COVID-19 has reduced EMS 911 call volume by 26% for agencies across the United States. The drop in 911 calls and interfacility transport has reduced workloads, idled crews and led to furloughs and layoffs for some EMS providers.
At the same time, millions of children are returning to schools that don’t have a school nurse. According to the National Association of School Nurses, about 25% of schools don’t have a nurse in the building and another 35% have a school nurse available less than 35 hours per week.
An Arkansas school district, in mid-September, anticipating the likelihood a school nurse will be quarantined during the school year, approved a plan to hire paramedics to serve as substitute nurses.
There is an opportunity to match the availability and skills of EMS providers with the need for in-school healthcare with a new role for EMS, the School Resource Medic. (Credit to @KyleKiper for coining the title “School Resource Medic” in response to my Tweet)
https://twitter.com/gfriese/status/1290254011585769472
COVID-19 has accelerated trends across every industry and profession. In EMS, COVID-19 has accelerated the use of telemedicine, treatment in place and transport to alternative destinations. EMS providers have been called on to teach COVID-19 recognition to other healthcare providers, test patients for COVID-19 and work as contact tracers. Our ability to work in any setting, with limited supplies, coupled with an ability to assess patients of all ages to quickly determine “sick” or “not sick” makes us a valuable resource to the new demands on schools.
Here are potential roles and responsibilities for a school resource medic:
Student and staff COVID-19 screening
Schools, whether the buildings are open at full or partial capacity, should be screening students and staff as they enter the building each day. That screening may include a temperature check and questions about symptoms or close contacts with anyone with COVID-19 symptoms. EMS providers, along with the school nurse and other staff, could perform this daily student screening. Students who have a high temperature, symptoms or close contacts could have additional vital signs taken, physical exam and history assessment completed by an EMT or paramedic.
Role modeling healthy behaviors
A school resource medic can share the load with teachers, parents, guardians and principals in role modeling infection control practices, distributing facts and combatting disinformation about COVID-19. EMTs and paramedics are respected members of their community. A smartly uniformed medic, wearing a face mask, with a washed and polished department vehicle nearby, can greet students as they enter school. As kids are completing COVID-19 screening, they can also remind them about the importance of wearing a face mask, staying six-feet or more apart, and regularly washing their hands.
Treatment in place
A school resource medic could provide in-school assessment and treatment or assist a school nurse assessing and treating the minor bumps, bruises, strains and sprains that children regularly suffer in gym, on the playground or in the school yard. A paramedic, working with online medical control or with a telemedicine consult, may be able to determine if a child needs ambulance transport, parent transport or no transport at all.
Vaccine clinic
EMS should be meeting now with public health officials and local healthcare system representatives to ensure EMS is part of the planning for influenza vaccination, in the near term, and COVID-19 vaccination, if and when a vaccine becomes available.
Follow-up care
Students who are sent home from school because of COVID-19 symptoms could receive a follow-up at-home visit from the school resource medic or another provider from the same agency. The follow-up visit might include a COVID-19 test, assessing other family members or people sharing the same housing unit, teaching the student’s family about isolation and quarantine, and what to do if a COVID-19 patient’s illness becomes worse and they need emergency care.
Teach lifesaving skills
A school resource medic, with permission from the school administration, could use their presence and relationships with staff and students to teach lifesaving skills. I’d focus on teaching students, with age-appropriate instructional activities, to recognize and treat time-critical emergencies, like:
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Heimlich maneuver
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Hands-only CPR
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FAST stroke assessment
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STEMI recognition
Be a helper
Many schools are likely to reduce in-classroom volunteer opportunities for parents and other community members. A known and trusted school resource medic might be able to tutor middle school and high school students with anatomy, chemistry, biology, math, writing and other topics. For grade school students, what a thrill it would be to read aloud to or with an attentive EMT or paramedic.
Introduce kids for EMS and healthcare careers
A school resource medic needs to be optimistic about the future of EMS and willing to recommend it as a career or as a gateway to other healthcare career fields. As a core function of high school is to prepare students to be career and college ready, a school resource medic can help students understand the opportunities in EMS specifically and public safety and healthcare generally.
A school resource medic might even champion a group of students through first aid, first responder or EMT training. An ambitious and dedicated school resource medic could lead a group of students through the Coursera online EMT class and then help the students learn, practice and prepare for practical skills test.
“A school resource medic will never work in my city”
You are probably right, a new role for EMS as a school resource medic isn’t likely to work in your town, village or city. The school nurses, teachers and principals are too entrenched in the status quo and your chief won’t take a risk. Making matters more complex, some school districts are expelling their school resource officers.
A school resource medic won’t work, but if it could work, what would it take for your EMS agency to be an active daily presence in schools? Here’s how I’d start:
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Get a meeting. Call a friend or friend of a friend to get a meeting with a teacher or principal. I’d ask as many teachers and school administrators as I can, “If an EMS provider could be at your school one hour, two hours or more each day, what would you have that EMS provider do?”
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Self-assess strengths. Evaluate the strengths and assets of your agency, as well as your state’s scope of practice. What could you bring to a school that would be valuable to the health and wellness of the children in your community? How can EMS make sure every school is open for instructions as much as possible during the pandemic?
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Communicate value. Explain the value of a school resource medic in terms educators are held accountable. How can a school resource medic improve student attendance, ensure the building stays open during this school year, and help students with grade-level competencies and graduation requirements?
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Find local funding. Don’t make funding your first worry. We already know that funding and reimbursement are a significant constraint on EMS expanding its capability to do anything other than transport patients to a hospital. After you match your agency’s capabilities to a need that can be expressed as a benefit, then seek out funding. Look locally for funding through community foundations, major business foundations, and hospital and healthcare foundations. Local funders have a vested interest in school success.
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Be persistent. Take my half-baked idea of a school resource medic and nurture it into something that works for your agency and community. Maybe a different audience, like the YMCA, YWCA, or Boys and Girls Club will be more receptive to regular visits and assistance from an EMS provider.
COVID-19 is upending every business and government service. EMS, like education, is going to look a lot different after COVID-19 than it did in early 2020. Don’t be idle waiting for a return to normal. Instead, purposefully shape the new normal for your EMS career and service.
Read next: Proactively expanding the EMT and paramedic scope of practice
Let me know what you think of the school resource medic in the article comments or join this Twitter thread.
