Tracing a new pathway for EMS workers

How the clinical and public health activities of testing, tracking and tracing should become sub-specialties of EMS going forward


Since the beginning of the COVID-19 crisis, World Health Organization Director-General, Dr. Tedros Adhanom Ghebreyesus, has consistently prescribed the pathway to control the pandemic. Tedros has continuously implored countries to isolate, test and trace new cases to effectively suppress and control the virus's spread, and implored that this strategy must be the "backbone of the response in every country."

Even our new national treasure, Dr. Anthony Fauci, NIH superhero, agrees, noting an outcome of the public health emergency is a much more robust system to identify infected individuals, isolate them and then do contact tracing.

So far, the U.S. has attempted the isolation phase, although the competing forces of politics and public health are currently swinging towards a reopening before we have identified, completely tested and investigated those with COVID-19. This act may well bring on a second surge, so the jury is out for approximately two weeks as we wait to see if we have re-infected ourselves into a new lockdown.

Armed with many of the required skills, EMS can contribute to what is about to be a growth industry: contract tracing. (Photo/Getty Images)
Armed with many of the required skills, EMS can contribute to what is about to be a growth industry: contract tracing. (Photo/Getty Images)

I have long maintained that EMS and public health are inextricably linked and we must work for hand in glove with our public health directors (I think, COVID-19 has driven this point home). With the downturn in call volume in some areas, organizations are faced with the prospect of reducing hours, imposing furloughs or layoffs, and localities are contemplating reducing the numbers in fire and police departments for both volume and income reasons as well. As COVID-19 is proving to be not only a healthcare, but also a business disruptor, EMS could play to its strength and pivot into this discrete area of the public health arena. Armed with many of the required skills, we can contribute to what is about to be a growth industry: contract tracing.

Contact tracing opportunities for EMS

In COVID-19 hotspot, New York, Governor Andrew Cuomo and former New York City Mayor Michael Bloomberg, have already announced a statewide contact-tracing program where they plan to hire up to 17,000. The Johns Hopkins Center for Health Security estimates that about 100,000 contact tracers may be needed nationwide to limit the spread of the disease and reopen the economy. According to Beckers Hospital Review, approximately 11,142 contact tracers are working now in the U.S with more needed in every locality.

Leading the charge in this area is American Ambulance of Fresno, 911 provider for the 4,000 square mile Fresno and Kings Counties in Central California. American Ambulance recently committed their staff to become a part of the county’s contact tracing medical investigation team (MIT). Having just hired 15 new EMTs, American faced the reality of having to immediately lay them all off as the pandemic caused a 25% reduction in call volume. Following discussions with Fresno County Department of Public Health, American was able to bring 13 of the 15 members of staff back on and commit them to the MIT. President and Chief Executive Officer of American Ambulance, Todd Valeri told me, “We were approached by public health department leaders to provide medical investigators and contact tracers as part of the county’s plan to reopen our local economy. I was pleased to see our public health department recognized EMS workers as key community partners who could be counted on to perform non-traditional roles.”

Valeri’s sentiment is shared by the Deputy Secretary for Health Preparedness and Community Protection at the Pennsylvania Department of Health, Ray Barishansky, who told me, “It is a natural fit as EMS providers are consistently engaged in the business of interviewing patients and their families about medical history and other pertinent facts.” Long a proponent of EMS and Public Health cooperation, he added, “This is another area where public health is learning about EMS capabilities and EMS is being educated about the importance of public health.”

Others also see the value in becoming involved in this essential program. Recently, the National League of Cities (NLC), representing more than 200 million people within their member organizations, published a document laying out how to beat COVID-19, including testing and tracing (not all elected officials and political staffers have epidemiological or public health knowledge or experience).

To learn more, and with a holiday weekend sunny Sunday afternoon to spare – I signed on to the free Johns Hopkins University/Coursera online learning platform and conducted the introductory 5-hour COVID-19 Contact Tracing class. The course was separated into five main sections:

  • COVID-19 basics
  • Fundamentals of contact tracing
  • Steps in investigating cases and tracing contacts
  • Ethics of contact tracing
  • Skills for effective communication during the tracing process

All was easy to inwardly digest, and the communication skills section alone would provide a good in-service refresher to anyone that has to face and interact with a patient or the public.

With the completion certificate in hand, I too was immediately able to see how EMS would be good at this task. Tracking and tracing is not simply a phone call from a distant call center followed by a quick Q&A – it is an episode in dealing with people who are likely to be upset, afraid and contemplating their demise. A medic’s empathy and ability to place people at ease while getting to the root of their complaint (while electronically charting) is a major part of this job requirement. The ability to build a rapport and gain confidence is key to putting minds at rest, persuading that isolation or quarantine is the best course of action, and extracting information that will lead to further contacts – all existing skills in the medic’s own emotional intelligence tool kit.

The impact of contact tracing on the EMS workforce

As we wait for many things right now including the possible second wave; further funding; a robust, affordable and delivered in time PPE supply chain; the clinical activity of testing and the public health activity of tracking and tracing could and should become sub-specialties of EMS going forward.

Listen: Tracing a new pathway for EMS workers - EMS One-Stop With Rob Lawrence

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