The Life of an EMT During Covid-19
The Life of an EMT During Covid-19
by Mackenzie Thompson
Life Saver, NHCPS
posted on Dec 11, 2020, at 11:10 am
Daily life has changed for a lot of people. But few more than EMT. As the front-line of the front-line, you’re often the first to see a possible COVID-19 patient. And for that reason, a lot is changing in the life of an EMT. It’s not just happening in your district or county. It’s nationwide. What changes are happening for the emergency medical technician today? Which of those changes may stick after the pandemic?
Expanding the Role of the EMT
An expansion of the EMT roles has been a topic of discussion for years. But sometimes, it takes something big like COVID-19 to hush the naysayers and get the profession actively moving in that direction.
Paramedics prescribing medications, doing nasal swabs, performing phlebotomies, and providing supplementary nursing support in over-whelmed nursing facilities and emergency departments have long been things paramedics could do with their training but rarely did. These duties are now becoming a part of their job–at least temporarily.
As their role has expanded, so have the duties of EMT-B and EMT-I.
A Chance to Step Up and Stand Out
The pandemic has given motivated emergency medical technicians an opportunity to put their skills to new use. By some accounts, this has required EMTs at various levels to get out of their comfort zones and stretch their skills, often picking up new medical skills in the process.
According to EMS Tactical Director Jim Morrisey of Alameda, CA, “The COVID-19 pandemic has been an opportunity for EMS to step up and provide support to the healthcare infrastructure and critically needed services to those that need it most.”
Will these expanded skill-sets be abandoned once the pandemic is over? Or will the industry integrate this expansion into the EMS process and protocols?
Fewer, but More Critical & Deadly Car Accident Calls
According to a McKinsey & Company research firm survey in June 2020, 60% of people say they are traveling less. This is supported by other data that shows around a 15% decline in miles driven by the US public from Jan-Sep 2020 compared with 2019, according to NSC.org.
If those numbers showed data for just March-June and October-November, we’d likely see an even greater decline.
However, even though fewer cars were on the road, the death rate per miles driven actually went up as much as 23%. NSC.org speculates that three primary factors play into this increased rate:
- Increased speeding on empty streets
- Failure to follow traffic signals because of fewer people on the road and possibly a belief that police are busy elsewhere.
- Increased number of people walking for exercise due to gym closures
This may have led to fewer calls, but a higher percentage were critical or deadly.
Huge Unexplained Differences State-to-State
Of course, many factors come into play. So some regions may experience different trends in the life of an EMT during the COVID-19 pandemic. This is evidenced in this interesting research from the National Safety Council (NSC).
Some states actually saw a decrease in road death rates: Tennessee (-58%), Mississippi (-21%), Wyoming (-52%), Maryland (-18%), Michigan (-13%),Maryland (-18%) South Carolina (-13%), Arizona (-10%) Florida (-4%) and Pennsylvania (-13%).
Then these states had the most significant increases: Louisiana (15%), New Hampshire (63%), Connecticut (39%), Missouri (12%), Arkansas (10%), Missouri (12%), and North Carolina (6%).
So if you are in Connecticut or New Hampshire, your life as an EMT has likely included a lot of fatal or critical accidents. If you are in Tennessee or Wyoming, you may have seen something contrary to the national trend.
Fewer Non-Covid Emergency Calls
In March and April, CDC.gov also reported a 42% national average decline in people showing up in the ER (or calling for an ambulance) with non-COVID emergencies.
The CDC has suggested this may be fear of emergency services where COVID risk is higher during a pandemic. The CDC thinks people with chest pain may choose to stay home instead of calling 911, for example.
But others, such as Jim Morrisey, have suggested that this may show some increasing altruism among the general public. In other words, people are trying to be more considerate. They want to save the ambulances for people who really need them during a global emergency. If that’s the case, we could actually see a more permanent shift in that mentality. So fewer people would be calling for ambulances just because they don’t have a ride.
COVID-Worried People Fill the Void
These drops in emergency calls were replaced early on by frantic callers worried that they had COVID and wanted ambulance transport to the emergency room. But many EMS systems have seen a significant overall drop in runs, especially in those early months. This freed up EMT workers to take on additional roles in both the emergency setting and among some of our most vulnerable in nursing homes.
More Cardiac Calls
According to EMS World, New York and New Jersey have seen a significant increase in cardiac calls. But these aren’t the typical cardiac arrest call. These are mostly cardiac emergencies related to COVID-19. Symptoms worsened quickly, and the victim couldn’t preemptively choose to go to the hospital.
New York City Sees Huge Spike
For example, New York EMS had a 400% increase in these calls in March and April. A startling 70% of those calls resulted in in-home pronouncements.
November and December 2020 numbers aren’t in yet. But as COVID continues to rise in many states, many states are experiencing this spike again.
A Call for Improving Out-of-Hospital CPR Protocol
Before COVID, cardiac life support training and protocols were already in question in many places. As the number of calls has increased, there is renewed interest in expanding the in-field CPR and Basic Life Support to Advanced Cardiac Life Support (ACLS), more commonly used in the hospital setting.
This would mean increased usage of life-saving machines in the field as well as greater use of drugs by EMT in a cardiac emergency. Some advocates are also calling for greater usage of the “heads up” CPR approach. This CPR method involves additional CPR steps, including slowly elevating a patient’s head so that gravity can improve blood flow in the veins, carrying pooling and expended blood away from the brain. Small but well-done studies have confirmed its safety, feasibility, and ability to improve outcomes. But more research is needed before this becomes the standard.
