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Editors` Expressions: COVID-19: I Have Questions
Here we are, two months into the novel coronavirus outbreak, managing as best we can with the information we have. I am reminded of a similar situation of uncertainty we dealt with a few years back.
I was teaching new recruits in the fire department in 2015 when our city received a stockpile of DuoDote autoinjectors to treat the victims of a potential nerve agent terrorist attack. We began training on the use of the DuoDotes. These newbies were wide-eyed, keen on learning how to administer this medication, memorizing the signs and symptoms, side effects, max dose—all of it. But behind their eyes was a fear, to be sure. And the more I thought about the scene of this potential terrorist attack, I became quite cynical, or maybe just realistic.
I said to my students: “Let’s be real—if a terrorist drops a big nerve bomb on this city and you’re on shift, what’re you going to do? You’re going to bust open a box of the DuoDotes, stuff a few down your pants and in your pockets, and aim the ambulance in the direction of your family to get home as quickly as you can.” I thought maybe, if the scenario played out right, you could chuck a few doses out the open back doors of the unit to the drooling, vomiting, seizing zombies chasing after your ambulance with their arms outstretched…but the real priority would be you.
EMS providers have been taught we should put our safety first: On a scene, if we don’t take care of ourselves, we won’t be able to take care of our patients. The mantra seems so relevant with this COVID-19 event. How are we managing now?
Might this outbreak provoke a temporary labor shortage, as EMS providers decide not to come to work because they’re worried about getting sick or being quarantined? What are our rights as workers? Will there be mandatory overtime if our ranks are depleted?
We signed up for risk, of course. On every call we accept an element of risk. We accept that risk in a 25,000-lb. truck barreling down the road with lights and sirens, hoping the car ahead creeping into the intersection sees us. We enter the “man down” scene, sometimes with law enforcement, sometimes alone, wary of what we might find, what might be lurking around the corner. We inject and insert instruments and needles and implements into the soft tissue of various man- or trauma-made orifices, usually wearing just a pair of gloves, maybe eye pro, maybe a mask…
So will the CDC’s latest screening questions dictate we don PPE for every patient who has flulike symptoms? Do we have enough PPE? How will we work through the processes of donning, doffing, and decontamination?
We're an EMS family, and many of us are wondering what it's like right now for the providers across the country who are quarantined. How are their families doing? Do they get paid even though they aren’t going to work? Is the exposure to the virus a worker’s comp claim?
Most important: Have they been given all the information they need?
Because now, more than ever, we need science. We need information. EMS needs to be able to speak with confidence and competence when talking to our patients. We need to be informed by the experts, and those who are quarantined deserve frequent updates, accurate testing, personal attention.
We must demand evidence-based, up-to-date policy, to be guided by well-thought-out plans that emergency managers, departments of health, and infectious-disease docs have been trained to provide to us. Chiefs, medical directors, employers, union reps: Give us clear, regular, and concise communications.
After all, this is indeed what we signed up for: the unscheduled, the unpredictable.
EMS is an integral part of the healthcare system—we are on the front lines, and our expertise is in the field, our savvy and comfort being in patients’ homes, liaising with nursing homes, putting the public at ease, dealing with the unknown. It’s in our wheelhouse and we should be helping to steer the ship.
For the latest COVID-19 guidelines, click on the following resources:
Hilary Gates, MAEd, NRP, is the senior editorial and program director for EMS World.
