As the nation grapples with the novel coronavirus, emergency medical service providers across the country are racing to adapt their playbooks to deal with the pandemic. Sean Dwyer, Deputy Chief of Manatee County EMS in Florida, shares how his organization has responded to this new threat by continually refining protocols, heightening communications, and being more proactive about monitoring stress within its ranks in an effort to better protect both paramedics and the public they serve. Sean recently presented his findings in a recent webinar along with his colleague Larry Luh.
As emergency medical providers, paramedics are trained to quickly respond to just about any situation. The progress of our work is measured in seconds because lives are in the balance. That said, the COVID-19 pandemic has struck with such ferocity and speed that we’ve all been challenged to keep up. With no playbook to deal with this particular threat, many of us in the medical community have had to create one – fast.
This is a story of how we at Manatee County EMS have responded to protect both our paramedics and the public we serve. We are just one of many first-responders in the country, and we recognize that everyone has adjusted in different ways. By sharing our experience, we hope to spark ideas and help collectively generate best practices to fight this current threat, as well as future pandemics.
Early signs of the COVID-19 threat
In February, we started to hear more about the coronavirus and how it was sweeping across the globe. We knew it was only a matter of time before it hit the U.S. This is when we began to review our policies and procedures to prepare for the threat.
On March 8, came the turning point. The pace of change increased dramatically with the Centers for Disease Control and other health organizations issuing new and more urgent guidelines. At Manatee County, we changed to a daily audit cycle of our protocols and round-the-clock monitoring of advisories.
At this point, our Florida beaches were still crowded with folks on Spring Break. That ended on March 25 when many local authorities in the state closed beaches and boat ramps and when Florida Gov. Ron DeSantis issued a statewide 30-day stay-at-home order.
Steps to protect physical health
Paramedics aren’t immune to infection. That’s always been the case, but we’ve stepped up our approach to decontamination and prevention.
For the vehicles, we deploy a 3-stage cleaning process.
1. Bleach solution: Using a solution of 1/3rd cup of bleach per gallon of water, we start by spraying down the vehicle inside out.
2. CDC-recommended EHS disinfectant: We do a secondary wipe down of seats, door handles, and other frequently touched surfaces. The CDC has a list of disinfectants that meet EPA’s criteria for use against SARS-CoV-2, the virus that causes COVID-19.
3. Chlorine dioxide-based fogging: Finally, we fog the inside of our vehicles using an AeroClave. We also spray the solution on frequently touched areas on the outside of the emergency vehicles.
For personnel, we’ve adopted the use of double-layer gloves, a full set of personal protective equipment and N95 masks. We also put in place a protocol for assessing patients from at least 6 feet away before we proceed to administer care.
Steps to protect mental health
Paramedics also aren’t immune to anxiety. Our Assistant Chief of Operations Larry Luh came up with a system where we ask our paramedics to check in twice a day to report their temperature, whether they’re coughing and if they have a sore throat – symptoms of a potential COVID-19 infection.
Just as importantly, we also have a sentiment question to gauge their stress level. If anyone reports feeling stressed, we try to adjust our shifts to give them time to rest and recuperate to prevent burnout. This is vital for first responders who must perform at their physical and mental peak to be able to make life-preserving decisions with little or no notice.
As safety professionals, we’re always monitoring all aspects of safety, including driver safety. We’ve noticed a few changes on the road in that regard. They stem from two major shifts: roads are far less congested as people shelter in place, and many people are choosing to avoid hospital visits unless they feel it to be absolutely necessary.
As a result, we’re seeing response time has improved 25 to 30 percent due to less road congestion. Our call loads have dropped by more than 50 percent as people choose to avoid emergency rooms. This has led to an 80 percent drop in the number of risky driving events and a commensurate drop in major collisions.
However, cellphone use has increased, likely due to more frequent communication between paramedics and frontline supervisors. This is a tough one, as there is a greater need for communication at times of heightened risks, and we are actively exploring ways to safely communicate with our paramedics on the road during this critical time.
As I’d just mentioned, we are doubling down on communications. In a crisis, particularly one that’s rapidly evolving, communication is critical. It gets the latest information out in a way that can help save lives. And it’s key to reassuring staff and creating a cohesive response. You can’t over-communicate in a crisis. We’ve instituted two all-hands conference calls every week on Mondays and Fridays to review changes, reinforce protocols, and answer questions.
Additionally, we are reviewing procedures and protocols on a near daily basis to develop a playbook for our paramedics and response teams.
Why is this important? In times of uncertainty, it’s reassuring to have protocols you can follow. Paramedics like to have a playbook, even if it’s one that’s constantly changing. That’s because a paramedic’s life is about adjusting to gray areas. No one patient will present the same way. In these situations, it’s incredibly helpful for a paramedic to be able to assess a situation and select a protocol from the playbook.
Our playbook is continually changing as we learn more about the SARS-CoV-2 virus and find new, better ways to fight it. We’re adapting and finetuning everything we do. But we also realize, as quickly as we are responding, we don’t have all the answers.
About the author
Sean Dwyer started in 2005 with Manatee County EMS, where he worked as an EMT, Paramedic, Lieutenant, District Chief, and now as Deputy Chief. Sean serves as the primary quality assurance officer for the department and provides training and guidance to department employees on best practices in service delivery. He also recommends revisions or additions to protocols for new medical devices and the placement and allocation of resources, reviews all patient care reports for compliance with protocols, completeness, and accuracy, and evaluates department performance and makes data-driven recommendations for improvements in service delivery.