The Public Health Perspective on Data and EMS

FirstWatch Medical Director Silvia Verdugo on coronavirus, outcome data and her experience as a paramedic and public health official.
Dr. Silvia Verdugo

For more than 17 years, Dr. Silvia Verdugo has worked to better other people’s lives. She worked as a paramedic with the Mexican Red Cross while attending medical school in Baja California, and then served as an emergency physician before obtaining her master’s degree in public health and leading the state health department’s HIV and sexually transmitted infection (STI) prevention efforts in Baja. Her research has included investigations into the intersection of drug use and STIs as well as ways to train EMS professionals to improve their interactions with people at risk for HIV and overdose.

Verdugo brings her extensive public health and EMS experience to her current position as medical director for FirstWatch, where she helps agencies identify opportunities for improvement and leads the company’s Clinical FirstPass team, helping FirstWatch partner agencies assess the care they are providing to their patients. She is also part of the FirstWatch team helping EMS and 911 organizations use their data to monitor public health challenges like opioid overdoses, the flu and, most recently, COVID-19.

Related: Complete COVID-19 Coverage from JEMS

In this interview, Verdugo discusses the response to public health crises, how better information can help 911 and EMS agencies deliver better care, and how collaboration and learning from the past are key to managing our current challenges.

JEMS: You’re a public health physician with knowledge and experience with infectious disease. Can you put COVID-19 and the severity of its impact in perspective versus influenza?

Verdugo: As COVID-19 expands, it looks more like the flu. If you look at strains of the flu, H1N1 is just one of those strains. It came out once, and now it’s mixed in with the general population. Like H1N1 or SARS, COVID-19 will only be an outbreak for a while before it becomes a normal part of a contagion population. So as that occurs, influenza and COVID-19 surveillance will continue. Obviously, if it appears more lethal, it will be even more important to surveil.

JEMS: What have your experiences with HIV, SARS, Ebola and flu prevention and monitoring taught you and your team that can help us respond to COVID-19 and future outbreaks?

Verdugo: One of the things I tell people when talking about health surveillance is that the key is knowing what “normal” is and being able to recognize a difference. That’s where everyday surveillance is so important. That way, you are aware that something has changed, whether it’s a flu-type event, chemical leak or something else.

That goes for the operations and clinical management of this outbreak as well: You can’t do something during a disaster that you don’t already do daily. Many states and EMS agencies have pandemic plans in place for dispatch, treatment and transport. And yet our system is built not to allow those recommendations until sometimes when it’s too late. We need to prepare for and act like we’re treating patients with a virus we don’t yet know about, rather than the flu or, in this case, COVID-19. Practicing proper infection control processes and using appropriate PPE during everyday calls reduces the risks of exposure. Sometimes all it comes down to is reminding people, “Hey, don’t forget to wear your PPE like you’re supposed to.” It’s all about normal precautions, take care of yourself and your future patients.

Our profession’s recent emphasis on preparedness for terrorism, natural disasters and active shooter situations has translated into great practice dealing with emergency situations. Similarly, FirstWatch’s past with biosurveillance in regard to SARS, H1N1, MERS and Ebola helped get organizations to a point where they have systems and models in place to track data, including symptoms, geography and other important information, and respond effectively. Everyone from the most basic providers to state agencies had training during those early outbreaks, which has proved useful in our surveillance of flu and now COVID-19.

We’ve also assisted agencies with tracking Ebola. At the time of the outbreak, we were thinking about geography and the logistics of tracking all of these different countries, variations of symptoms, and the growing number of patients with the virus. This work has been invaluable, as most of our customers that used Ebola triggers have simply repurposed them to look for COVID-19 coming out of China and other affected areas. However, the situation is changing literally as we speak, and it has become less important where it’s coming from. By the time this is published, it will be in even more countries and specific travel history might not be as relevant.

JEMS: How has your background in public health changed how you view EMS and its role in responding to pandemics or outbreaks like COVID-19?

Verdugo: Public health has a different mindset. I’ve been in EMS a while, and that’s how I paid my way through school. The majority of my immediate family had something to do related to EMS, so I’ve had the ability to start from EMS and then move on to work as a physician in both a clinical environment and in public health, giving me a fuller perspective.

