Resident Eagle: How EMS Docs Convinced COVID Vaccine Skeptics

Resident Eagle is a monthly column profiling the work of top EMS physicians and medical directors from the Metropolitan EMS Medical Directors Global Alliance (the "Eagles"), who represent America’s largest and key international cities. Tentative dates for Gathering of Eagles 2021: June 14–18, Hollywood, Fla. For more see useagles.org.

As we pass a year since COVID-19 emerged and reshaped American lives, there may finally be an end in sight. Vaccine efforts continue, intimately involving EMS on both ends of the needle. For a current pulse on how things are going, EMS World held a roundtable on the vaccine during EMS World Spring, March 3–5, 2021.

Kenneth Scheppke, MD, state EMS medical director and chief medical officer, Florida Department of Health and Palm Beach County Fire Rescue: 

Some of these young, healthy folks think, Well, I’m relatively healthy, why should I get the vaccine? To have (Palm Beach County) Chief Reginald Duren and three crew members who suffered severe COVID and were hospitalized and now suffer long haulers syndrome create a video to make it real for the folks they’ve worked with, that helps [supplement] when I come in and say this is really a Russian roulette game. Maybe you will have an asymptomatic case because you’re young and healthy. Maybe you will have a mild case. But while 80% of the deaths are in [people] age 65 and older, that means 20% are in young people.

Also, this long hauler syndrome is a real phenomenon, as you see from your coworkers. Just looking in the crystal ball a little bit and realizing what lies in the future, your choice is really not vaccine vs. nothing, because the pandemic is not going to go away until we reach herd immunity. Realistically your choice is vaccine or get infected, particularly in the healthcare industry. That’s the far more likely of the two. And looking at the vaccine’s safety record, now that we have some pretty good data, the safety is very good. It’s really a game of luck. It’s like playing the lottery when you get infected—what’s going to happen?

There’s almost a microculture per station. There are some stations where pretty much everybody has gotten the vaccine, and others where almost nobody has. I visited those stations and had one-on-one, free-flowing conversations and let crew members express their concerns before going through the data. One thing I’m clear about is that I’m not trying to be a salesperson for the vaccine. But if you’re going to make a decision, I want you to make it based on scientific facts, not on rumors and misinformation. After we went through that exercise, we saw many of those folks in those stations starting to get vaccinated. 

Michael Kaufmann, MD, FACEP, FAEMS, EMS medical director, state of Indiana:

It’s using facts. Seventy percent of our EMS services in the state of Indiana are operated by our fire departments or municipalities. We did some early surveys in the November–December time frame. We knew vaccine acceptance was exceedingly low. It was probably less than 50%. With the fact that our state health commissioner made EMS first responders in that top 1A tier to get the vaccine, we knew we had some work to do early to get that vaccine acceptance rate at a higher level. 

Social media really did a disservice—what I call “water fountain facts,” the facts people just make up as they’re standing in line for a drink of water. Scientific facts are really what made the difference for us. 

We brought in Dr. Scheppke. Ironically we had our state EMS medical directors conference in December, and Dr. Scheppke gave us a presentation on the scientific facts of the vaccine—how it was developed, how it worked, the data from the trials. That made a huge difference. We were able to then take that information and do a couple of things with it: We were able to send it out over social media; we were able to present it through our local fire chiefs association; and we were able to put together a training program and publish that through our state training portal. Because of that our acceptance rate has soared, and we now have a lot of our EMS and fire first responders accepting the vaccine. 

Jon Jui, MD, EMS medical director, Portland Fire & Rescue and Multnomah County, Ore.: 

We have three large agencies in Portland. The first is our transport agency, AMR, which has been carrying the heavy load and having the most encounters with COVID patients. They get notified whenever there is a positive COVID patient. When you look at the vaccination rates of the most highly encountered agency, it’s a 91%–92% vaccine acceptance rate. 

Our second group is our Portland firefighters and medics. They have also had high exposure. It’s interesting that their vaccine rate rose from 50% to about 80%–82% the last time we counted. Then we have our third, smaller agency, the Gresham Fire Department. They have had fewer encounters. Their vaccine rate is about 60%–65%.

There is probably a correlation between the number of individuals you encounter, either in your station or among your colleagues and patients, and acceptance of the vaccine. A lot of us are very concrete: “This is a figment of your imagination,” and “No, Joe got it.” There is some of that direct encounter changing the acceptance of the vaccine.

Joelle Donofrio-Ödmann, DO, FAAP, FACEP, FAEMS, associate medical director, San Diego Fire-Rescue:

We have been very early and up front with trying to get accurate information out for vaccinations. I think all the same things you hear on social media— “It doesn’t work,” “Does it alter your DNA?”, fertility issues. The big thing is, “My friend got COVID, I’m going to get it, and I’m going to be asymptomatic too. It’s just going to be a mild runny nose. It’s not that big of a deal.” That’s what we hear a lot—“Sunshine, some zinc, and we’re all going to be good.” It’s trying to combat that and talk to them about science and logistics and showing graphs and showing real data. 

Also, like Dr. Scheppke did, we shared our own personal experiences of personnel who got COVID. We have some young, healthy people who were down for the count for quite some time.

Susanna Visser, MS, DrPh, policy colead/senior advisor, health systems and worker safety, CDC COVID-19 response:

A major goal of the CDC emergency response has been to empower healthcare professionals to vaccinate with confidence. If you ensure healthcare professionals feel confident in their decision to get vaccinated themselves, they’ll also recommend vaccination to their patients. 

One of the overarching values we’ve had is that trusted partnerships matter. We have established an alliance of community healthcare workers, pharmacists and nurses, faith leaders, and many clinician groups to ensure that we’ve got these trusted partnerships at the ready, and certainly our EMS colleagues have been a pillar of those partnerships. We’ve learned a lot from you all. Trusted partnerships matter. Getting people to think creatively is a really important piece of the job. Our work together has been important for dispelling myths and misconceptions. We are really appreciative of this partnership and know it’s a central pillar of our clinician society.

James Augustine, MD, FACEP, national director of prehospital strategy, U.S. Acute Care Solutions:

The International Association of Fire Chiefs and International Association of Fire Fighters both argued vociferously to get fire/EMS personnel put on the high-tier list for getting vaccines. In October–November [they] asked members of the fire-EMS service whether they would take the vaccines. Subject to no science, just what they read in the media, they said no. 

Fortunately many medical directors and other leaders got involved, began to talk individually and in groups, and some individuals [provided] really important materials to build confidence among the fire-EMS force. Then the CDC asked us to be involved because they know how important fire and EMS people are to communities’ perceptions about safety and acceptance of good behaviors about avoiding infections.

We worked very hard. We surveyed the Eagles, and medical directors reported a 65% confidence rate when that survey was done in January, with about 35% of our fire-EMS personnel across the many agencies saying they were not ready to take the vaccine or were on the fence. But when medical directors got involved and talked to the crews, that rate dropped by about half. So about 15%–20% still did not want to take it for a variety of reasons. 

The real move in confidence is when they put their arm forward. And in many of our places, the acceptance rate is at 90%—so good news on that front.

EMS has to be heavily involved in this. In both a passive way, getting people vaccinated who are ready to come to it, and as well carrying it out into the community where people are not so mobile. There is frankly no better group at knowing where the pockets of people who can’t access good healthcare are.