First responders brace for strain from coronavirus

EMS taking new measures amid concerns about exposure, lack of protective equipment
David Beranek (right), operation field supervisor at Metro Atlanta Ambulance Services, assists Anthony Zajac (left), clinical field supervisor at Metro Atlanta Ambulance Services, with his protective gear . (ALYSSA POINTER/ALYSSA.POINTER@AJC.COM)

David Beranek (right), operation field supervisor at Metro Atlanta Ambulance Services, assists Anthony Zajac (left), clinical field supervisor at Metro Atlanta Ambulance Services, with his protective gear . (ALYSSA POINTER/ALYSSA.POINTER@AJC.COM)

Just hours after first responders in south Fulton went into self-quarantine after being exposed to the coronavirus, Dr. James Augustine knew he needed to move urgently.

“What we can’t do during a battle is lose our forces,’’ Augustine told the AJC while on his way to address concerns of the remainder of the emergency medical crews, which he oversees as medical director in south Fulton.

Augustine is among emergency medical services practitioners who are deeply concerned about the spread of COVID-19 and its impact on crews that are the backbone of an already short-handed emergency medical response system.

If a growing number of communities lose first responders to COVID-19, there won’t be enough left to handle emergency calls of any type, resulting in a public health crisis.

» COMPLETE COVERAGE: Coronavirus in Georgia

“Each and every individual that is in our EMS system we now have to take great care of,’’ said Augustine, who has served as medical director for EMS systems in multiple states, including Florida and Ohio. “We don’t have a surplus of people that are capable of caring for our communities, especially as we begin to get a wider outbreak of this disease.”

On a national level, top EMS task forces and related organizations, such as the International Association of Fire Chiefs, of which Augustine is a member, have noted that a severe outbreak, like the one in Washington state, could put an unprecedented strain on local EMS systems.

In Georgia, many EMS agencies already are dealing with a shortage of medics, and some areas, particularly rural ones, lack enough ambulances to respond to the volume of calls they have been receiving. That adds to the risk that no one will be able to pull in enough resources to deal with an overwhelming number of cases of COVID-19.

Dr. James Augustine is medical director for some EMS agencies in south Fulton.

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If the virus spreads, first responders also could grapple with shortages of medical equipment, such as respirators, and protective equipment for their crews. Such equipment is in short supply around the country.

This week, the International Association of Fire Fighters told federal health officials that N-95 or higher respirator masks are essential for protecting the workforce and that face masks are not an acceptable alternative. "When working in an ambulance or on any emergency scene, our members should have full mobility without the concern of a mask breaking, gapping or shifting," the association wrote.

Thomas Kamplain, owner of a Covington-based EMS training program, said he has noticed on social media that EMTs and paramedics are already complaining that some employers are not providing personal protective gear, like N-95 masks, for them.

» RELATED: Firefighters who aided Fulton teacher with coronavirus are quarantined

» MORE: Coronavirus to test Georgia's chronic health gaps

“Sometimes on these ambulances, you have small, medium and large (masks), and there’s too few smalls, or something, and generally too few masks,” he said.

“What do you do if the crews and responders are sick? That’s what’s going to shut the system down when you can’t go to work because you’re sick,’’ Kamplain said. “Right now, there’s no vaccine and if you get it, you know you’re out of service for almost a month. You’re quarantined.”

Before they can return to work, three firefighters in south Fulton who were exposed to the virus last week are expected to undergo more testing. They were exposed to the virus at a school last week after aiding a teacher who had the coronavirus.

‘Job to do’

First responders told the AJC that to protect themselves, they rely heavily on the on-scene training that they receive early in their careers. That training requires that before working with patients, they assess emergency scenes and take precautions to limit threats to their personal safety.

“It’s something that is just drilled into students,” said Jerome Moore, a former paramedic who is working on his licensure to become an instructor for medics seeking certifications as advanced EMTs.

Anthony Zajac, clinical field supervisor at Metro Atlanta Ambulance Services, puts on protective gear for a demonstration of how crews will respond when transporting a patient with coronavirus. (ALYSSA POINTER/ALYSSA.POINTER@AJC.COM)

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That’s why, he and other EMS officials say, it’s so important that medics believe that EMS agencies are equipping them with proper equipment and resources to do their jobs. That kind of support will allay fears that they might have when they encounter unexpected cases of COVID-19, Moore said.

“I believe anxiety is something we all currently have,’’ Moore said. “You’re at a more heightened awareness. You’re given a warning by the government and the powers that be. Now, you’re going in with the full idea that, ‘Hey, I know this could happen.’ ”

Several emergency response agencies told the AJC said they are instituting additional safety precautions to ensure that their employees and patients are safe.

In College Park, EMS and Fire Rescue officials say they have ordered additional masks and protective gear for first responders. An extra shipment to support their inventory, they said, is expected to arrive any day.

» RELATED: Reforms aim to improve quality of EMS in Georgia

» MORE: What nurses should know about the coronavirus pandemic

They, as well as other first response agencies, told the AJC they are also conducting additional cleaning to disinfect and decontaminate rescue vehicles, as well as ambulances and ambulance equipment.

Puckett, Central and National EMS, which serves large swaths of metro Atlanta, has instituted additional screening questions for dispatchers to identify patients who exhibit symptoms or have a travel history that would expose them to cases of COVID-19.

In College Park, EMS and fire rescue officials have developed a similar questionnaire.

Some providers are now equipped with special software that enables them to identify clusters of patients who exhibit symptoms associated with the virus, based on call volumes.

An official at Gold Cross EMS told the AJC that its dispatchers are also notifying hospitals of patients with symptoms of COVID-19 who are on their way to the emergency room.

David Beranek (left), operation field supervisor at Metro Atlanta Ambulance Services, uses a germicidal disposable wipe to clean the inside of an ambulance while demonstrating how paramedics will disinfect their vehicles following a transport of a patient with coronavirus. (ALYSSA POINTER/ALYSSA.POINTER@AJC.COM)

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“We’re also going to pop a mask on a patient” if it is appropriate and the patient has symptoms of the virus, said Steve Vincent, an executive at Gold Cross in Augusta.

Metro Atlanta Ambulance Service of Marietta said that to protect medics from exposure, it has adopted additional procedures. Many medics now arrive on the scene of certain calls with N-95 masks, face-shield safety goggles, gowns and protective suits and gloves.

In addition, this week office staff in charge of billing, quality assurance and other non-medical calls in Marietta were expected to work from home, said owner Pete Quinones.

“Nobody has built up an immunity yet to this virus, and that’s the concerning part,” Quinones said.

No one at Grady Emergency Medical Services, among the state's largest ambulance providers, was available to comment on its contingency plan.

Meanwhile, Chad Black, chairman of the Georgia Emergency Medical Services Association, made it a point to emphasize that responders should be safe, if they take the necessary precautions.

“The big thing is that we don’t need to panic,’’ Black said. “We still got a job to do.”

That’s the focus of metro Atlanta area EMTs like Maddy Wetterhall. The 24-year-old is finishing up her clinicals as she obtains her licensure as an EMT-advanced, the level a medic must reach before obtaining the highest skill-level of paramedic.

Wetterhall says she’s not too worried about exposure to COVID-19.

“My personal concern for my own safety is not very high,’’ she said. “There are a lot of protocols that are in the EMS system and in the medical system that they have been updating and putting in place.”

As more information is shared about the disease, she says she can soak up more ways to protect herself and minimize exposure.

“I feel the professionals know what they’re doing,” Wetterhall said. “I trust the system they have in place.”