Mass. EMS builds testing sites in 2 hours to adapt to virus trends

Fallon Ambulance EMS Director Kevin Mont said the agency has the process of setting up efficient, portable testing sites across the region "down to a pretty good science"


Jeannette Hinkle
The Patriot Ledger, Quincy, Mass.

QUINCY, Mass. — On Tuesday, the day before Framingham's "Stop The Spread" COVID-19 testing location was to open at Keefe Regional Technical School, the parking lot was quiet.

No workers were setting up tents, wrangling extension cords or erecting signs.

EMTs register people waiting in their cars at the start of a day of COVID-19 testing at Keefe Tech in Framingham. Fallon Ambulance now has the ability to set up testing sites in about two hours, according to Director of EMS Kevin Mont. (Photo/Ken McGagh, Daily News, Wicked Local)
EMTs register people waiting in their cars at the start of a day of COVID-19 testing at Keefe Tech in Framingham. Fallon Ambulance now has the ability to set up testing sites in about two hours, according to Director of EMS Kevin Mont. (Photo/Ken McGagh, Daily News, Wicked Local)

Fallon Ambulance now has the ability to build a coronavirus test site in about two hours, according to Kevin Mont, director of emergency medical services operations for the Quincy-based ambulance company.

"We do have it down to a pretty good science," he said. "There have been times we've been told the day before, literally, 'Can you operationalize tomorrow in this spot?' And we do. We've kind of got the ability to stand up quickly, shall we say, for these types of things."

The key is simplicity, Mont said.

"We purposely designed it to be simple and portable, rather than some of these sites that have these massive tents that you see on the news in Florida that are 6 acres that you drive through and probably took seven days to set up," he said. "We get the call, we show up, we can organize and we can deploy. That's really what our goal was when we started to do this."

Though Fallon Ambulance has experience with transporting patients with infectious diseases, before the pandemic struck the company had not directed and managed an operation like the testing site that attracted hundreds of residents from throughout the region to Framingham over the past week.

But times have changed. Fallon staff have now operated more than 50 larger-scale drive-up test sites, but when smaller testing efforts are included — testing at skilled-nursing facilities and group homes, for example — the number shoots up to roughly 2,100, Mont said.

Mont said that as coronavirus cases began to rise in the spring, Fallon prepared its staff to transport potentially infected patients safely. Calls were beginning to roll in: A patient may have been exposed to the virus, but could Fallon take the person to be tested at the hospital and then take the person back home?

As cases climbed in Massachusetts, Fallon leadership began wondering if that testing strategy was sustainable. The method was inefficient - and possibly dangerous.

"That was one of those questions internally that we were just asking out loud," Mont said. "Why can't that person get a test either at home or in a different manner rather than going all the way to the hospital via transport to get it when you potentially are now exposing that person who is positive to multiple other people to get a test?"

At the end of March, Fallon began training staff on how to administer coronavirus tests. In the first week of April, Fallon received a call from state officials working on COVID-19 response asking if the company could administer tests at Department of Developmental Services group homes. Fallon's staff got to work.

"We went operational right around Easter Sunday," Mont said.

As Fallon began running more testing at locations like group homes, the company began to hone its strategy for getting pop-up sites up and running quickly.

"As far as logistics, the ability to scale into a much larger thing, that just came through the experiences of doing a few smaller ones, seeing what you need to really accomplish that task, then, 'OK. How do I scale this?'" Mont said. "We learned on the fly a little bit."

Fallon also reached out to ambulance operators around the country, asking questions about their strategies for running test sites.

Because they are inherently mobile, EMS providers are well equipped to run test sites that are able to move with infection trends, Mont said.

"I think EMS is an important mechanism for public health to use for this," Mont said. "It's great that in Massachusetts, toward the beginning, right in March, the state allowed EMS to get involved, issued an emergency protocol that allowed us to do testing, gave criteria to fall under in order to do it. Since then, we've been out doing it."

When cases surged in Massachusetts this spring, Mont said Fallon worked with eight different ambulance companies to support testing efforts statewide.

"All our EMS partners totally stepped up and got involved," he said.

Each site is different, and while Fallon staff are now able to quickly mobilize a working test site, the company does tweak staffing levels and setup throughout the operation.

Over the first two days of testing in Framingham, Fallon staff completed 726 coronavirus tests, according to Mont. On Wednesday, the first day of testing at Keefe Tech, cars were lined up hours before opening, and when the site officially opened at 2 p.m., Framingham police worked to organize the continuous flood of vehicles, which at times spilled out onto Winter Street.

Mont said the average wait time on Wednesday was about 45 minutes.

A test site that Fallon ran in Melrose recently had wait times of up to two hours, but Mont said testing at Fallon's Revere "Stop The Spread" site has gone more smoothly.

"Revere's flow has been much shorter than that, partly just because people are coming in at different times, they're not all coming at once, which was the Melrose experience," he said. "In Melrose, they just kind of all showed up before it even opened and even though we opened early, it still led to lines. I would say people should understand that there is potentially an hour wait to get through."

Waits stem largely from the time it takes to register and collect the contact information of those being tested, Mont said, adding that Fallon aims to test four vehicles at a time. "The test itself is so very quick," Mont said. "It's the registration process that actually is determining how quickly we can go."

Fallon's monitors, those registering testees, ask for very limited information -- most importantly a contact number and email address to communicate results from the lab that tests the nasal swabs paramedics and EMTs collect.

Still, it can be difficult to communicate from outside to inside a vehicle and sometimes staff cope with language barriers, though Mont said that issue has been manageable. Fallon staff have flyers in multiple languages, including Spanish and Portuguese, that explain the steps of the testing process.

"The EMTs and paramedics are also able to communicate effectively by showing what's going to happen and using hand gestures and things like that to get people to take the test appropriately," Mont said. "It's been a limited issue."

To speed up registration in Framingham, Fallon has added additional staff to enter registration data into the onsite computers and made a few other adjustments to how contact information is collected, Mont said.

After swabs are collected, placed into tubes and labeled, Fallon staff transport them to the Broad Institute in Cambridge, which analyzes the samples. From there, Fallon staff notify people of their results. Usually, a negative result will be communicated by email, unless the email bounces back. A positive warrants a phone call, Mont said.

"Both can get phone calls, but positives definitely get phone calls," he said.

On Friday, the state announced that Framingham's test site will remain open through Sept. 12. It was originally expected to run for just one more week.

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©2020 The Patriot Ledger, Quincy, Mass.

McClatchy-Tribune News Service

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