NC boosts vaccine workforce by allowing EMTs to administer shots

Orange County Emergency Services Medical Director Joseph Grover submitted a plan last year to temporarily permit EMTs to vaccinate patients

Tammy Grubb
The Herald-Sun, Durham, N.C.

ORANGE COUNTY, N.C. — As cars lined up in the Cedar Ridge High School parking lot, Orange County EMT John Herrera and other staff were waiting with syringes to administer the COVID-19 vaccine.

As an emergency medical technician and volunteer firefighter with the Eno Fire Department, Herrera said he usually fills a supporting role at medical emergencies, keeping patients stable until an ambulance can get there.

Orange County EMT John Herrera administers a COVID-19 vaccine to New Hope Fire Chief Charles Bowden. North Carolina is boosting its vaccine workforce by temporarily allowing EMTs to administer the shots.
Orange County EMT John Herrera administers a COVID-19 vaccine to New Hope Fire Chief Charles Bowden. North Carolina is boosting its vaccine workforce by temporarily allowing EMTs to administer the shots. (Photo/Orange County North Carolina Health Department)

As a volunteer in the Orange County Health Department's COVID-19 vaccination effort, it's a more "intense" experience, he said.

People seeking vaccinations can wait in line for an hour or more — and no one likes to wait, he said — while volunteers and staff make sure each one gets the necessary information, understands the potential risks of vaccination and gives legal consent.

It helps to stay positive and also inject a little humor into the situation, said Herrera, a former Carrboro alderman.

"I feel like we are fighting a war, and this is one way to win it," he said. "This pandemic is just devastating. I have friends who have died, because they never got the vaccine on time."

EMT vaccination volunteers

It can take 100 people, including volunteers managing traffic and paperwork, to vaccinate roughly 160 people per hour at Orange County's COVID-19 drive-thru clinic, community paramedic Katie Benedyk said.

By redefining the job description of an emergency medical technician, the Health Department and Orange County Emergency Services vastly expanded the number of people who could help roll out the vaccines, officials said.

EMTs only need 200 hours of training to do their job, compared with 1,000 hours for paramedics, but their duties are more limited. The state, for instance, only lets EMTs give shots when patients are experiencing an allergic reaction or an overdose. A paramedic, on the other hand, can administer a range of vaccines and medicines as part of the job.

But there's a "tremendous" shortage of paramedics nationwide, said Joseph Grover, Orange County Emergency Services medical director. That's largely due to their increasing education requirements and lagging salaries, he said, noting that with a little more training, paramedics can become nurses, at least doubling their pay.

In September, he submitted a plan to the state EMS office to use EMTs recruited from Emergency Services, the South Orange Rescue Squad and rural fire departments. In October, the county let EMTs administer the flu vaccine to the public as a practice run.

They were ready when the State Medical Board agreed to a temporary program, Grover said.

By December, EMTs made up roughly 36% of the staff preparing vaccines for distribution and monitoring patients at Orange County's drive-thru clinic. EMTs also made up 45% of the vaccination staff; paramedics, 16% of that group.

Last week, Gov. Roy Cooper issued an executive order letting counties also recruit licensed dentists, retired and out-of-state licensed health care workers and advanced medical students, in addition to skilled but unlicensed volunteers, to administer the vaccine.

Not using EMTs is "shooting ourselves in the foot," Grover said.

"From my perspective, it seems almost counterintuitive that, on the one hand, you're telling me that we train our EMS providers how to give an intramuscular injection for the sickest of the sick patients, but we can't train them to administer a medication for the patient who's requesting a vaccine and is well," he said.

Black, Hispanic numbers lagging

About 145,000 doses of the two-dose Pfizer and Moderna vaccines are arriving in North Carolina each week for its 10 million residents, up from 120,000 doses a week, said Dr. Mandy Cohen, secretary of the N.C. Department of Health and Human Services.

It's still not enough to meet the demand, Cohen said, but there is hope for a third, one-dose vaccine from Johnson & Johnson, which could arrive by the time public school teachers become eligible on Feb. 24.

The vaccine is available now for people in Groups 1 and 2, covering health care workers, long-term care staff and residents, and people 65 and older. So far, however, the statewide effort to provide equitable, efficient access to the vaccine has been a work in progress.

There have been stumbles, from a software-related bottleneck in getting vaccines to health departments and hospitals to the limited vaccine supply going to states and a cumbersome data collection process. Some residents also remain reluctant to trust the vaccine.

DHHS reported Thursday that more than 22,204 people in Orange County had their first dose of the vaccine, out of 1 million people statewide. Orange County also had administered 10,300 second doses.

Nearly 81% of those receiving their first dose in Orange County were white. Only 8% were Black, 6% Asian and about 3% Hispanic. The county reported receiving 600 first doses last week and having 17,675 people on a waiting list.

The low vaccination rates for people of color has been a statewide problem, officials said, but there has been some progress.

Two weeks ago, roughly 18% of the state's available vaccine went to Black residents, up 65% from Jan. 13, when only 11% of the vaccines were going to Black residents. Roughly 22% of the state's population is Black.

Hispanic residents, who constitute about 9% of the state's population, received only 2% of the available vaccine doses.

Herrera, a native of Costa Rica, said he remains very concerned about North Carolina's Hispanic and Latino immigrants, many of whom fill essential jobs. When they share with him their fears about the vaccine, he said, it's important that he can explain in Spanish how it works.

"I think it's crucial that the Health Department, that the policy makers understand it does make a difference in a pandemic to have bilingual, bi-cultural health providers who can explain to folks in their own language, people who look like them, because that helps build trust and understanding," he said.


(c)2021 The Herald-Sun (Durham, N.C.)

McClatchy-Tribune News Service

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