A Bandanna and a Serape

When I started in EMS in Massachusetts in 1989, in only one of the three towns I responded in were their first responders and in that town, the fire department first responder was a single fireman in a bronco, not an engine with a four or five man crew. (For those not in EMS, a first responder is a service that responds to the scene in addition to the ambulance. In our state, first responders are typically police and fire). In Connecticut every town has a unique EMS system with a unique array or responders. In one town you will get us in the ambulance along with a police officer; in another you will get a police officer and sometimes two fire engines, the second comes if the first one doesn’t have its own paramedic.

I just went on a call in another town where I arrived at the same time as the fire engine. Four people jumped out all already wearing their N95 masks. They raced in ahead of me, and two stood around the patient when I finally made it up the two flights of stairs to the patient’s room. I did my questioning from six feet away and determined neither the patient nor I (nor the first responders) needed a mask. The caller had no fever, no dyspnea, no cough. The FD used 4 masks that we are only supposed to use then performing aerosolizing procedures on high-risk patients.   Plus for the FD to enter the house and expose themselves when the patient was able to walk out on his own power is an added danger that accumulates with entry into each home or 911 scene.

When you see a fire chief on TV begging for more N95 masks, you might want to ask him how many responders he is sending in to each call and whether or not an ambulance is also there. In the end, only the ambulance is truly essential. Someone has to take the person to the hospital. Let’s save our first responders from unnecessary exposure and save our supply of PPD so when medics have to perform procedures like intubation or giving a nebulizer, they have a better mask than a surgical mask available.

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Some say this is the PPE of the not too distant future after we have run out of masks and gowns.

 

 

 

 

 

 

 

 

A bandanna, a serape, and a gun.

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I was a bit of a first responder myself last week, working in the city fly car, which I do periodically. I responded to the fire dispatch which is usually always a minute or two before the ambulance dispatch. I cut our response times considerably, but often I just turn the call over to another medic after only being with the patient for a minute or two. If the responding ambulance is BLS, then I ride it in if it is an ALS type call. One call was for a patient with fever and respiratory distress. A supervisor told me not to respond. The response delay was only a minute  and what was the sense of getting another person exposed to a potential PPE patient, as well as having to use another body isolation kit, which we are supposed to don for clearly identified high risk patients.  And like most respiratory distress calls we are dispatched to, the person’s problem was more chronic than acute.  They transported to the hospital without lights and sirens.

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At our hospital, we sent the following advisory out:

Dispatch Modification Recommendations to Municipalities for First Responders

In an effort to reduce the exposure of emergency medical first responders, many of whom are relied upon for providing critical law enforcement and fire protection to the community, municipalities should consider the following:

Only dispatch first responders to patients when one of the following critical findings is identified:

Case Entry Questions:

Is s/he conscious? – caller answers “no”
and/or
Is s/he breathing? – caller answers “no” or indicates ineffective breathing

Key Questions:

If the patient is reported to be conscious and breathing during case entry, first responders should only be assigned
under the following circumstances:

Chest pain in anyone over 35 years of age

Difficulty breathing as a chief complaint or component of another medical or traumatic complaint

Altered level of consciousness is the chief complaint (excludes not responding appropriately when identified during key questioning; excludes “altered mental status”)

Severe hemorrhage is reported at any time

Imminent childbirth

First Responder Patient Assessment:

Limit the initial number of personnel entering the scene (area of patient contact) to one unless the situation dictates more enter the scene (e.g. cardiac arrest).

The remaining crew should stage outside the immediate scene and be ready to assist the crew member inside if requested.

Screen all patients for COVID-19 (observing 6 feet separation during initial phase), use appropriate PPE, and place a surgical mask on any patient who screens positive for COVID-19 symptoms.

Additional personnel should only enter when needed for care or extrication as requested by the primary responder.

If determined that the patient is not at imminent risk and would not benefit from care by the first responding unit, delaying patient contact may be considered when the second unit is either an ambulance or a responder of higher certification.

Patient care should never be delayed if imminent risk cannot be ruled out and/or life-saving care is needed that can be provided by the first responder (CPR, hemorrhage control, etc.).

Properly doff PPE, clean and disinfect equipment and dispose of material according to agency protocol/policy.

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Be safe everyone.

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