So far in the pandemic, EMS has been ever-present on the front lines and has been the utility player that has bailed out and propped up other areas of the healthcare spectrum. We have not only responded, but tested, tracked, evacuated, augmented and deployed. In addition to COVID-19, we have provided mutual aid in large numbers to parts of the country that have suffered both tempest and inferno. With a few months to run in 2020, we are all checking our bingo cards to identify what could be next! The answer is vaccinations – both giving and receiving.
It is reasonable to assume that EMS and its competent and qualified workforce will soon feature in the national effort to vaccinate a population of 320 million people. Given the emerging detail on the research and trials, we may well be part of the plan to deliver 640 million doses as the inoculation regimen may require a two-part dose over a few weeks. Vaccinations are about to become a “thing,” as we work out if we are to be a part of the delivery plan for our locality, district or state. Secondly, and more of a challenge for every chief, is ensuring their workforce is protected and immunized with a jab that according to sources, only 50% currently want. Let’s break it down further.
Vaccine delivery logistics, challenges
On Sept. 16, 2020, HHS and DoD released two documents laying out the Administration’s detailed strategy to deliver safe and effective COVID-19 vaccine doses. The documents, part of the President’s Operation Warp Speed program, provide a strategic overview and a more detailed playbook for state, tribal, territorial and local public health programs and their partners on how to plan and operationalize a vaccination response to COVID-19 within their respective jurisdictions.
The immediate task laid on states is to produce “micro plans” to cover delivery, distribution, administration and documentation. Vaccination sites have to be selected, staff or subcontractors have to be identified and onboarded, and the IT system that is going to document a nation's worth of inoculation – and ensure patients return for their second bolus from the same batch within the specified time – needs to be established. Storage, in particular, may well be an issue as typical vaccines should be stored in a refrigerator (influenza vaccines are stored at 35°F to 46°F (2°C to 8°C), but COVID-19 vaccines may have more stringent storage requirements up to and including freezing – the cooler on the truck that contains the iced water isn’t going to cut it this time!
As part of that preparation, states are beginning to authorize expansions of local scopes of practice. Organizations are being invited to develop processes and procedures with their local health departments to authorize paramedics to administer seasonal influenza vaccination, and, when available, COVID-19 (SARS-CoV2) vaccination. In short, there is a lot of work to be done in short order, and agencies, departments and organizations need to identify their place in the task ahead. According to the Warp Speed documents, plans and planning are afoot. This may all lead to a case of “hurry up and wait,” as the actual arrival, post Phase 3 testing of the vaccination from one of the manufacturers remains, despite political promises at an unknown date.
Vaccinating EMS for COVID-19
An immediate leadership and management challenge is emerging, which must be addressed before we inoculate the first patient. The recently published EMS1 survey on the impact of COVID-19 vaccination amongst frontline personnel yielded – some will say – predictable results. The survey received more than 500 responses identifying that paramedic chief respondents were most likely to get a COVID-19 vaccine, at a rate of 51%, vs 32-35% in EMTs and supervisors, and 22-23% in paramedics, AEMTs and medical first responders.
Only a few weeks ago, we lobbied hard to be included in the highest priorities of vaccination rollout. We are in the category of healthcare workers and vulnerable populations, which is where we should be, but there is a current reluctance to be at the very front of the line, which may cause some federal consternation. With the vaccine in Stage 3 clinical trials, many are concerned over the potential side effects, speed of the approval process, efficacy and availability of an imminent vaccine. Many more believe that as they have been operating in the COVID-19 environment for the last six months and are fine, why should they be vaccinated now?
There are a lot of known unknowns going forward, and to feel weary of COVID-19 considerations is perhaps a natural thing.
But the challenge is to follow the science and not an infodemic of disinformation, and to ensure our own clinically minded staff understand the risks and benefits to their health and wellbeing. Public health understanding and messaging are going to a major player in the next few months, and to put the minds of our overworked and probably exhausted workforce at ease, we must keep them informed and engaged.