“When we call for an ambulance, you have to come.”
How many times have EMS practitioners heard this statement from not only patients, but hospital and nursing home personnel? EMS has always found a way to answer that call, even when resources such as personnel are taxed.
However, with the increasing occurrences of novel infectious diseases — such as H1N1 “Swine Flu” (a title the pigs in Iowa find offensive) — folks may soon realize that their local EMS agency may not be able to respond.
In 2006, the Iowa Department of Public Health conducted the Virtual Influenza Pandemic Exercise Response (Operation VIPER), a three-week, real-time function exercise focusing on an infectious disease outbreak.1 As Operation VIPER progressed, the probability that EMS would not be readily available for 911 responses or Interfacility transfers in a pandemic situation became evident. In fact, EMS would most likely be among the first workforce groups to be stressed, for obvious reasons.
There have been many predictions about the effect of the H1N1 flu pandemic on all businesses and their workforces, with several estimations showing a 40 percent depletion of available workers. What will happen when that number is applied to an EMS workforce such as a rural service, one that comprises eight paid practitioners and 80 volunteers to fill five ambulances to cover 578 sq. miles and a population of more than 11,000? What will happen when 50 percent of those fall into the targeted high-risk groups for infection?
After presenting several pandemic scenarios to volunteer services, one glaring fact became evident: there is a profound lack of communication among many entities involved in prehospital medicine. The volunteers stated they were overwhelmed by perceived increases in their duties (although decontamination for H1N1 is really no different than what they are expected to do following every response), the fear of becoming infected and then infecting their children, loss of time at their paid jobs, and even the fear that no one would be left to man the ambulance in their community if a member of their own family was in need.
EMS will be subject to a decrease in resources in a pandemic situation due to:
• EMS practitioners getting sick and/or dying
• EMS practitioners taking time off to care for family (children, spouse, parents) who are sick or dying
• EMS practitioners not responding or staying off the job for fear of getting infected by patients or other workers and spreading it to their families
• Difficulty obtaining supplies due to increased demand with decreased manufacturer and supplier workforces
The CDC has published interim guidelines for EMS in the care of patients suspected of H1N1.2 The majority of the guidelines — such as wearing appropriate PPE, hand washing, and thoroughly cleaning and disinfecting the ambulance following a call — are all things that should already be an automatic part of our daily duties. Diligence and the addition of just a few precautions that may not be performed under normal circumstances can make a huge impact on preventing the spread of H1N1. They include:
• Changing gloves periodically throughout transport to prevent cross contamination of EMS equipment (remember surfaces in the patient’s home may also be contaminated)
• Using reverse isolation by wrapping the patient in a sheet or bath blanket and keeping them wrapped while transferring to a hospital bed
• Wiping down steering wheels and grab bars following every call with a disinfectant solution
Following these guidelines will help to protect you as the provider as well as your families at home and may lessen the stress on the EMS workforce during a pandemic.
Whether a volunteer or career responder, notify your employer, your partner, other crew members, and the communication center when you are not going to be available to respond and why. It is important for them to know if you are sick, taking care of someone who is sick, or if you are unable to respond for other reasons.
The hospitals should also be notified if the service is not going to be available. In systems that are staffed primarily with volunteers who also have a career service as back-up, including simultaneous ALS responses, the loss of the volunteer and first responder units will further tax the availability of these career services and increase response delays. Additional resources, through contingency plans and mutual aid agreements, will need to be notified. Remember, neighboring communities may be experiencing the same challenges you are.
Communication is the key to facing the workforce challenges and unrealistic expectations of EMS during any disaster, including a pandemic. Planning with hospitals, public health, and other community partners should include proactively working through scenarios that include a depleted EMS response capability. Communication among all services within a system is also vital. Education on the prevention of exposure and contamination will go a long way in dispelling misinformation and fear. Volunteer and career practitioners will be less likely to stay home from fear if they are given an active role in planning and accurate information on how to protect themselves and their families.
The public expects the ambulance to arrive when they call 911 for help, often not considering ambulance personnel also get sick or have families they need to stay home to take care of. Hospitals often do not realize that the ambulance is not available to transfer patients due to a depleted workforce or loss of appropriately trained EMS personnel for the level of transfer. The unrealistic expectations will continue unless EMS as a profession does a better job of dispelling them through communication and working with our partners in health care in developing solid response plans, that include a back-up plan for those times when there is no one to man the ambulance.
References
1. http://www.idph.state.ia.us/adper/common/pdf/focus/june2006.pdf
