Thanks to Will Dunn, Clinical Manager at Eagle County (Colo.) Paramedic Services, for suggesting resources for rural EMS surge capacity and commenting on a draft of this article. Will discussed the Eagle County COVID-19 response on the Inside EMS podcast and shares a chronological timeline of preparation methods, including training and tabletop planning, and how they are using their community paramedics, what patient care is like right now and areas to watch out for.
COVID-19 cases in the United States are expanding exponentially and already overwhelming the capabilities of many public safety agencies. As this unprecedented pandemic continues, EMS, fire and law enforcement agencies need to consider innovative strategies to increase or supplement their ranks.
Public safety personnel are unable to socially distance from home when their work does not stop and are being exposed at an exponentially higher rate than many other Americans. The first responders who answered the call to the Life Care Center nursing home in Kirkland, Washington, where so many of the first U.S. fatalities originated, are now on extended quarantines due to lab testing delays.
Already within hospitals, ICU providers are projected to be in dire need shortly. The Society of Critical Care Medicine has recommended tiered staffing strategies in the ICU to incorporate non-ICU physicians, providers and nurses.
Outside of the hospital, EMS leaders need to rapidly consider and implement strategies to increase the number of personnel available for emergency response, including, but not limited to, COVID-19 calls. With a straightforward assignment and appropriate supervision, civilians can pitch in immediately with helping restock bags, cleaning response vehicles, doing laundry or cooking meals for responders.
Personnel resources for rural EMS
We will reach a point where calls for service outweigh the number of available units with responders home sick or quarantined. While large urban areas have multiple layers of redundancy in their response planning and may not see this for months, or ever, depleted staffing will hit the hardest in our rural communities that often rely exclusively on volunteer fire and EMS responders. There are other first responders, likely in your community, with basic first response training, albeit outside of an ambulance, who may be able to jump in and help with the response in this exceptional time. Here are some ideas:
- Lifeguards: American Red Cross lifeguards are trained in CPR and First Aid, and may provide additional hands with patient care. You might already have conducted joint training with them.
- SAR Techs: Many search and rescue agencies around the country require their members to be trained in Incident Command Systems (ICS), and those SAR members often have Wilderness First Aid or Wilderness First Responder training, as well as knowledge about radio operations.
- Raft, hunting and fishing guides: Many guides are required to have basic first aid training and are used to working in challenging conditions for long hours.
- Radio Operators: Often, SAR teams have supplemental radio operations units, which may be able to assist dispatch centers with operations as well.
- Civil Air Patrol: Members of the CAP likely have ICS and radio operations training and may be helpful in assisting dispatchers with their operations.
- Ski Patrollers: In resort towns, local EMS agencies should consider reaching out to their ski resorts, as the National Ski Patrol outdoor emergency care training includes quite a bit of EMT-Basic level knowledge and skills. Ski patrols, as well as outdoor recreation businesses and summer camps, may have caches of supplies that should be brought to an accessible area, inventoried and on hand for EMS surge capacity.
- Medical Students: Some medical schools require medical students to take an EMT-Basic course as their first medical school course, and many of these students have now been sent home. There are also medical students, like me, who were EMTs or paramedics before going to medical school and can step back into those roles within the community easily.
Extraordinary time calls for extraordinary measures
Minnesota has suspended ambulance regulations that require emergency driver qualifications, allowing civilian drivers to assist with responses. Additionally, the suspension lifts requirements for certifications for responders. This may allow other civilians with some qualifications, such as National Ski Patrol, medical students, nursing students, and Wilderness First Responders, to provide needed short-term assistance under the direct supervision of a trained and qualified EMS provider.
Our skill set as EMS providers are unique and cannot be replaced by others who have not undergone the specific training that provides us with both the medical and logistical knowledge that is required for strong prehospital care, and I am not advocating for that. However, in this unprecedented time, we may have to welcome into the ambulance those willing to help us maintain a field response capability to the communities who depend on us.
