EMS Leadership Focus: COVID-19 and the Federal Response

Jon Krohmer, MD

This year, Jon Krohmer, MD, thought he’d be focused on the release of new National EMS Education Standards, the continued evolution of the National EMS Information System (NEMSIS), and the celebration of the 50th anniversary of the creation of the National Highway Traffic Safety Administration (NHTSA).

Of course, that all changed with the arrival of COVID-19 in the United States. Since then, Dr. Krohmer and the staff of the NHTSA Office of EMS, where he has served as director for nearly four years, have focused on supporting local and state EMS systems in their efforts to fight the pandemic. In this interview, Dr. Krohmer talks about his team’s role in the federal response, the lessons we’ve already learned and what EMS Week 2020 means during this unprecedented time.

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JEMS: As a local EMS medical director, a former federal official with the Department of Homeland Security, and now the director of the NHTSA Office of EMS, you’ve been thinking about pandemic response for much of your career. How has the current situation challenged the assumptions and plans we’ve made over the last several decades?

This event has confirmed many of the pandemic response assumptions we’ve made in previous plans and exercises, but there have been some differences. The supply chain dependence on international sources for some of our PPE needs exceeded my previous understanding. In addition, the intricacies of the international and national supply chain will lead to additional planning modifications.

Even though the country experienced several very large hot spots, the pandemic is clearly a nationwide–and global–event that has reinforced the importance of using the Incident Management System. It has also reinforced the importance of the integration of EMS into our health care communities and response plans. We must improve our communications with the public about 911 use, including when to access 911 and how to use it appropriately. The impacts of this crisis on our daily EMS activities will continue to evolve over the coming months and will modify our daily practices.

I have been unbelievably impressed with the dedication and commitment from individuals at the local, regional, state and national levels to our lifesaving mission.

JEMS: The NHTSA Office of EMS has a small staff and your role is not to respond on the ground in situations like this. What role have you and your team had in the federal response to COVID-19?

The NHTSA Office of EMS staff started working daily with the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) early in the event to facilitate dialogue and collaboration with local and state EMS communities, initially establishing frequent conference calls with stakeholders to share information and to work with them to identify local and state needs.

As HHS activated its Emergency Operations Center, NHTSA Office of EMS assumed increasing responsibility for that EMS interface, while ASPR focused on overall disaster response issues and working with FEMA on national ambulance contract issues. When FEMA opened the National Response Coordination Center, NHTSA Office of EMS assumed leadership of the FEMA Healthcare Resiliency Task Force EMS/Prehospital Team. That team, comprised of representatives from NHTSA’s OEMS, the Centers for Disease Control and Prevention, the U.S. Department of Homeland Security, and the Coast Guard, focuses specifically on the EMS needs and in the response.

As part of that engagement, we have increased our outreach to EMS through webinars, conference calls and meetings to ensure we have a reliable understanding of issues and needs on the ground. We have developed a series of planning and response resources for the EMS community, which are available on EMS.gov. The members of the EMS/Prehospital Team have been phenomenal in addressing these issues and providing support to EMS clinicians everywhere.

JEMS: What has surprised you most about what your colleagues in health care and government know, or don’t know, about local and state EMS and 911 systems?

All of us in EMS have been working for many years to educate everyone about the capability of the EMS system and its importance as a critical component of our nation’s response and health care systems. This event has shown national and state leadership the truly valuable role EMS plays, as well as the dedication, resilience, capabilities and resolve of the EMS workforce.

EMS can further support the country’s public health needs by continuing to care for patients with medical emergencies, evacuating long-term care facilities, providing treat-in-place care (according to quickly implemented protocols), and helping with and conducting COVID-19 testing in the field. We have learned more about overall EMS operational and equipment issues that will help us respond to future emergencies.

Many colleagues have been impressed with the capabilities of NEMSIS. Data and information generated by NEMSIS and the National EMS Database has been incorporated into the national COVID response assessment and projection. This event has also provided us with new insight into EMS operational and equipment issues, as well as other ways that EMS data can contribute to the health care. We have been able to educate leadership about our 911 infrastructure and its interface with response and health care activities — and the need to upgrade and modernize that infrastructure.

JEMS: How can EMS services and other first responders prepare for a “second wave” of novel coronavirus?

We must remain very vigilant in the coming months. We must pay attention to our experiences over this part of the response and use those lessons to plan for and prepare for a potential resurgence later this year. This response again reinforces to the entire nation the importance of appropriate preparedness, and we must maintain that preparedness.

We have an unbelievable team of dedicated responders in EMS in the country. Tragically, some first responders, including EMS, and other health care providers have lost their lives due to COVID-19, and we must never forget the sacrifices they made. Moving forward, we have to ensure that first responders have the appropriate personal protective equipment and other equipment. We must ensure they have the resources and supplies they need to fulfill their responsibilities.

JEMS: As we begin to look forward to a time of “normalcy,” what kind of long-term impact do you think the COVID-19 pandemic will have on EMS?

It will be interesting to see what the new normal will be. To be sure, we will be placing even greater reliance on the safety of our responders. We will be working closely with our other first responder communities and with health care and public health partners. We will see EMS clinicians evolving their patient care activities to support the nation’s health outside the transitional EMS boundaries. We are seeing how telehealth offers significant capabilities and opportunities to health care, and that will apply to EMS and 911 systems as well.  

JEMS: We are once again recognizing National EMS Week and this year’s theme is “Ready Today. Preparing for Tomorrow.” What do those words mean to you and the NHTSA Office of EMS?

Clearly this year has demonstrated that EMS clinicians are ready for anything, even when the system struggles and we are forced to adapt quickly. Many folks have heard me say by now that there are actually five blood types: A, B, AB, O and EMS!

All of us have been focused and challenged this year. When I need encouragement (a blood transfusion of sorts) in daily activities, I turn to the Office of EMS staff and the EMS folks throughout the country. I look at what they do on a daily basis and how they sacrifice to care for those in need so that others may live, and I am inspired and re-energized. I am truly proud to be associated with such a wonderful group of lifesavers! This year’s EMS Week theme is so appropriate, because everyone in EMS is ready each and every day and always preparing for tomorrow. I truly believe that we are and will remain “EMS strong.”

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