That broad experience in the industry allows me to see the importance of EMS most people don’t see. For example, if they have worked in a hospital, public health workers tend to focus on hospital data. I would make the point that if you just take hospital data and don’t look at EMS, you are missing a large portion of the picture. EMS is an important part of the chain, and first responders (including 911 call takers) are the first, and in some cases the only, contact a patient has with a clinician. So the impression that EMS has on that person is huge. It’s a path. My speech is always, “You need to look at EMS data.”

JEMS: What data is critical in tracking a pandemic like a COVID-19?

Verdugo: For something like this,information about symptoms is critical. However, they’re going to be generic. Anything that comes up, whether it’s severe respiratory distress or other symptoms related to respiratory viruses will be important, but we’re going to get a lot of them. To start, you don’t know if it’s just a cold, regular pneumonia, or the coronavirus, so it’s going to be linked into all respiratory disorders or diseases that are causing an illness. Currently, we’re ahead of the curve. Because we already started to build surveillance around the respiratory system for the season, we were ready to monitor it before we even knew about the new threat of COVID-19 this year.

We came up with a basic template that looks into categories of travel, determines the appropriate EMS response on the dispatch side and scans for keywords related to symptoms. When someone asks for something on COVID-19, we generally share that information with them and say, “Okay, this is our best practice and best approach.” From there, we use it to build something for our clients and tweak it as needed.

Some clients have a set idea of the information they’re looking for in regard to symptom tracking. Many of the dispatch centers already have a specific code, specific phrase or set of words that they need to use; or, they need to type in their comments. For example, we have a customer that uses a specific phrase. So we’ll scan records for that specific phrase through their entire test system. Once it’s found, we can send an alert so 911, EMS and other leaders know immediately that there’s a patient who met these criteria. These alerts have allowed EMS leadership to reinforce the need for appropriate PPE on specific patients, and in some cases, provided a backup warning system when busy dispatch staff have not passed on the information to crews.

JEMS: How important is sharing information during a situation like the one presented by COVID-19?

Verdugo: One of the great things about working in public health is that everyone in the field believes in transparency–we can best address public health problems when we notify our colleagues of them early on and continue to share best practices throughout. Although our specialty at FirstWatch is helping customers mine their own data, we take pride in also serving as a convener, bringing people–and their data–together. An example is our Regional Influenza Network. This system was built for flu symptom monitoring with 911 and EMS, allowing agencies to track flu-like illnesses as they move across the U.S. and Canada. For years, this has helped agencies prepare for an influx of patients carrying viruses, minimizing the impact by reducing exposure to healthcare workers and their families. I’m lucky to work closely with Pam Farber, an infectious disease nurse at FirstWatch who has helped lead these monitoring efforts for more than a decade.

We also have partnered with major EMS organizations including the Paramedic Chiefs of Canada and the International Academies of Emergency Dispatch to host webinars and share information related to major public health threats. That happened in 2009 with H1N1, later with Ebola, and has continued this year with COVID-19. We’ve seen systems make improvements and policies get changed because of information shared through both informal and formal networks we’ve helped maintain, and that’s exciting and humbling to be a part of.

JEMS: You were recently named medical director at FirstWatch. What does that mean and what kind of work will you be doing?

Verdugo: My overall goal is to leverage my background as a clinician to lead the team and do things a little bit differently, by focusing even more on what we do to improve clinical performance. I also plan on focusing a bit more on using outcome data to improve surveillance and quality improvement, and to work with our customers and the huge amounts of data we help them examine to conduct more robust research. I think there are great opportunities to form partnerships and get even more out of EMS and 911 data. We have a brilliant data scientist, Bocar Mbengue, working with us, and we’re just scratching the surface of what we can learn.

JEMS: How does using outcome data help EMS make better decisions?

Verdugo: We need outcome data from the hospital to close the circle. That way, we are able to not just see individual performance–the process of dispatchers handling calls, the time it takes to dispatch EMS practitioners or how long it takes the EMS crew to get there–but also the quality of care we’re giving the patient. Instead of focusing on individual portions of this cycle, we can see things from the patient’s perspective.

This also helps identify challenges within EMS systems, showing how EMS can provide adequate treatment while also improving dispatch, transport times, treatment and outcomes. That completes the circle and allows for endless opportunities of improving models in healthcare.

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