Commentary, Fire EMS

COVID-19 and Firefighter Response

The fire service is an “all hazard” responder with multiple reasons we respond to those in need. From hazards, seen and unseen, rescue, hazardous materials, to service calls and medical aid. Medical aid calls for most department’s average over 70% of the total call volume. Those EMS responding departments staff their fire apparatus, aid cars or paramedic vehicles with trained and qualified staff at the basic 1st aid, EMT and EMT-P level. Some innovative departments are staffing the apparatus with mid-level practitioners at the Physician’s Assistant or Nurse Practitioner level especially when engaged in a Community Paramedic Responder program.

ALSO

WA Firefighters Quarantined as Coronavirus Deaths Increase in U.S.

What EMS Providers Need to Know about the Novel Coronavirus (2019-nCoV)

Firefighters and EMS responders now are responding into an increasingly infectious environment and with the quarantine of over 20 Kirkland (WA) firefighters after a response into a local nursing home, it’s time, again, to take infection control seriously. Many states have or are declaring a state emergency for this pandemic and your department or municipality needs to be aware of the benefit of this declaration.

For clarity and to avoid confusion the novel coronavirus is officially named SARS-CoV-2 and the disease caused by SARS-CoV-2 is officially named COVID-19.

Apparently Washington State is the U.S. epicenter of the epidemic with an increasing number of sick and several who have died originating from a local nursing home.  The numbers continue to rise with a spread across the country. Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus disease cases.

If you or patients are infected, it will look like this with symptoms that may appear 2-14 days after exposure.

  • Fever
  • Cough
  • Shortness of breath
  • Appears ill
  • Age and current medical condition of immune compromised or the elderly or frail may be contributing factors

In addition to my other occupations in fire and law, I am also a health care provider (PA-C) for over 40 years and staff a local health care clinic in Washington State a couple of days a week and see occupational injuries and sick individuals.

I take personal precautions such as masking the sick patient, washing my hands and make sure staff performs room decontamination on all contact surfaces after each patient visit, sick or not sick.

This is what happens when I see a potential sick patient in my clinic: Medical front office staff does the initial evaluation at the front desk of the course of illness, travel to an affected area and symptoms. A mask is placed on the suspected patient and the patient is brought to the back and placed in a room away from other patients. Medical staff takes a detailed history of current and past illnesses, immunizations, and any travel history to an affected are, or potential personal exposures and obtain a temperature. If the temperature is over 100 degrees and they have been ill for the past few days with a cough, malaise and high fever and after my physical evaluation, a chest X- ray and a CBC, we do a nasal swab for Flu Type A and B. If those tests come back negative, I call the King County (WA) Novel Coronavirus Call Center and present my patient to a call screener. They will make a determination based on the symptoms to order a test for Covid 19. The state and local health department will assist me to collect, store, and ship specimens appropriately. If the patient meets the criteria for more severe illness such as pneumonia with a high fever, arrangements will be made to transport the patient to a hospital with pre-notification of a patient arrival. Usually the patient drove themselves to the clinic, so they drive themselves or with family members to the hospital Emergency Department (ED) for additional testing treatment and possible quarantine. Most patients are sent home to recover with fluids, medications and are quarantined at home.

The word from our health department is for potential patients to STAY AWAY FROM THE ED and call their health care provider for treatment and direction.

As this is an evolving pandemic, those instructions may change on a frequent basis, so check with your local health department or receiving hospital to determine the best course of patient care practices if you respond to a  

We have seen numerous infectious disease outbreaks in the US that have appeared to not infect our first responders. Prevention of transmission to the responders is using the cornerstone of infectious disease protocols – handwashing, eye and respiratory protection.

Over the last 20 years we have seen a number of viruses infecting our response population to include MERS, SARS, Meningitis, TB, Type A & B Flu and other viruses and bacteria’s of all types creating infections and contagious diseases.

We are often surprised when we believe our responders get sick from contact with our patients but remember we are not always at work and we come into contact with infectious and contagious individuals in our daily activities either shopping, at the gym or school or hanging out with our friends or family.

Personal health practices are important to your health. Most of us received our childhood immunizations, but you should do an audit of what your received as a child.

Make sure you have up to date immunizations such as the:

  • Latest flu vaccine
  • Tdap (tetanus, diphtheria, pertussis)
  • MMR (measles, mumps and rubella)
  • Varicella (chickenpox if you have not had the disease as a kid)
  • Hepatitis B a three (3) series of shots with a possible booster
  • And for you senior responders Zoster (Shingles) and Pneumococcal Vaccination

The cornerstone of infection control is handwashing using soap and water or prepared alcohol based gels that we see everywhere.

If there is an obviously infected patient you are managing, wearing masks for the patient and responder is advised. We are prone to wearing gowns and gloves which remains a great idea and after transporting a sick patient, clean the transport vehicle prior to the next response.

Remember, there continues to be people who have Type A or B Flu (similar symptoms), pollen allergies, other upper respiratory illness or other respiratory illnesses. Precautions remain the same.

Do not let your guard down when approaching your next EMS call for a sick patient.

Currently, testing is delegated to the local health department as the current shortage of testing kits is limiting a broad range of distribution to local health care providers.

So, while this article could be long and protracted and for reading brevity I offer the following preventative and information tips obtained from the Centers for Disease Control and other sources.  As this is an evolving situation, please look at these sites frequently for updated information.

The CDC is advising there is currently no vaccine to prevent coronavirus disease 2019 (COVID-19). The best way to prevent illness is to avoid being exposed to this virus.

However, as a reminder, CDC always recommends everyday preventive actions to help prevent the spread of respiratory diseases, including:

  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose, and mouth.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
  • Follow CDC’s recommendations for using a facemask.
    • CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases, including COVID-19.
    • Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others. The use of facemasks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a health care facility).
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
    • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.
  • Keep your unwashed hands from your face
  • Avoid handshakes – fist and elbow bumps are back or the air “high 5” is appropriate.

When responding to your sick population, the CDC also recommends the adherence to your SOG’s and SOP’s  for your department when responding into a known or unknown infection hazard occupancy keeping in mind airborne precautions including the use of eye and respiratory protection.

Your standard precautions must assume that every person is potentially infected or colonized with a pathogen that could be transmitted to you as a health care responder or in the healthcare setting and elements of standard precautions that apply to patients with respiratory infections, including those caused by COVID-19 and attention should be paid to training on correct use, proper donning (putting on) and doffing (taking off), and disposal of any PPE.

Your fire station could be an incubator for infectious or contagious diseases so make sure you clean your station and your apparatus on a daily or after each response basis.

Finally, if you are sick, stay home. This will drive your employer crazy due to staffing shortages, but there is no sense taking down your entire crew by sharing your viruses. Your department needs a contingency plan for your staffing plans if there are a critical mass of sick firefighters needing to stay home for a period of time depleting your available staff.

This may be good time to review and update your mobilization plans.

Endnotes

General CDC Website – https://www.cdc.gov/coronavirus/2019-ncov/index.html

Health Care Providers – https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html

High Risk Populations – https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/index.html

King County (WA) Health Department – https://www.kingcounty.gov/depts/health/communicable-diseases/disease-control/novel-coronavirus.aspx

World Health Organization – https://www.who.int/emergencies/diseases/novel-coronavirus-2019