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Elbow bumps are the new hugs

Coronavirus spread in an already busy flu season calls staffing contingency plans and a commitment to hygiene and PPE


Washington Gov. Jay Inslee, right, bumps elbows with a worker at the seafood counter of the Uwajimaya Asian Food and Gift Market, Tuesday, March 3, 2020, in Seattle’s International District.

AP Photo/Ted S. Warren

I’m on the flight home from EMS Today. It was wonderful seeing hundreds of longtime friends and meeting a batch of new folks. Of course, this year, every greeting involved some kind of awkward coronavirus-inspired dance. Do we fist bump knuckles? Touch elbows like chickens? Do some weird footsie thing? A twerk-like butt touch? Blow air kisses from 15 paces? Or just go for the traditional handshake or hug?

It was both comforting and a little disturbing watching people line up for the sinks in the bathroom after doing their business actually washing their hands with pride, as if this was some newly-acquired skill. As someone who attends lots of professional conferences, I’ve noticed that EMS people are more likely to use the sink to give the bacteria a quick drink if they hit the sink at all, while physicians tend to have a longer back up at the sink than they do for the urinals and toilets.

EMS agencies and the people who work in them all over the world are taking action to protect themselves from acquiring an infection and from transmitting this virus between patients. Our team at FirstWatch is actively building triggers that alert key people instantly when a call with symptoms consistent with the flu or COVID-19 is entered into the CAD, ProQA or an electronic medical record.

A few EMS, fire and law enforcement professionals are in 14-day quarantine in various parts of the U.S. in part because they were exposed or were possibly exposed to COVID-19 and may not have used adequate personal protective equipment. We’ve had several situations where a CAD-inspired alert got information to responding crews to use PPE when that information was not included in their dispatch information. Hopefully, this is helping to prevent avoidable quarantine.

Adjusting staffing plans for coronavirus implications

Before I boarded my flight, my friend Assistant Chief Scott Dorsey from Snohomish County Fire District 7 reached out to me with some questions about data that he’s using to plan alternate staffing models for his department who transported the first coronavirus patient in the U.S. I suspect/hope that many or most EMS and healthcare systems around the world are engaged in similar contingency planning. Chief Dorsey is a data-driven leader. He plotted the number of sick calls in his department by day so far this year using a Shewhart Statistical Process Control Chart:


What this chart shows is that his department has regularly and reliably produced three sick calls per day so far this year, with a high of seven and a low of none. Statistically, this shows common cause variation, which means that unless something changes, like a virus infecting a large percentage of his department, this sick call rate of three per day will continue. The natural variation in this process shows an upper control limit of just over eight sick calls a day. That means the system could have eight sick calls on one day and it would not be a signal that something has changed. But if there’s nine or more, that would be special cause variation, which would signal that something needs attention.

Chief Dorsey and his team are closely monitoring guidelines being updated by the Department of Homeland Security, the World Health Organization, and the Centers for Disease Control. As of this writing, the DHS recommends contingency planning for staffing shortfall where 40% of your staff are out sick or unable to work due to quarantine.

For Chief Dorsey’s team, nine people out sick – the number necessary for special cause variation – would be equivalent to 25% of their workforce. He’s building plans for 25% and 40%. As this virus continues its spread over the next several months, it’s a good idea for all of us to have constantly updated and evolving plans for how we would deal with a significant decrease in our available workforce.

Staying healthy is part of EMS on and off-duty responsibility

As I reflected on the number of EMS folks, myself included at the conference this week who would start our greeting with some kind of awkward non-transmitting touch and then make some kind of split decision to throw caution to the wind and go for the handshake or hug, I felt guilty. There is a possibility, that I/we were transmitting a viral infection. Most likely, it would be the flu, but there’s a growing chance it could be COVID-19.

I know that it’s awkward to shun the hand or the embrace of friends and colleagues. Maybe it feels like we are judging someone as being unclean or a carrier and our desire for connection overrides our desire for our own safety, but it shouldn’t. The reality is that we could be unaware carriers and if we really love and care about our friends and our family, we should suck it up and be uneasy, graceless and gawky in the spirit of safety.

I figure that we of all people in the world have some additional responsibilities in this virus-sharing world above and beyond PPE and contingency planning. I believe that we have the responsibility to set the example for others on handwashing, using proper sneeze and cough practices, and non-transmitting greetings. Even if we are not worried about getting sick ourselves, staying healthy to maintain staffing for what’s likely to be a time of increased call volume is part of our on- and off-duty responsibilities.

I’m committing to better hygiene practices, are you willing to join me? Elbow bump will be my awkward greeting of choice.

Read next: Quick Take: NEJM coronavirus paper tackles viral load, survivability

Mike Taigman uses more than four decades of experience to help EMS leaders and field personnel improve the care/service they provide to patients and their communities. Mike is the Improvement Guide for FirstWatch, a company which provides near-real time monitoring and analysis of data along with performance improvement coaching for EMS agencies.

He teaches Improvement Science in the Master’s in Healthcare Administration and Interprofessional Leadership at the University of California San Francisco and the Emergency Health Services Management Graduate Program at the University of Maryland Baltimore County. He’s the author of “Super-Charge Your Stress Management in the Age of COVID-19.” Contact him at