By Dr. Brian Maguire
The emergency medical services system is in desperate need of resources to help it respond to the COVID-19 pandemic. The 21,283 EMS agencies in the U.S. already attend to 30 million calls for assistance every year and were already under enormous strains before the pandemic. Now, we are expecting call volumes to begin rising dramatically at the same time that large numbers of EMS personnel begin succumbing to the virus.
Agencies in urban areas may not be able to keep up with demand and rural agencies will have the added burden of having growing numbers of patients who need extended transport times to get them to specialized intensive care facilities. In addition to the ongoing cardiac and other emergencies, EMS agencies will now be expected to take large numbers of patients to improvised health facilities such as converted gymnasiums and may be asked to help provide home care for large numbers of people who are ill but for whom hospitalization is either not required or unavailable. The Medicare program only reimburses EMS agencies for patients taken to hospitals.
There may be a small window of opportunity to take drastic actions that could potentially save lives across the country and that may keep the EMS system from collapsing. Immediate state, federal and private funding is needed to implement the following actions:
1. Activate a national EMS communication program
Today, the 21,283 EMS agencies are each, individually trying to solve many, very similar problems. A national communication program will facilitate interaction and provide a forum where agency leaders can share lessons learned, post resources and ask for advice.
2. Expand the EMS workforce
Immediately hire thousands of people to begin assisting the EMS agencies. At the same time that many EMS agencies may begin collapsing due to enormous demand, millions of young, healthy workers have been told not to come to work. These people will not be turned into EMS professionals within two weeks but some could be taught enough to assist the EMS personnel and some could be taught how to drive the emergency vehicles so that the EMS personnel could stay in the patient compartment of the vehicle. Large numbers of people could also learn how to clean and disinfect the ambulances and equipment, thereby allowing clinical staff to focus on caring for patients.
3. Deliver national online training program
In conjunction with hiring these thousands of individuals, a national online training program is needed. The first priority for such a program is to provide critical training the new workers will need. The national program will need to hire local instructors to provide some hands-on training and those local instructors will need training on how to safely provide the training.
A training program is also needed to provide critical training updates to the EMS workforce on a timely and ongoing basis. Such a program could also provide training for the thousands of people who will be needed to support the health centers being planned for converted gymnasiums, cruise ships, hotels, and community buildings.
4. Bulk PPE purchase
EMS agencies need funding to purchase bulk supplies of critical resources such as personal protective equipment.
The tsunami of patients is coming. We might have weeks to prepare, we might have less.
