PPEs

Depending on the PPE in question, cost can vary greatly. Pre-COVID, KN95/FFP2 masks could be purchased at or below $1 a piece, but today, that same mask can cost as high as $10/each. The greatest cost incurred is in shipping. Below are the cost for the first round of our KN95/FFP2 masks shipment we are expecting at AmeriClerkships:

Base cost to receive 3000 KN95/FFP2 masks from China:

    • Minimum order: 3000 (150 boxes of 20)
    • KN95/FFP2 per mask cost: $1.69/mask
    • International shipping: $1755
    • Trade Insurance: $136.50 (2%)
    • Total: $6961.50, or $2.32 or $46.41 for a box of 20

Additional average costs incurred by AmeriClerkships to send 1 box of 20 KN95/FFP2 masks to its Members and healthcare facilities in the United States:

    • Handling and FedEx preparation at AmeriClerkships: $25
    • FedEx 2-3 day delivery (https://www.fedex.com/en-us/online/rating.html; $30-60): $50 flat rate (average $30-60 to anywhere in the contiguous United States)
    • Management of above: Highly variable, but no less than $1000/week

Net cost for a box of 20 KN95/FFP2 masks to be sent by AmeriClerkships to its Members and Hospitals across the United States (PPE Package): $46.41 + $50 + $25 = $121.41, which is the exact same price our Members-in-need will pay regardless of any added expenses we incur as a result of obtaining KN95/FFP2 masks, or by including other PPEs as they arrive at AmeriClerkships for free.

PPE Packages for (at cost) Purchase by AmeriClerkships Members

As of April 14, 2020, AmeriClerkships Members with scheduled clinical blocks starting in May, June and July can purchase their own PPE Packages. Each PPE Package is priced based on the cost of a 20-pack box of KN95/FFP2 face masks for a single member’s personal use during AmeriClerkships rotation and associated shipping and handling fees as outlined above. If available at the time of shipping, AmeriClerkships will include other (all but KN95/FFP2) Personal Protective Equipment (PPE; face shields, gowns, etc.) in the same shipping box for free. Shipping covers most of the contiguous United States:

  • PPE Package (First box of 20 KN95/FFP2 for 1 paid clinical block): $121.41
  • Additional boxes of 20 KN95/FFP2 (1 box per paid clinical block; simultaneous purchase of a PPE Package is required to avoid paying for additional shipping costs): $46.41

AmeriClerkships Members: See below on how to purchase your PPE Package and additional boxes of KN95/FFP2.

PPE Package Donations to Affiliated Healthcare Centers

The AmeriClerkships COVID-Response Team is in direct communication with our affiliated healthcare facilities and key allies to establish their need for PPEs. As of 4/25/2020, AmeriClerkships has donated 2,180 KN95/FFP2 face masks to healthcare facilities in Florida and Georgia. The distribution of PPEs will be up to each hospital administration to coordinate.

AmeriClerkships Affiliated Healthcare Facilities: See below on how to apply for PPE donations.

Frequent Questions Answered

As of April 27, 2020, AmeriClerkships has been able to secure face masks with the following Filtering Facepiece Respirator (FFR) performance standards:

  • FFP2 (Europe EN 149-2001)
  • KN95 (China GB2626-2006)

Subject to change depending on demand and need for donation, AmeriClerksips Members may purchase up to ONE box of 20 face masks per paid clinical block with start dates in May, June or July of 2020. The first box will cost $121.41, and $46.41 for each additional box (to save on shipping costs, if all purchased and shipped simultaneously).

As shown in “Comparison of FFP2, KN95, and N95 and Other Filtering Facepiece Respirator Classes” published by 3M, respirators certified as meeting below standards can be expected to function very similarly to one another, based on the performance requirements stated in the standards and confirmed during conformity testing:

  • N95 (United States NIOSH-42CFR84)
  • FFP2 (Europe EN 149-2001)
  • KN95 (China GB2626-2006)
  • P2 (Australia/New Zealand AS/NZA 1716:2012)
  • Korea 1st class (Korea KMOEL – 2017-64)
  • DS (Japan JMHLW-Notification 214, 2018)

Not at this time, but it may change. Just like most healthcare facilities across the United States, we have not been able to secure NIOSH Certified N95 face masks either. However the first shipment of KN95 face masks we secured carry a product classification of FFP2 (used by the European Union), which according to CDC have similar performance requirements to NIOSH-approved devices.

