The Fault Lays on Our Policies. The Problem, the Solution and How We Go from Here.
As an EMS provider, lecturer and scientific researcher, I sometimes find that my practice often clashes with what I preach. In EMS, we tend to do things on the ambulance merely because, well, that’s the way it’s always been. Despite the establishment of national EMS curriculum standards, EMTs, paramedics and other first aid providers still carry out practices that simply are not evidence based. It is a fault that certainly does not rest of the providers who work diligently every day to keep us safe, but on the structures that be.
- Managing COVID-19: Applying an Asymmetric Solution to an Asymmetric Problem
- Regions Hospital (MN) Community Paramedic Response to COVID-19
- IAFC Supports Vaccine Prioritization for First Responders
During the ominous and unprecedented era of COVID-19, we would like to think that our responding emergency healthcare providers on the frontlines are prepared with the training, equipment and administrative organization necessary to tackle this pandemic head on; but the truth, as recent science has shown, is that we are far from it.
On May 3, 2020, the EMS Pandemic Response Research Lab at the Bard College Network published preliminary findings from a national study on EMS resource capacity and competency amid COVID-19 in the United States.1 The findings, albeit disheartening, were not surprising.
Like most other countries, EMS organizations were funded by the federal government beginning in the 1960s when Congress adopted legislation to support funding to local first aid squads, volunteer ambulances and other EMS agencies. This lasted until 1981, when the Omnibus Budget Reconciliation Act cut off categorical funding at the federal level to states, which in turn forced local and state governments to search for funds to support EMS and ensure the quality of emergency care on their own.2
This ultimately led to the lack of national oversight in EMS, leaving communities of lower socioeconomic status to suffer disproportionately from reduced quality of care, ultimately leading to many social inequalities. Today, the unfortunate reality is that the quality of care you get when you call 911 can vary depending on the zip code you call from.3-5
During the time of the novel coronavirus, it has now become more pressing than ever to investigate this further. In an effort to address the areas where EMS providers and agencies need the most support, our research team has conducted a national study involving 192 active EMS personnel participants in 47 U.S. states (including the District of Columbia).
One of the lab’s studies, available publicly in Cell Press, revealed that regular decontamination of EMS equipment after patient contact is not a regular practice. In fact, 43% of personnel report that they do not sanitize their stethoscope on a frequent basis.1
Additionally, about a third of surveyed personnel were unsure of when a COVID-19 patient was infectious. It is becoming increasingly evident that decontamination practices and pandemic response training are extremely lacking, and it could be costing people their lives.
COVID-19 has already taken the lives of several FDNY emergency medical workers who were department veterans and worked on post-9/11 recovery efforts. Understandably, it is incredibly difficult to develop an evidence based pandemic protocol when the evidence simply does not yet exist.
Although these are certainly unprecedented times, our optimism lays in our ability to quickly learn from our shortcomings.
- We can look into using SARS-Cov-2 detection methods to assess the efficacy of current EMS unit and equipment decontamination protocols.6
- We can create federal recommendations for EMS agencies that encourage the practice of patient to provider distancing, ration guidelines for personal protective equipment (PPE), and suspected COVID-19 positive patient response.
- We can write a new chapter into specialized pandemic response in new editions of EMS textbooks, and we can use these case studies of COVID-19 patients in the EMS classroom.
After all, we owe it to our patients, our first responders everywhere, and their families.
1. Ventura, Christian, et al. “Emergency Medical Services Resource Capacity and Competency amid COVID-19 in the United States: Preliminary Findings from a National Survey.” Heliyon, vol. 6, no. 5, 2020, doi:10.1016/j.heliyon.2020.e03900.
2. Emergency Medical Services at the Crossroads. National Academies Press, 2007.
3. Ebrahimian, Abbasali, et al. “Exploring Factors Affecting Emergency Medical Services Staffs’ Decision about Transporting Medical Patients to Medical Facilities.” Emergency Medicine International, vol. 2014, 2014, pp. 1–8., doi:10.1155/2014/215329.
4. Mitchell, Michael J., et al. “Socioeconomic Status Is Associated with Provision of Bystander Cardiopulmonary Resuscitation.” Prehospital Emergency Care, vol. 13, no. 4, 2009, pp. 478–486., doi:10.1080/10903120903144833.
5. Villani, Melanie, et al. “Geographical Variation of Diabetic Emergencies Attended by Prehospital Emergency Medical Services Is Associated with Measures of Ethnicity and Socioeconomic Status.” Scientific Reports, vol. 8, no. 1, 2018, doi:10.1038/s41598-018-23457-5.
6. Gibson, Cody Vaughn. “Emergency Medical Services Oxygen Equipment: a Fomite for Transmission of MRSA?” Emergency Medicine Journal, 2018, doi:10.1136/emermed-2018-207758.