Administration and Leadership, Commentary, Coronavirus, Exclusives

What Does the Future Hold for EMS after COVID-19?

EMS leaders need to consider the future and have a plan in place after the COVID-19 pandemic ends, writes David Lowe. (Photo/Queensland Ambulance Service Facebook)

What a year 2020 has been so far. I was in Tampa, Florida, in March for EMS Today listening to excellent speakers and hearing the latest in EMS innovation, learning and trends.

One of the sessions I attended was “A Lethal Wind, A High Consequence Event: EMS Planning, Mitigation, and Recovery when Predictive Systems Fail.” While it wasn’t what I expected, it was an eye opener to what was about to occur and did predict and discuss issues that would turn into reality shortly thereafter.

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Who could have predicated the severity or impact of a virus like COVID-19? After all, we live in modern times with advanced health services and have international supply and distribution networks that meet our every need.

Within a month of attending EMS Today, we had panic buying, stock shortages, travel restrictions, lockdowns, social distancing, overwhelmed health systems and an unprecedented number of deaths. Even now, we have an increasing numbers infections and death from COVID-19.

One the subject covered in the session was supply chain breakdown from pandemics. It was almost like they had a crystal ball. The perceived shortages here in Australia started with toilet paper and continued with hand sanitizer and soap. When the news came from Italy about the increasing death rate, pasta, pasta sauces and mince flew off the shelves. Why pasta? Who knows; most of it is produced locally. Toilet paper sales increase by a third across the country, the demand was so great that supermarkets imposed restrictions on the amount you could purchase. People were fighting in the aisles over a pack of one ply. I have never feared more for my safety in 30 years of service more than the day when I walked the 250 metres from the supermarket to the office with a 24 pack of the good stuff.

Internationally, there were shortages in the ambulance and medical sector from increased demand and reduced supply capacity from COVID-19. We saw shortages of PPE supplies, ventilators and staff as infection rates grew. Health systems became overwhelmed and struggled with the number of patients they were confronted with. EMS systems struggled with reduced workforces as frontline staff became infected and increased call volumes from the community and transfers of high-acuity patients between hospitals.

In Australia, we locked down hard with international and state border closures. Bars, cafes and restaurants also closed, and there were restrictions on public gatherings and social distancing requirements. Locally, with the fear of COVID exposure and reduced movements within the community, there was a 20% decrease in call volume; the local emergency department also saw similar reductions.

We ceased non-essential and non-core activities and increased service capacity. In-service training and community activities were cancelled because of social distancing rules, but that meant we were able to place additional staff into frontline services. We also discovered we didn’t know what we didn’t know. With no clear knowledge of what PPE we had, and what the actual usage was, it required a rapid development of systems to monitor supply levels and usage across multiple locations.

The undisputed fact – apart from the very clear, human and social impact of this pandemic – is the massive economic impact of COVID-19 on the community and governments at all levels across the world. People have lost their jobs, reducing what expendable income they have, and governments have reduced revenue streams while increasing expenditure trying to lessen the impact.     

While the optimist in me hopes for an earlier end of COVID-19, the realist believes we have a long ride ahead of us. When this finally ends, what does the future of society look like and what does future hold for EMS? All can we expect is a new normal.

Senior leaders from our service talk about a whole new world post COVID. Our service, like many, look at how we “do business.” More importantly, we look at where we concentrate our service delivery and focus our core business activities while being mindful that governments or health insurance funders will be reviewing spending.

That word core business in EMS is an interesting and dynamic word as anyone that has been involved in EMS for a number of years would know. We have seen our role expand over the years from the old “Three P” system (Pick them up, Put them in the back and Piss off) to that of highly skilled interventions of the modern paramedic practitioner. What was a transport medium designed to get people to hospitals quickly has evolved to an integrated part of the health system with community paramedics looking for solutions that prevent hospital admissions through improved community care pathways.

While it is impossible to know what EMS after COVID is going to look like, it will be different for each service depending on what the community expects. It is plausible to say that the people who fund us will be looking at what it costs and if they are getting value for their money. Other questions that may be asked: Are all the services provided by EMS essential? What are the core services needed? What are the minimal requirements to provide a service? What does an expanded role look like and is it needed? What level or type of service can we afford or need?

While our current focus is maintaining our service, supporting your staff and staying safe through this pandemic, EMS leaders need to consider the future and have a plan for when and if we are asked these important questions.

This article is not written to provide you with the answers. The answer will be different for each individual service. This article is about provoking thought and considerations to what we really need and how can we justify it if and when asked.