If and when NIOSH Approved N95 face masks become available, AmeriClerkships will do its best to purchase and make them available to its Members for at-cost purchase, and affiliated healthcare facilities in need for donation.

For KN95/FFP2 purchased by AmeriClerkships between April 23 to May 7, 2020:

On February 29, 2020, CDC published guidance Strategies for Optimizing the Supply of N95 Respirators. This guidance provides Crisis Alternate Strategies that includes the option: “Use of respirators approved under standards used in other countries that are similar to NIOSH-approved N95 respirators.” The other countries listed in the guidance and their associated product classifications are shown here.

The straps go around the ears and not behind the head; the healthcare facilities we have donated our KN95/FFP2 to are addressing any nursing concerns about possibly not getting a full seal around the edges by putting on a surgical mask over them. Despite the above, all US hospitals and healthcare facilities have happily accepted our donations.

No. As of April 27, 2020, every hospitals and healthcare facilities we have shared the certificates and test results that came with our KN95/FFP2 shipments has approved and accepted them, and gladly received our donations.

Although CDC published guidance Strategies for Optimizing the Supply of N95 Respirators, providing that as Crisis Alternate Strategies: “Use of respirators approved under standards used in other countries that are similar to NIOSH-approved N95 respirators”, some healthcare facilities or job responsibilities may still only permit NIOSH Approved face masks (with or without providing them to AmeriClerkships Members). In this case, KN95/FFP2 are used as ‘surgical masks’ which are currently worn in most U.S. hospital floors and departments with and without an underlying respirator.

AmeriClerkships Medical Society (ACMedical or AMS) is facilitating an efficient means by which to provide access to Personal Protective Equipment, face masks, surgical masks and other healthcare supplies (collectively, PPE) to its Members, hospitals, employees, healthcare facilities, health care providers and other personnel who need such PPE (collectively, User or Users). AMS or ACMedical, and each of their affiliates (each, a Party, and collectively, the Parties), are not qualified to evaluate or inspect the PPE, or evaluate the suppliers or manufacturers of PPE in advance. Users receiving PPE are solely responsible for evaluating any PPE any and all Users may receive from AMS, and in particular, are responsible for confirming that the PPE provided to Users (donated or paid for) meet any applicable requirements and specifications, are not defective, adulterated, or otherwise unsuitable for the intended use. Neither AMS or ACMedical nor any other Party makes any representations or warranties regarding the functionality or performance of PPE, or that use of such PPE will result in any particular outcomes, or that any documents or certificates provided by the manufacturer or the distributor to AMS are authentic or valid. Users acknowledges and agree that any PPE they receive is accepted on an “AS IS” basis, with no representations or warranties of any kind, express or implied, including without limitation any representation or warranty regarding quality, compliance with any applicable specifications, non-infringement, merchantability or fitness for a particular purpose, prevention or treatment of any disease. Any use of PPE received through AMS or ACMedical is at the Users own risk. Neither AMS or ACMedical nor any of the other Parties will be liable for any damages of any kind arising from (i) the use of, or reliance on, any PPE received by any person or entity via AMS or ACMedical; (ii) any allocation or non-allocation of PPE using AMS or ACMedical; or (iii) any delay in delivery or failure to deliver PPE for any reason. Each User who agrees to receive PPE from AMS (either paid or donated) must sign the disclaimer below.

Evidence-based Recommended PPE Usages

The type of Personal Protective Equipment (PPE) recommended depends on the scenario. Click here (or the chart below) to read WHO’s recommendation on when, where and who should wear PPE, in the context of COVID-19 disease.

