Commentary, Features, Fire EMS

Lessons Learned: SARS-CoV-2 and the Fire/EMS Profession

Chicago Fire Department members in masks at the funeral for Paramedic Robert Truevillian
Chicago Fire Department members in masks at the funeral for Paramedic Robert Truevillian. Photo courtesy of Tim Olk

By Tom Jenkins

It’s now common to talk about 2020 and the complications and stress it has brought to our profession and personal lives; it has had an impact on all of us. In December 2019, I watched and heard reports of the virus’s impact in China. Twitter and other social media outlets brought a glimpse of the concern and threat the virus might pose if it made its way to the United States. Infectious disease and its threat to large populations have always interested me since the anthrax scares immediately following the September 11, 2001, attacks. This virus, although not weaponized, captivated my attention early on. This experience has created some of the best and worst memories of my career. Yesterday, after a year or so of planning, worrying, collaborating, and working, I received the first dose of a vaccine. Although receiving a vaccine could seem to be the “beginning of the end,” it is important to take inventory on the items we should incorporate into our operations going forward. As with a significant fire, we would be remiss if we didn’t conduct a postincident analysis or after-action report on this pandemic. This is the first (and hopefully will be the last) widespread pandemic that we’ve encountered. It is incumbent on us to learn these lessons and integrate them into our policies, practices, and habits so that the next outbreak requires a shorter learning curve and fewer hectic decisions. Although I don’t pretend to know the complexities and particulars of every fire department, my conversations about COVID-19 and its impact on fire departments have involved firefighters from all over, from the Fire Department of New York to those in volunteer and combination departments in rural America. Here is what we should not forget.

Know Your Community

We shouldn’t think we have public education down to a science just because we do Fire Prevention Week. In the early stages of the pandemic, we watched the number of cases slowly increase in our metropolitan area (northwest Arkansas), disproportionately impacting those areas of the city that were at or below the poverty line. Additionally, it also hit our non-English-speaking communities. We recognized our  need to communicate with our Spanish-speaking population, but we also learned that we have a large population of people from the Marshall Islands. Our department knew there was a significant number of Marshallese in a neighboring city, but we were unaware that this community also began to populate our southern border. We realized we were well behind the learning curve in communicating with and helping this tight-knit, vulnerable population with their own language and customs. Early in summer, the virus outbreak affected this population the most.  

Plan Ahead

Waiting until a pandemic hits to discover that you have a population segment that requires alternative communication techniques is too late. Standard community risk reduction practices tell us that we must familiarize ourselves with the “pulse” of our community to understand its makeup, character, and risk. Knowing the people we serve at the fire station level is imperative to early public education interventions. Although we learned about the significant Marshallese population in our city as a result of the virus outbreak in their community, we won’t forget the lesson going forward. We will ensure that our public education materials are translated into their language.

Mandate PPE Use

Our department provides advanced life support ambulance service in addition to the standard services that most fire departments provide. Looking back, you would think we were better on using personal protective equipment (PPE) on calls where patients might have a respiratory-borne illness. Unfortunately, we were haphazard at best. Why did we not stockpile N95 masks in our cabinets and closets long before the coronavirus hit American soil? In the time I have been a firefighter, we have faced anthrax scares, H1N1 influenza, Ebola hemorrhagic fever, and SARS. The availability, and more importantly, the habitual use of particulate filtering masks should not have been anything new when this pandemic occurred. When I ask veteran firefighters how often they’ve worn N95 masks on calls where patients had obvious upper respiratory symptoms the most frequent answer is “almost never.” This will not work in our future.

Educate and Protect Your Firefighters

Pandemic or not, if our firefighters are our most important resource, we need to do a better job educating and protecting them from known exposures in the line of duty, including common respiratory virus and bacteria. Departments should enact policies and practices that require the use of masks on any call where respiratory exposure is a likely concern. In 1992, OSHA published the standard on blood borne pathogens requiring the use of gloves. This slowly became the rule when it came to patient contact. I remember some healthcare providers fighting this change then, but it would now seem taboo to encounter and treat a patient without this PPE. I suspect the same will be true for masks when encountering patients who might have a respiratory illness or expel respiratory droplets in the course of treatment. Rather than wait for another pandemic or a federal regulation, I submit we lead the way and protect our people better than we have in the past.

Collect and Share Data

During a pandemic, the need to track information and predict problems becomes a first-order problem. It is now common to see states and metropolitan areas regurgitating information about healthcare metrics and case statistics each day. Many fire departments have been collecting, disseminating, and interpreting various data elements to help make decisions. I have seen numerous examples of COVID-19 dashboards and other creative instruments that departments use to push information out to frontline emergency workers. This data collection effort is typically used to characterize the impact to the workforce, assess the ongoing impact to the community, and promote a presence of coordination.   

Although we should applaud these data efforts, we should acknowledge that we don’t need to wait for a pandemic to make data-driven decisions and share the information we have. Fire departments have been too data-averse for too long. Sharing information about community risk, ongoing workforce impact, and other data elements that are important should be a priority in the most normal of times–not just the stressful.

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As of this writing, according to the National Fallen Firefighters Foundation, 130 fatalities have occurred in our profession due to COVID-19. In my own state and community, the number of active cases is on the rise and our healthcare system is barely holding together. From this dark season will come lessons for all industries and professions, however, I hope that the fire service–with its tradition of adaptation and no-nonsense ingenuity–will lead the way.

Tom Jenkins is the fire chief of the Rogers (AR) Fire Department and a 22-year member of the fire service. He has a bachelor’s degree in fire protection and safety engineering from Oklahoma State University and a master’s degree in public administration from the University of Oklahoma. He is a past president of the International Association of Fire Chiefs (2017-2018) and serves on the PulsePoint Foundation Advisory Board, National Fallen Firefighters Foundation Advisory Board, and the Executive Board of the International Fire Service Training Association (IFSTA). In 2020, he was appointed to the Department of Homeland Security’s Homeland Security Advisory Council.

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