Emergency medical service personnel across the country are struggling with an onslaught of new issues as we prepare for a tsunami of patients. We may have a very small window of opportunity to take drastic actions. These are some suggestions for specific actions that EMS leaders and personnel can begin.
This paper will address the following topics: Latest information; EMS considerations; frequent questions; and conclusions.
Latest information as of 22 March 20:
- Globally: 292,142 confirmed cases and 12,784 deaths.1
- U.S. as of March 20: 15,219 cases and 201 deaths.2
- It is possible that by April we will be seeing 100,000 new cases per day in the U.S. and by May it could be 500,000 new cases per day.3 We can hope that it is not that bad, but those are the numbers we should be preparing for. We should prepare for the emergency to last at least through August and possibly longer.
- The virus can remain viable on surfaces for 72 hours.4 We should immediately begin working under the assumption that everything we touch is contaminated. If we touch something and then touch our radio or phone and then wash our hands, our radio or phone may still be contaminated.
- Infected persons may not become symptomatic for 14 days.5 For some, possibly large, proportion of this time, a person may be both asymptomatic and contagious. For us, it means that we should immediately begin working under two assumptions: everyone we meet is contagious and, that we are contagious. Those assumptions will help us do everything we can to keep our patients, partners, colleagues, friends and family from catching the virus.
- Once sick, a person may be contagious for two weeks after symptoms subside.6 Operationally, that means that EMS personnel who become ill must maintain isolation for two weeks after they recover.
EMS Considerations
Some of the big considerations for EMS are:
- We should plan for call volume to soon start doubling on a regular basis.
- A growing number of patients will need ventilators and many of them may need extended transports. New field hospitals, as well as regular hospitals, may be calling often for us to do interfacility transports.
There may be more and more requests for EMS to:
- Transport to field hospitals being set up in many communities
- Care for people at home who are ill but do not need a hospital or if no hospital beds are available.
We should plan for decreasing numbers of EMS personnel:
- Growing numbers will be sick
- Growing numbers, through no lack of dedication, will be forced to make tough decisions, for example, to stay home to care for ill family members.
We should work with 911 call centers to have as many ambulatory persons as possible make their own way to a doctor’s office, clinic or field hospital.
We should be hiring people for logistic support including to clean and disinfect the ambulances and equipment. Materials management teams should be hired and trained to keep ambulances stocked. We should be hiring people to drive the ambulances to help take pressure off the EMS professionals. EMS personnel should be focused on patient care.
We should be hiring people for auxiliary operations to drive non-emergency vehicles (e.g. regular cars). Having a team of people driving regular cars will allow the option of triaging low acuity calls who don’t need an ambulance but do need transport. I know some will say that these low acuity patents should not be our responsibility during a crisis like this. Maybe we will not be able to help them. Maybe EMS will be the only ones who can set up and manage a system to safely get even low acuity patients to and from the health care centers.
On a related note, we should revaluate any procedure or protocol that suggests that we must transport people and we should re-evaluate how we triage; for example, can we do more over the phone or via a platform such as Skype.
Keep in mind that this is and will be a very stressful experience for people. We need to manage our own stress, and, at the same time, help our colleagues, our patients and our loved ones manage their stress.
We urgently need to communicate our needs to our local, state and federal representatives.7
The good news is that it seems likely that there are only two ways for us to get infected:
- If you are directly exposed to droplets either from someone as far away as six feet sneezing or coughing, or a person closer in proximity exhales the droplets and you inhale them.
- If you touch something contaminated and then touch your face.
Frequently Asked Questions
How long will it last?
- No one knows for sure. It is prudent for us to expect the emergency will extend at least to August; it is possible it will last longer than that.
How can I convince some EMS people that something is wrong?
- We are at the beginning of the tsunami. The beach is dry and everything seems okay. However, by the time the cars start floating down the street it will be too late to plan.
Should I tell a medic who has been exposed to a confirmed case to stay home for two weeks?
- Simple math tells us that if we do that, we will very soon have no personnel left.
Conclusions
We are going to get through this, but EMS cannot work alone. We will need help and we must work together with public health officials, elected officials and other services to help coordinate care for our communities.
Although it is okay to hope that everything will get better very soon, EMS professionals need to plan and prepare for a tsunami of patients. We might have two weeks to prepare, there might be less.
On an individual level, if you are healthy, be grateful. Remember to stay healthy, stay hydrated and stay positive. Keep encouraging family, friends and neighbors to be vigilant about social distancing.
I believe that when this is over, people in America will fully appreciate what people in other countries have already learned, that EMS professionals are strong, dedicated and compassionate health care providers who should be paid a professional salary and who should be recognized for their unique skills, knowledge and abilities.
Be safe and let’s continue to take care of each other.
References
1. World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report —62. Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200322-sitrep-62-covid-19.pdf?sfvrsn=f7764c46_2. Accessed March 22, 2020.
2. U.S. Centers for Disease Control and Prevention. Cases in U.S. Updated March 20, 2020. Available at: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html. Accessed March 22, 2020.
3. Glanz J, Leatherby L, Bloch M, et al. Coronavirus Could Overwhelm U.S. Without Urgent Action, Estimates Say. The New York Times. March 20, 2020. Available at:
https://www.nytimes.com/interactive/2020/03/20/us/coronavirus-model-us-outbreak.html. Accessed March 22, 2020.
4. van Doremalen N, Bushmaker T, Morris DH, et al.. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. New England Journal of Medicine. 2020 Mar 17. Available at: https://www.nejm.org/doi/full/10.1056/NEJMc2004973?cid=DM88773_&bid=171481724. Accessed March 22, 2020.
5. Baum SG, Lauer SA et al. COVID-19 Incubation Period: An Update. Annals of Internal Medicine. 2020 Mar 10. Available at: https://www.jwatch.org/na51083/2020/03/13/covid-19-incubation-period-update?cid=DM88773_&bid=171481724. Accessed March 22, 2020.
6. Herman AO. COVID-19: U.S. Officials Issue New Guidelines to Slow Spread / WHO Emphasizes Isolation for 2 Weeks After Symptoms Stop. Medical News | Emergency Medicine. March 16, 2020. Available at: https://www.jwatch.org/fw116453/2020/03/16/covid-19-us-officials-issue-new-guidelines-slow-spread?cid=DM88773_&bid=171481724. Accessed March 22, 2020.
7. Maguire BJ. Urgent EMS needs for COVID-19 response. EMS1. Available at: https://www.ems1.com/coronavirus-covid-19/articles/urgent-ems-needs-for-covid-19-response-9v3lseTKtgByPYzb/. Accessed March 22, 2020.
