With the situation involving the COVID-19 outbreak changing by the hour, the International Association of Fire Chiefs (IAFC) held a briefing for fire chiefs on Monday, March 16. IAFC leaders shared information about dispatch and response protocols, personal protective equipment (PPE) recommendations, patient transport, supply chain considerations, and how the association is working with federal partners to address key concerns of fire and EMS agencies. Following are a few takeaways from the session.
What We Know
By now firefighters and EMTs can probably recite the basic COVID-19 facts, but the presenters shared a few considerations that have evolved recently or are at least worth repeating. These include:
- Dispatchers no longer need to ask whether a caller has traveled to an affected area or interacted with someone who has. Dr. James Augustine, MD, FACEP, advises that because community spread of the virus is present in nearly every state, dispatchers are better served asking callers whether they have COVID-19 or a known exposure.
- The virus is spread through droplets (not through the air), which generally don’t travel farther than 6 feet. Therefore, a safe radius for patient interaction is 6 feet. To limit exposure, when possible one provider should work within the 6-foot radius while others stay outside it until/unless they are needed.
- When interacting with a patient who has tested positive or is suspected of having COVID-19, immediately provide a surgical mask to the patient and ensure it covers their nose and mouth.
- Air circulation works in our favor. As much as possible, treat patients in open air. Dispatchers should consider telling callers to meet crews outside. EMS providers should try to increase air flow to the patient compartment, including leaving ambulance doors and windows open while transferring patients and completing reports.
- Providers conducting aerosol-generating procedures—intubation, nebulizer, throat swabs, CPAP, nasal spray, etc.—must use an N95 mask as well as wearing a gown and/or coveralls. Aerosol-generating procedures make the patient “spew” the virus, Augustine says, making additional PPE essential.
- Agencies should increase cleaning frequency of ambulances, fire stations and non-transport vehicles.
What We Need to Know
More so than the typical emergency, the challenge of COVID-19 lies in what we don’t know.
The CDC is tracking the number of cases nationwide, but less clear is the extent of the impact on the fire and emergency service. Jeff Dulin, a strategic advisor for the IAFC who oversees the National Mutual Aid System (NMAS), introduced a new tool, the Fire Department Personnel Impact Dashboard, which uses a quick questionnaire to measure the impact of COVID-19 on the fire service. Dunlin urged all fire department to fill out the questionnaire daily. Obviously, the more departments report, the better the impact assessment will be. You can view daily results here.
“What we can’t do during a battle is lose our forces.”
Another key question is where essential PPE is going to come from. Fire Chief John Sinclair, the chair of IAFC’s COVID Task Force, emphasized that PPE shortages—masks, gloves, gowns and ventilators—are already occurring. He recommends departments calculate their “burn rate”—how fast they tend to move through each piece of PPE.
“I would highly suggest you take a look at what your PPE stocks are, assess your potential burn rate, and affect your burn rate by modifying” how PPE is used, Sinclair says. Modifications include having only one provider approach the patient so that other providers don’t have to mask up until absolutely needed.
Finally, confusion swirls over when first responders need to be quarantined when they have been exposed but are asymptomatic. Sinclair noted that quarantine recommendations include a caveat for medical workers—they can continue to work, but need to wear a mask. But this guideline has not been extended to public safety personnel. As the number of cases rises dramatically nationwide, it will not be practical for all public safety personnel who come into contact with infected individuals to be quarantined.
“The IAFC, IAFF and CDC are working together to find out if there is a way that we can begin we can temporize some of the quarantine,” Sinclair says. “Our response force is fragile in many communities; we don’t have a lot of medical surge, so quarantine is going to be one of those things we have to look at. Can we have people work and take countermeasures while they’re at work if they’ve been exposed?”
What We Need to Prepare For
COVID-19 has already brought unprecedented changes to daily life, but fire and EMS personnel need to be prepared for additional changes. How personnel interact with hospital staff, for example, will likely change as more hospitals enact universal respiratory precautions. Hospitals may implement outdoor triage and limit admissions to the sickest of patients, sending milder cases home. This will result in higher call volume as COVID-19 patients who are attempting home treatment get worse or become scared and call 9-1-1.
Confusion swirls over when first responders need to be quarantined when they have been exposed but are asymptomatic.
As noted above, PPE shortages are a near certainty, meaning agencies need to get creative about how they source and use supplies. “This is new day in our use of PPE and protection of our personnel,” Augustine says. Departments will need to consider the use of expired PPE and identify alternate sources. Sinclair cited a chief in Colorado who is prepared to purchase rain gear for personnel as a substitute for gowns and hoods.
Most agencies will eventually face the need to quarantine personnel, so this too is something to plan. Where will you isolate personnel—at the fire station? In another location? Sinclair noted many hotels have excess capacity right now, making them possible quarantine locations. However, he advises involving your agency attorney when contracting with a hotel for quarantine purposes, to ensure issues of liability are worked out ahead of time. Additional considerations around quarantine of personnel include payment and medical leave options and how you’ll support mental health and logistical needs.
The Three Ps
In many ways our journey with COVID-19 and all its impacts is just beginning. While the challenges are numerous and the distractions constant, groups such as the IAFC and IAFF are doing important work to advocate for the needs of first responders and pass along essential information.
To help leaders focus, Augustine points to the “three Ps”:
- Personnel—keeping our personnel safe
- Places—protecting fire stations, testing sites, low-acuity patient care sites and hospitals
- Processes—building better processes in real time, but also when things settle down and we have an opportunity to reflect on how we can improve responses to future pandemics
To adequately protect their communities, Augustine stresses, agencies must first protect their personnel: “What we can’t do during a battle is lose our forces.”