For many EMTs who are taking on an expanded role, this will mean obtaining or renewing ACLS certifications and Pediatric Advanced Life Support (PALS) to be prepared for these expanded roles that may continue after COVID. EMTs who are investing in themselves and the future of the industry will be taking these and other training certificates every EMT should obtain.
More Emphasis on PPE & Deep Sanitation Practices
With fewer people out, a greater number of calls are taking place to residences instead of places of business, entertainment venues, or eating establishments. This is putting EMS personnel in increasingly unpredictable and risky environments, such as a poorly ventilated apartment that is filled with COVID particles.
EMTs have always taken precautions to keep themselves safe from blood-borne pathogens, airborne particles, and the like. But the COVID-19 pandemic has re-inforced the importance of using personal protective equipment properly and regularly to both prevent transmission to a victim or from the victim to yourself.
Greater PPE Availability, But Shortages Remain
Slowly but surely, there has been greater availability of N-95 masks, that protect both the wearer and the victim. According to a Nature Journal study, N-95 and KN95 masks can prevent outward transmission by 70-94%. And an October 2020 study confirmed around a 95% protection factor for the wearer when worn as intended. When N-95s are not available, data also showed around a 50% prevention rate for layered cloth face masks such as those worn by the general public. So something is clearly better than nothing when PPE is in short supply.
Ambulances Getting a Deep Clean More Often
Sanitation of ambulances has always been important. But during the pandemic, more frequent cleanings and enhanced sanitation techniques between runs have become the norm.
That’s especially true when a suspected COVID positive person was on your last trip. EMS systems are utilizing foggers, wipes, and other disinfectant means. This additional sanitation is adding 30-60 minutes to prep for the next trip.
Crew Configuration Changing
Many states require two Paramedics or EMT-I per vehicle or at least 2 on BLS ambulance. But as some areas have had an increase in ambulance runs or fewer healthy EMTs, states have had to make concessions. That’s the only way to keep ambulances running when faced with staffing shortages. In some cases, an EMR has replaced one of the EMTs.
This has expanded the role of the EMR. They don’t have the advanced training of an EMT,-B or EMT-I and especially not a Paramedic. But they are in many cases being asked to assist with more complex first responder tasks.
It’s similar to the EMT-I expanding in Paramedic territory during the pandemic.
Formal Broadening the Scope of Practice for EMR, EMT, and Paramedics
Clearly, many EMTs have been doing a lot more during the pandemic, broadening their roles. Some states are quickly recognizing the changing conditions on the ground and are making expansions in EMT roles legal and more permanent. Not only does this provide greater job protections. It may lead to increases in pay.
They recognize that during this crisis, everyone’s role has expanded and changed.
In some states, EMT-I can now legally do the following:
- Use bronchodilators
- Do end-tidal waveform monitoring
- Administer OTC pain killers
This would have been unheard of in most states before the pandemic.
EMS World Magazine reports that in Ohio, Paramedics can administer rapid COVID tests. Texas has given administrators the authority to expand the roles of EMR, EMT, and Paramedics to address public needs. In New Jersey, paramedics are now authorized to perform advanced life support in hospitals to address hospital staffing shortages.
Leaving without the Patient
There has been an increase in the number of people calling 911 because they are having COVID symptoms, even though they are not currently experiencing a life-threatening emergency.
This has led some EMS services to examine the victim. That may administer a rapid COVID test. Then if the person is not experiencing a life-threatening emergency, they are instructed to stay home, take care of themselves and call 911 if symptoms become life-threatening.
This is a far cry from the old days when the EMS leadership might instruct the EMT to complete the transport out of an abundance of caution.
Since we now know that a large percentage of COVID patients will not get seriously ill, it makes sense to let them manage their care at home rather than exposing emergency room personnel to more COVID and further stretching resources.
However, EMS payment structures that only pay the ambulance company if a transport takes place may have to rethink their payment system.
EMTs Using Telehealth to Make Leave/Transport Decisions
Where available, EMTs are now using the hospital’s established telehealth programs to virtually meet with a patient’s doctor or hospital doctors to assess whether a specific person needs to travel to the hospital or can manage their symptoms at home. This has required the waiving of HHS’s requirement that these chats must be initiated by a medical facility, according to JEMS.org.
Changes in Documentation
Many industries have abandoned the practice of obtaining a signature, whether it’s package delivery of a restaurant bill. EMS has been no different. The once harmless practice of handing someone a pen or computer screen to sign a form is now a potentially dangerous task. So the US Department of Health and Human Services (HHS) and CMS.gov (Medicare / Medicaid) have suspended patient signature requirements.
EMS Training Requirements May Change
Emergency medical responders, basic and intermediate emergency medical technicians, and paramedics alike are stepping into these roles. And as they do, they’re learning on the job and demonstrating their willingness to perform these roles and ability to do it competently.
But what happens once we are officially out of the pandemic? Will the roles shrink to fit into the boxes they did before? If history tells us anything, it’s that that’s not likely.
Generally, when an emergency expands the role of someone, that expansion continues. So we’ll likely see a broadening of EMT education across the board and stronger encouragement for EMTs to get the advanced certification.
How the pandemic has changed your or your friends/relatives lives? Do you know anybody who works as an EMT? Share with us on social media.