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Pandemic Protocols: How EMS are Handling COVID-19

March 31, 2020
EMT with PPE Mask

This past weekend, New York City’s 9-1-1 system experienced a larger volume of 9-1-1 calls than they did on 9/11 – as the COVID-19 pandemic shutters the city, medics like myself are trying to keep up with the demand for service while rationing supplies and personnel. We’re operating under pandemic protocols –a set of rules and guidelines we follow to protect ourselves, our patients, and our communities.

What are pandemic protocols?

For EMS, pandemic protocols range from the types of personal protective equipment (PPE) we have to wear to the number of service providers we send to each call. Other first responders like police, fire, and 9-1-1 telecommunicators all have their own job-specific protocols, but generally we’re all advised to wear PPE to limit contamination, and to limit the amount of contact we make with people to avoid unnecessary exposure.

For EMS, PPE includes goggles or protective eyewear, a full body gown, gloves that go over the gown, a N95 mask if/when available, and potentially even shoe/head coverings. If that sounds like a lot of stuff, it’s because it is.

We also have to strategically reduce the amount of people we send to each call. For example, for a cardiac arrest we may typically send two EMTs, two paramedics, a police officer, firefighters and an ambulance for transport. Now, depending on local guidelines, critical calls may only see two or three responders total.

Meir Berkman in full PPE

Making do with scarce resources

Healthcare providers and first responders are struggling with scarce PPE resources. Even though today’s protocol suggests we use PPE on every call, it’s becoming unrealistic for us to do that given the shortages, especially as more calls roll in than ever before.

Providers are being forced to make real-time decisions about their safety: should I use my last set of PPE now, or save it for the next patient? Every time we go out, we also have to factor in the added time it takes to prepare for each call with proper PPE.

If it takes five minutes to put on protective gear, that’s five more minutes before a critical patient may receive care. For context, the American Heart Association estimates that for cardiac arrests, each minute of delay means a seven to ten percent increase in mortality. 

We also have to consider that the more time we spend in the field, protected or unprotected, the higher the likelihood is that first responders contract the virus. The NYPD already had 300 officers test positive for COVID-19, with thousands more out sick. Considering New York State estimates the peak, or peaks are still two to three weeks away, we’re likely to see a shortage of not just PPE, but personnel as well. The reality for the 7,000+ calls a day is that we’ll have less cops, medics, and firefighters to respond, with less protective gear available to them.

The ethical dilemmas of a pandemic

With shortages comes tough decisions. It’s our mandate to answer every emergency call, but systems are being forced to prioritize and triage which calls get answered when. In the context of a pandemic, we also have to choose what protective gear we wear on which calls, and which patients would truly benefit from a hospital visit rather than managing symptoms at home, or utilizing telemedicine. 

We’re forced to ask ourselves ethical questions that would never arise under normal conditions, like, “what if I wear my last N95 for the day to this call, but the next call is for someone infected?” or “do we bring a patient to the hospital who is vulnerable to the virus, knowing they’ll likely become infected?” These questions weigh on us every day, and become harder to answer as the hospitals reach capacity.

Help is on the way

As the infection’s peak rapidly approaches, all hands are on deck to help. We’re grateful for and amazed by the response of both the public and private sector to help fight this pandemic. From the folks on the frontlines, like medics, doctors, and police officers, to the grocery store employees, delivery drivers, and gig economy workers who are helping us maintain a sense of normalcy: everyone is doing their part.

For the average citizen, we ask that you never hesitate to call 9-1-1 for help, but only call if you’re experiencing a true emergency. If you’re in need of medical advice or consultation, call 3-1-1, contact your physician, visit an urgent care clinic, or utilize telemedicine resources for advice. 

Now is the time to make good decisions about your health: listen to your body, monitor your symptoms, and follow the CDC and WHO guidelines to protect yourself and your loved ones from infection. New York State, CMS, and many others, are going to great lengths to ensure telemedicine resources are reimbursable through your insurance.

The virus spreads primarily through community contact: social distancing is the recommendation for a reason. You can help save lives – and make first responders’ jobs a little easier – by following instructions and staying healthy.

What if I do need help?

In the event you do need to call 9-1-1 for help, be prepared to answer a litany of questions about your health. It may feel like an interrogation, but it’s so we can deliver the best care to you while protecting our personnel. A telecommunicator will likely ask you if you’re experiencing any symptoms of COVID-19, their severity, and how long you’ve had them for. 

It’s one of the reasons we do what we do here at RapidSOS: we help deliver this data instantly to 9-1-1, so first responders can make better, smarter, and more efficient decisions in the field. Health data from wearable or PERS devices can become especially critical in these cases – smart watches can tell us about a person’s preexisting health conditions before they need to verbalize them. The more information medics like myself can get our hands on ahead of making patient contact, the fewer decisions we have to make on the fly.

Together, we’re fighting back this virus one day at a time. It’s an existential threat the likes of which we haven’t seen in our lifetimes. Things might seem bleak at times, but if there’s one advantage we have over the virus it’s this: we have good people willing to go to the ends of the earth to save lives and cure this disease. If we support each other, follow the guidelines, and trust in ourselves, we’ll make it through this. 

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