Emergency Medicine

Defending the front lines during the COVID-19 pandemic: Protecting our first responders and emergency medical service personnel

Journal logoUnlabelled imageAmerican Journal of Emergency Medicine 40 (2021) 213-214

Contents lists available at ScienceDirect

American Journal of Emergency Medicine

journal homepage:

Defending the front lines during the COVID-19 pandemic: Protecting our First responders and emergency medical service personnel

This is the first wave of COVID-19, indicating an impending second wave set to emerge in the coming winter [1]. Along with the concern for additional outbreaks, studies are showing inconclusive evidence re- garding the effectiveness of antibody-mediated immunity in those re- covered from COVID-19 [2]. The possibility of reinfection combined with another wave of COVID-19 further supports the need to protect our frontlines. The number of COVID-19 cases continues to rise to 1,053,036 infected people and a quarter-million deaths [3]. Given this situation, it is imperative that our frontlines are protected physically and mentally.

Though EMS protocols were established for an infectious disease outbreak, the magnitude of this crisis left our first responders with sig- nificant safety considerations [4]. This raises the question of how first responders ought to respond to calls during this pandemic to prevent patient-to-patient and patient-self transmission. Since only 43.8% of COVID-19 patients present with a fever, EMS must proceed with caution [5]. The use of PPE at all times is crucial to the protection of our front- lines, however, there is a massive PPE shortage [5,7]. The incredible global demand for PPE has led to worldwide shortages. Our frontlines are experiencing a lack of adequate N-95 respirators, gloves, face shields, and gowns [7]. In an effort to address this gap in supply and funding, the government increased PPE orders and provided $100 mil- lion dollars specifically for EMS to purchase PPE [8].

Current EMS PPE strategies are focusing on reducing the number of

responders needed to successfully care for a patient [9]. To reduce risk and PPE use, implementing designated triage centers adjacent to hospi- tals can expedite COVID testing while restricting possible routes of trans- mission to EMS staff. Another suggestion involves the use data collection to identify and track hotspots in the city while still working diligently with dispatch to determine the caller’s risks of having COVID-19 [9]. When aware of hotspots, EMS personnel can make informed decisions. A further recommendation focuses on analyzing the data from the cur- rent outbreak to better diminish the impacts of the second wave [9]. With more data analyses, EMS can enforce proactive strategies to in- crease their efficiency without increasing their personal health risks.

One EMS institution designed a workforce protection program that

includes: wellness screenings before each shift, PPE worn during the en- tire shift, check-ins for those out sick, rapid testing for those with symp- toms, Return to Work program, and providing Hotel Housing options [5]. These EMS resources work to consider the safety of both the front- line workers as well as their families to preserve the EMS workforce.

Our most valuable resource is our first responders themselves. With- out proper PPE our frontlines are at high risk of infection [2,5,6]. The PPE shortage cultivates role strain as first responders, must consider their duties to their patients versus their personal safety as well as the

wellbeing of their loved ones [10]. Addressing this concern, a suggestion is to hire non-EMS drivers in effort to conserve the workforce. In addi- tion to conserving the workforce, it is possible to expand the front lines through the use of telemedicine [11]. By appropriately advising pa- tients when and where to seek care, the EMS patient burden is de- creased [11]. Following suit like other EMS institutions, the use of portable decontamination systems, particularly the use of vaporized hy- drogen peroxide is recommended [12].

To further safeguard the health of our EMS team, their mental wellbeing must be bolstered. The effectiveness of EMS is significantly impacted as more deficits in job performances occur as stress and other negative mental health issues arise [13]. There exist stigmas and barriers to mental health care for first responders, causing an increased risk in chronic conditions such as PTSD [14]. EMS personnel also experi- ence high levels of stress and depression [13-15]. Such health concerns can lead to incapacitated first responders, reducing the workforce [14,15]. Increasing mental health resources now can prevent current and future burnout and reduce the chronicity of mental health concerns [14]. The National Volunteer Fire Council provides a webinar mini-series titled Reset and Recharge [16]. Additionally, EMS.gov hosts a web page for mental health resources [17]. These resources promote building staff-staff and family-family bonds in order to foster peer support dur- ing this pandemic. With peer support, EMS and first responders can connect with additional resources while also providing each other with a source of mental/emotional support.

During this pandemic, our frontlines have taken on a huge role in serving and caring for the population. We must take the necessary steps in providing ample resources and strategies for our EMS. Pre- paring for the next wave of COVID-19 includes anticipation of workers’ needs, flexible plans and sustainable protocols and equip- ment [5,7].

Haley Ehrlich

Department of Surgery, Division of Trauma and Surgical Critical Care,

Kendall Regional Medical Center, Miami, FL, USA

Mark McKenney, MD, MBA

Department of Surgery, Division of Trauma and Surgical Critical Care,

Kendall Regional Medical Center, Miami, FL, USA University of South Florida, Tampa, FL, USA

Adel Elkbuli, MD,MPH

Department of Surgery, Division of Trauma and Surgical Critical Care,

Kendall Regional Medical Center, Miami, FL, USA

?Corresponding author at: 11750 Bird Road, Miami, FL 33175, USA.

E-mail address: [email protected].

5 May 2020

https://doi.org/10.1016/j.ajem.2020.05.068

https://doi.org/10.1016/j.ajem.2020.05.068

0735-6757/(C) 2020

214 Defending the front lines during the COVID-19 pandemic: Protecting our first responders and emergency medical service personnel

References

  1. Moreno J Edward. Fauci: second wave of coronavirus ‘inevitable’. TheHill. thehill.com/

homenews/news/495215-fauci-second-wave-of-coronavirus-in-fall-inevitable; 29

Apr. 2020. [Accessed 28 April 2020].

  1. ‘Immunity passports’ in the context of COVID-19. World Health Organization; 24 Apr. 2020. www.who.int/news-room/commentaries/detail/immunity-passports-in-

the-context-of-covid-19. [Accessed 28 April 2020].

  1. COVID-19 map. Johns Hopkins Coronavirus Resource Center. coronavirus.jhu.edu/ map.html; 30 Apr. 2020. [Accessed 30 April 2020].
  2. Isakov Alexander, J. H. (TRACIE). EMS infectious disease playbook; 2017; 86. https:// www.ems.gov/pdf/ASPR-EMS-Infectious-Disease-Playbook-June-2017.pdf. [Accessed 16 April 2020]. [accesses April 30, 2020].
  3. U.S. Department of Health and Human Services. COVID-19 pre-hospital/emergency medical services (EMS) resources. ASPR TRACIE. asprtracie.hhs.gov/technical- resources/114/covid-19-pre-hospital-emncy-medical-services-ems-resources/99; Apr. 2020. [Accessed 29 April 2020].
  4. COVID-19: strategies for optimizing the supply of PPE. Centers for Disease Control and Prevention. www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index. html; 22 Apr. 2020. [Accessed 30 April 2020].
  5. Ranney ML, Griffeth V, Jha AK. Critical supply shortages — the need for ventilators and Personal protective equipment during the Covid-19 pandemic. N Engl J Med. 2020;41(1):1-2. https://doi.org/10.1056/NEJMp2009027.
  6. COVID-19 appropriations legislation with funding for AFG expected to be enacted. National Volunteer Fire Council. www.nvfc.org/covid-19-appropriations-legislation- with-funding-for-afg-expected-to-be-enacted/; 30 Mar. 2020. [Accessed 30 April

2020].

  1. Center for Disease Control (CDC). National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. Interim Guidance for Emergency Med- ical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19 in the United States. https://www.cdc.gov/coronavirus/2019-ncov/hcp/ guidance-for-ems.html; 2020. [Accessed 23 March 2020]. Updated March 10, 2020.
  2. Santarone K, McKenney M, Elkbuli A. Preserving mental health and resilience in frontline Healthcare workers during COVID-19. Am J Emerg Med. 2020 Apr 15. https://doi.org/10.1016/j.ajem.2020.04.030 S0735-6757(20)30258-8.
  3. Whiteside T, Kane E, Aljohani B, et al. Redesigning emergency department opera- tions amidst a viral pandemic. Am J Emerg Med. 2020. https://doi.org/10.1016/j. ajem.2020.04.032.
  4. US Department of Homeland Security. Portable ambulance decontamination sys- tems market survey report. September; 2015 [Accesses April 29, 2020].
  5. Regehr C, Leblanc VR. PTSD, acute stress, performance and decision-making in emer- gency service workers. J Am Acad Psychiatry Law. 2017;45(2):184-92.
  6. Haugen PT, McCrillis AM, Smid GE, Nijdam MJ. Mental health stigma and barriers to mental health care for first responders: a systematic review and meta-analysis. J Psychiatr Res. 2017;94:218-29. https://doi.org/10.1016/j.jpsychires.2017.08.001.
  7. Substance Abuse and Mental Health Services Administration. Disaster Technical Assistance Center Supplemental Research Bulletin First Responders: behavioral health concerns, emergency response, and trauma; 2018; 1-15 [accesses April 30, 2020].
  8. COVID-19 information and resources for EMS. National Volunteer Fire Council. www.nvfc.org/coronavirus-19-information-and-resources-for-ems/; 23 Apr. 2020.

[Accessed 30 April 2020].

  1. EMS.gov. Coronavirus/COVID-19 resources for EMS. www.ems.gov/projects/ coronavirus_covid-19_resources.html; 2020. [Accessed 30 April 2020].

Leave a Reply

Your email address will not be published. Required fields are marked *