Note: AmeriClerkships strongly encourages that its willing and qualified medical students & graduates to remain in clinical rotations, and to only observe (6-8 feet distance) patients being treated for or suspected of having COVID-19. To preserve PPE for frontline healthcare providers (double gowning [isolation + surgical], face shields, shoe covers, surgical masks, etc.), entering isolation rooms or designated treatment areas by AmeriClerkships Members is strongly discouraged.

Ensure PPE use is rationalized and appropriate

According to WHO, PPE should be used based on the risk of exposure (e.g., type of activity) and the transmission dynamics of the pathogen (e.g., contact, droplet or aerosol). The overuse of PPE will have a further impact on supply shortages. Observing the following recommendations will ensure that the use of PPE rationalized.

  • The type of PPE used when caring for COVID-19 patients will vary according to the setting and type of personnel and activity (Table 1).
  • Healthcare workers involved in the direct care of patients should use the following PPE: gowns, gloves, medical mask and eye protection (goggles or face shield).
  • Specifically, for aerosol-generating procedures (e.g., tracheal intubation, non-invasive ventilation, tracheostomy, cardiopulmonary resuscitation, manual ventilation before intubation, bronchoscopy) healthcare workers should use respirators, eye protection, gloves and gowns; aprons should also be used if gowns are not fluid resistant (1).
  • Respirators (e.g., N95, FFP2 or equivalent standard) have been used for an extended time during previous public health emergencies involving acute respiratory illness when PPE was in short supply (3). This refers to wearing the same respirator while caring for multiple patients who have the same diagnosis without removing it, and evidence indicates that respirators maintain their protection when used for extended periods. However, using one respirator for longer than 4 hours can lead to discomfort and should be avoided (4−6).
  • Among the general public, persons with respiratory symptoms or those caring for COVID-19 patients at home should receive medical masks. For additional information, see Home care for patients with suspected novel coronavirus (COVID-19) infection presenting with mild symptoms, and management of their contacts (7).
  • For asymptomatic individuals, wearing a mask of any type is not recommended. Wearing medical masks when they are not indicated may cause unnecessary cost and a procurement burden and create a false sense of security that can lead to the neglect of other essential preventive measures. For additional information, see Advice on the use of masks in the community, during home care and in healthcare settings in the context of the novel coronavirus (2019-nCoV) outbreak (8).

Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings

Background
This document recommends practices for extended use and limited reuse of NIOSH-certified N95 filtering facepiece respirators (commonly called “N95 respirators”). The recommendations are intended for use by professionals who manage respiratory protection programs in healthcare institutions to protect health care workers from job-related risks of exposure to infectious respiratory illnesses.

Supplies of N95 respirators can become depleted during an influenza pandemic (1-3) or wide-spread outbreaks of other infectious respiratory illnesses.(4) Existing CDC guidelines recommend a combination of approaches to conserve supplies while safeguarding health care workers in such circumstances. These existing guidelines recommend that health care institutions:

  • Minimize the number of individuals who need to use respiratory protection through the preferential use of engineering and administrative controls;
  • Use alternatives to N95 respirators (e.g., other classes of filtering facepiece respirators, elastomeric half-mask and full facepiece air purifying respirators, powered air purifying respirators) where feasible;
  • Implement practices allowing extended use and/or limited reuse of N95 respirators, when acceptable; and
  • Prioritize the use of N95 respirators for those personnel at the highest risk of contracting or experiencing complications of infection.
    This document focuses on one of the above strategies, the extended use and limited reuse of N95 respirators only; please consult the CDC or NIOSH website for guidance related to implementing the other recommended approaches for conserving supplies of N95 respirators.

There are also non-emergency situations (e.g., close contact with patients with tuberculosis) where N95 respirator reuse has been recommended in healthcare settings and is commonly practiced.(5-9) This document serves to supplement previous guidance on this topic.

Read the full CDC article here.

How to Obtain PPEs from AmeriClerkships

Please read the following PPE Disclaimer carefully, then sign and submit. This form is required by any recipient of AmeriClerkships PPE, whether donated or purchased. PPE availability at AmeriClerkships is limited, therefore we will contact you in the order that PPE Disclaimers are received: