NJ EMT Reflects On the Early Days of the Pandemic

A headshot of Amiel Rimberg, EMT-B.
Amiel Rimberg, EMT-B

My experience with COVID-19 began in the first week of March 2020, with reporters filming live in the center of the Yeshiva University campus and with an FDNY ambulance parked outside Rubin Hall standing by during COVID-19 testing for students. One of the parents of a student at my college was the second-documented COVID case in all of New York. Out of “an abundance of caution,” classes were canceled for one week – then two – when a university student himself tested positive. I decided to spend more time at home where I planned to catch up on some schoolwork, spend quality time with my family and pick up some extra shifts at the Teaneck (NJ) Volunteer Ambulance Corps (TVAC). I didn’t know that would end up being my last time on campus before graduating.

Related: As Our Roster Thinned Because of COVID-19, I Couldn’t Sit Back on Sidelines

I remember receiving a message from the TVAC Chief stating that I would be forbidden from taking ambulance calls due to my potential exposure at my school. Once I was cleared by the medical director a couple of days later, I was excited to get back to volunteering, which consisted of a 16 hour shift beginning Thursday night and responding off-duty as needed. During my first shift back, I was dispatched to my first call for a suspected COVID-19 infection. My partner and I donned full PPE including N-95 masks, gloves, eye protection, and Tyvek® suits. We treated and brought an elderly female to the hospital. I felt an excited nervousness on that call. I was potentially dealing with the respiratory virus at the center of everyone’s attention. That first night, we had five emergency calls, including calls for syncope and chest pain.

Other than the suspected COVID-19 call, my partner and I were not wearing masks, and neither were any of the patients. All we knew was to look for flu-like symptoms and that respiratory distress could develop in more severe cases. We later found out that all of the patients we saw that night tested positive. No one could have predicted the rapid explosion of infections throughout Teaneck that followed the next several weeks. Our PPE protocols quickly changed to wear N-95 masks and to place a mask on the patient. What appears so obvious and standard today was new to us then. COVID-19 seemed distant at first, but it became very real very fast.

The next thing we knew, TVAC’s call volume doubled (from 12.5 calls per day on average to 25-30 calls per day) and was made up almost entirely of COVID-19 cases. Despite the call volume, there was very little need to put the sirens on, as the streets were eerily empty. The healthcare system in our area became overwhelmed very quickly. The first hospital to hit divert status was Holy Name Hospital in Teaneck, so we made the effort to transport patients to Englewood Health or Hackensack University Medical Center unless the patient’s condition was life threatening.

However, when those hospitals diverted and the emergency calls still continued to come, the patients had to go somewhere. This led to Holy Name Hospital constructing additional space for hospital beds and the appearance of refrigerated trucks outside the hospital for dead bodies. Initially, the spread of COVID-19 seemed to occur among the general population and not as much within nursing homes and independent living facilities. Seeing what the virus was doing to members of the general population, we strongly hoped that infections would stay outside these facilities, which were taking precautions against outside visitors. Our hope didn’t last very long. COVID-19 snuck its way into the nursing homes, demonstrated by one call on the second floor of the building and with a second call a couple of rooms down from the first. Within several days, the virus had made its way up to the third floor and infected nearly all of the residents in nursing homes. I distinctly remember responding to a COVID-19 call at the nursing home and watching a second ambulance crew come in at the same time to help a patient a couple of doors down.

The things we saw in the worst weeks, during the height of the pandemic, were unforgettable. There was little time to process, which I think helped me through that time period. I saw five people die in their homes in 24 hours and was left wondering how many other patients I transported were dead or alive. Dozens of people of all ages pleaded for help because they could not breathe. Not only was the number of patients I treated large, but they were also in conditions I have never seen before. I remember assessing an ambulatory patient who was speaking in full sentences to find that his oxygen saturation level was 88%. An elderly woman lying in her bed saying, “I don’t want to go to the hospital. Leave me here to die. I don’t want to live anymore.” Her respiration rate was rapid, her oxygen saturation level was 48%, and her bed was soaked with sweat. I heard her daughter begging and crying over the phone to “listen to the EMTs and do it for me.” The patient agreed to be transported, but I was only left wondering what happened to her after that. I assumed that many patients, who were not in good condition, either due to severe respiratory distress or unresponsiveness, were going to die.

