Trending Topics

Quick Take: COVID-19 EMS Patient Management: Myth vs. Reality webinar

Communication, PPE and decontamination strategies highlighted the 4th FirstWatch and Paramedic Chiefs of Canada COVID-19 webinar


A person is loaded into an ambulance, Thursday, March 12, 2020, at the Life Care Center in Kirkland, Wash., near Seattle.

AP Photo/Ted S. Warren

On March 13, FirstWatch and Paramedic Chiefs of Canada delivered the 4th webinar in their ongoing series. The topic was COVID-19 EMS Patient Management: Myth vs. Reality. What was delivered from the outset was the shape of things to come – not the COVID-19 outcome, but the cooperation and partnerships required to work as one prehospital, public safety and public health team.

Also signing on to this latest webinar was the Academy of International Mobile Healthcare Integration (AIMHI), National Association of Emergency Medical Technicians (NAEMT), the California Ambulance Association (CAA) and the International Academies of Emergency Dispatch (IAED). The webinar itself was chaired by NAEMT President, Matt Zavadsky. Through COVID-19, the alphabet soup of associations is spelling UNITY and this is no bad thing.

COVID-19 lessons from Solano County quarantine

The COVID situation is currently changing on a global scale almost minute by minute and dominates the world news. In the Webinar, Jimmy Pierson, president/COO Medic Ambulance (also vice president, California Ambulance Association), Solano County California; Dr. Bela Matyas, Solano County Public Health director; and Ted Selby, Solano County EMS administrator, gave an account of the management of their COVID-19 confirmed and persons under investigation (PUI) patients at Travis AFB in Northern California.

Solano County and Medic Ambulance became deeply involved in the COVID-19 related planning and handling of patients after the federal decision was taken to quarantine returning personnel at Travis Air Force Base (AFB), which is in Solano County. Repatriated citizens arrived at Travis AFB in three distinct waves.

First to arrive were the U.S. State employees arriving directly from Wuhan, China. Second were evacuees from the cruise ship Diamond Princess, who arrived from Japan. And finally, 800 transfers arrived from the cruise ship Grand Princess, which landed its passengers in the Port of Oakland. All were to spend a period of quarantine at Travis AFB with those with confirmed COVID-19 and PUIs being transferred to local hospitals for observation and treatment.

During the planning, preparation and execution phase of the repatriation, the Solano team had the opportunity to roll out their MCI plans and learn lessons as the situation evolved. They also had the opportunity to consult with Riverside County, California, which was receiving repatriated citizens at a DoD facility there also. During the Travis repatriation(at the time of writing), more than 40 patients have been transported to area hospitals for further treatment.

Take-Aways from the COVID-19 EMS Patient Management webinar

Here are the top takeaways.

1. Communications and leadership

An all-informed organization. Technical and clinical issues aside, the clearest lesson – and one that is playing out across the EMS and public safety community right now – is the need for strong leadership combined with clear communication. Pearson was very clear that an all-informed communication style is needed. That is not limited to email and social media communication, but also includes the ongoing need to ensure that everyone possible available attends the organization’s conference calls to hear the news and situational updates directly from leadership.

Dr. Matyas stressed the importance of over-communication and having hundreds of people on calls. This approach was met with positivity by all staff and, in turn, assisted with the maintenance of morale and without a doubt confident in the leader.

For those staff placed in quarantine, communications with employees and their loved ones are of paramount importance, with a minimum of daily personal calls to ensure they too were briefed and up to date in the latest situation.

Maintaining a wide communication net. Ted Selby reinforced the communications message. To operate in a multi-jurisdictional environment, particularly when planning was occurring around the repatriation of citizens and patients from cruise ships, it was vital to have all the key decision makers on the calls and ensure no one was overlooked.

Selby stressed that there is also a requirement for all involved to have an exceptionally clear understanding of the mission at hand. Selby also stressed the need to keep neighboring jurisdictions informed as transporting through those areas or using local healthcare facilities may be required as the operation unfolds.

2. CDC COVID-19 PPE guidelines

Pearson said that the PPE levels that Medic used were right out of the CDC guidelines “with N95 mask, (with the local addition of a) face shield, gown, boot protection and hair protection, and that’s it.” Though Medic is a California regional authorized infectious disease transport provider equipped with ISOPOD units, Tyvek suits, and PAPR units, they were not needed. Pearson observed that while they had earlier seen other agencies deploy PPE to the full extent, the Medic team had confidence in their techniques and procedures, and robust decontamination protocols.

3. Vehicle preparation and decontamination

Pierson noted that they resisted the urge to recreate the “Ebola era” ambulance, with the patient compartment covered, top to bottom in plastic. They did make every effort to segregate the cab area from the patient compartment, if necessary where an open space existed, with a plastic sheet. Additionally, crews placed a disposable style blanket on top of the gurney to add a level of protection and offer a further barrier.

To provide comprehensive vehicle decontamination, Medic took the practice from its AIMHI partner at the Richmond Ambulance Authority and purchased an electrostatic sprayer. These devices work by spraying an electrostatically charged mist onto surfaces and objects. The electrostatic spray uses a specialized solution that is combined with air and atomized by an electrode which then sprays positively charged particles that can aggressively adhere to surfaces and objects. Because the particles in the spray are positively charged, they cling to and coat any surface they’re aimed at. These devices work by RAA Biochemical cleaner

Additional resources for COVID-19 response

The whole webinar is now available online for all to hear, but the key takeaway bar none is Communicate, Communicate, Communicate!

The next Joint Webinar hosted by FirstWatch is planned for March 26, and will cover the lessons learned from staff quarantines on Solano, California; Kirkland, Washington; and Toronto, Ontario. Top tip – register early as the 1,000 caller cap will soon fill up!

Additionally, a wealth of websites and apps are emerging containing COVID 19 Information. Learn more here:

Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.