Another Challenge

It seems like every time we turn around, we are faced with another challenge. Whether it is a saline or drug shortage directly affecting patient care, or new (or sometimes delayed) rulings from CMS that impact our business operations, we are constantly adapting to an ever-changing landscape.


In the post-9/11 world, one of the challenges that we had to evaluate, train and prepare for was the biological threat. Smallpox, botulinum, anthrax and others became common names, and when we added in the chemical threat it was as if we had gone back to school to refresh our minds with biology and chemistry classes. Not only did we have to educate our personnel, we had to purchase additional personal protective equipment, ensure our employees’ vaccinations were up to date, develop operational plans to deal with an outbreak and create contingency plans in the event our staff couldn’t come to work.


Remember SARS, H5N1 and H1N1? These were biological diseases that caused great concern over the possibility of becoming pandemics. We again changed our processes, placed hand sanitizer everywhere and we even quit shaking hands. Well, we now have another biological challenge staring us square in the eye.


With the influx of people at our borders, we are seeing individuals coming into the country with tuberculosis, lice, scabies, measles and other diseases that we have been able to control within our borders. These same individuals are being moved to different areas of the country for holding and processing, or even being released into communities, thus taking their diseases with them. Our challenge is that, as EMS providers, we will be the ones responding to these sick patients. Are your personnel up to speed on the signs and symptoms of diseases we haven’t seen for years? Are they vaccinated against these? In some instances, even our physicians are having difficulty rapidly identifying certain illnesses simply because they are not accustomed to looking for them.


With all of this, we now throw in another challenge: Ebola. In our highly mobile world, there is concern that Ebola, as well as other serious diseases, could end up in the U.S. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC), has stated that he doesn’t believe we would see a large-scale outbreak in the U.S.1 However, we also knowingly brought Ebola into the U.S. in early August.


How many of us watched the two Americans being transferred by Grady EMS from the airport to Emory University Hospital? Did you notice that the providers were in Tyvek suits with powered air purifying respirators (PAPRs)?2 When was the last time you tested, or even trained, your personnel to provide patient care or drive an ambulance in this equipment? Have you thought about the coordination that this would require should a sudden outbreak occur?


When we had the outbreak of hand, foot and mouth disease several years ago, in one training scenario the affected community would be completely quarantined. A perimeter was to be established around the community by law enforcement and National Guard, and all persons entering or leaving would be decontaminated at the perimeter line. They were also to be evaluated by EMS for signs and symptoms of any disease prior to entering or exiting. All of this was to be done on a 24/7 basis until the outbreak was contained. Are you prepared or even able to provide this level of staffing for this length of time?



My point through all of this is that it is extremely important that EMS stays closely engaged with fire, law, hospitals, public health, emergency management, fusion centers and others so that we aren’t left in the dark with expectations that may be beyond our capabilities. If we are going to successfully deal with these types of issues, we have to work together as a team, which means we plan together, train together and respond together. We already know this; we just need to be better at making it happen.


Ultimately, we need to make sure that we have taken the proper steps to protect our people as well as our operation because everyone else will be depending on us. There will always be the next “thing”, and it is up to us to decide how we will handle another challenge.




1. Radnofsky L. (Aug. 7, 2014) CDC Director Confident U.S. Won’t See Large Ebola Outbreak. The Wall Street Journal . Retrieved on Aug. 11, 2014, from


2. Elliott R. (Aug. 4, 2014) Hospital EMS official describes trek with Ebola patient. WSB-TV2 Atlanta . Retrieved on Aug. 11, 2014, from

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