The hospitals had a limited number of ventilators at the time, and priority was not given to patients coming to the hospital in cardiac arrest. Because of this and the fact that space in the hospital was  limited, there was a time when we stopped transporting patients without a pulse. Furthermore, due to the   greater threat of infection to EMS providers while performing chest compressions and ventilations with a bag-valve mask, when we found patients in cardiac arrest, we placed the AED on their chest, noted whether it advised shocking the patient’s heart or not, and if it didn’t, the patient was pronounced dead by the paramedics. It didn’t feel natural or right to do this because of our instinct to help, but we knew it was what needed to be done at the time. There were times where I felt helpless as a healthcare provider, going through the cycle of putting PPE on, administering oxygen through a nonrebreather mask, loading the patient into the ambulance, dropping the patient off at the hospital, decontaminating, and then responding to the next call right away. I can only imagine the loneliness patients experienced and the family members’ helplessness due to restricted visitation at the hospitals.

However, not all the patients we saw were critical patients. In fact, many calls we received were from people infected with COVID-19 experiencing relatively minor symptoms, such as a fever, cough or general malaise. Many infected people were afraid of what they were seeing happen to people in the community, so they called 911 for guidance. Under normal circumstances, EMS cannot refuse transport to any patient requesting to go to the hospital. That fact did not legally change during the pandemic.

Nonetheless, for the good of the patient and the system, there were times I strongly discouraged patients from going to the hospital. The principles of triage I had learned about in EMT school actually came to be used. People often didn’t realize the situation in the emergency rooms: the overcrowding, the fact that they would wait many hours just to find that nothing was going to be done for them, and that they would simply be sent home. I found that reasoning with patients and illustrating that counterintuitively, I was looking out for their best interest, worked the majority of the time.

If a patient still wished to be transported despite this, we transported them. There’s no doubt that this was a precarious situation in which I was trying to do the right thing for individual patients and for the system as a whole. After all, just because a person is experiencing minor symptoms right now doesn’t mean they won’t deteriorate soon afterwards. I therefore made sure to explain to patients that if their symptoms worsened, such as if they began feeling shortness of breath, experienced syncope, or anything along those lines, that they should call back and we would gladly transport them to the hospital.

Inversely, many people, not infected with COVID-19, were afraid, and quite understandably so, of going to the emergency rooms. Patients with pertinent medical history who called 911 for various reasons, whether it be chest pain, dizziness, or other symptoms, expressed to me their fears about contracting COVID-19 in the emergency room and asked, “what do you think I should do?” This was truly a difficult and crushing question for me to answer. Aside from feeling greatly underqualified, I realized that their fear was reasonable and valid. There was a real chance of getting infected at the hospital. On the other hand, they were experiencing a health problem at home that needed to be checked. My approach was to explain to patients that their concerns were justifiable and that the reality at the hospitals could not be ignored.

At the same time, they ought to weigh the potential infection that could occur at the hospital against the definite problem they were currently experiencing and that in the end, the decision was theirs to make. There were some patients that refused transport to the hospital and who likely should have been transported. I wonder how many people didn’t call 911 and suffered because of it. I remember responding to one call for a patient in cardiac arrest who was in his 50s, who was not infected with COVID-19, and wondering for how long he had been experiencing problems before he ultimately passed away. Several times, I heard the police be dispatched over the radio to welfare checks for elderly people who had not been heard from in several days, only to find them dead. The fear of family members of spreading COVID-19 to the elderly was legitimate, but not visiting them led to other consequences in certain cases.

Despite the negative parts of the pandemic I experienced in March and April of 2020, my overall experience is not negative. In the face of the challenges EMS providers experienced during the pandemic, I became a more competent and confident EMT. I had the opportunity to work with and develop relationships with members of TVAC I had never taken calls with prior to this. Furthermore, I developed tight bonds and formed some of my closest friendships by spending countless hours with the same people. Understandably, people didn’t want to be around us EMTs, so we were there to support each other. We became like a family. My interactions with FEMA nurses in nursing homes flown in from various parts of the country, paramedics out in the field, and emergency room staff at the hospital all geared toward the same purpose led to a certain level of cohesiveness I had never felt before. Citizens showed enormous appreciation for medical providers. Everyone waved at the ambulance as it drove by.

One night, TVAC received so many food donations that we went to three local hospitals to drop off extra food for emergency room staff. Powerful moments have been ingrained in my mind and have remained with me. In between calls, we took ambulances out to participate in drive-by birthday parades for children in conjunction with the fire and police departments. Watching little kids, who were stuck at home on their birthday jump up and down as the ambulance drove by was touching. Most of all, I am extremely proud to be a part of an organization of amazing, dedicated individuals. I once asked one of our members, who is in his upper 60s, whether he was afraid of becoming infected and perhaps risking his life. Why didn’t he opt to take a leave of absence? Without hesitation, he simply replied, “we are placed in this world to do good.” If he was going to become gravely ill, as some of our members did, he wanted to give of himself for others.

I am glad to have been able to do good for others with a remarkable group of people during a time of need.

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