NFPA Journal - May/June 2020 - 40

A responder in Germany receives a nasal swab as part of a test for coronavirus
antibodies. Worldwide, responders have experienced high levels of COVID-19
infection as a result of their exposure to coronavirus patients. GETTY IMAGES

Association of Fire Fighters (IAFF), in
mid-April, there were nearly 12,500
firefighters across North America quarantined, 700 infected, and six who had
died. The actual numbers are certainly
higher since many fire districts, including most in New York City, haven't yet
shared their data with the IAFF.
At FDNY alone, about 3,000 EMS
and fire personnel were out sick during
one stretch in early April, which represents about a quarter of the entire
EMS membership, and 17 percent of
all firefighters, according to local news
reports. All the while, the department
was setting new records almost daily
for call volume, peaking at nearly 7,000
calls per day. A typical busy day is
around 4,000 calls, according to FDNY.
Although regions in New York, Italy,
and Spain have been hit hardest in the
pandemic, as of this writing, responders
everywhere have faced degrees of the
same overwhelming challenge: how to
handle an unprecedented surge in sick
and contagious patients while dealing
with dwindling manpower and severe
shortages in supplies and critical personal protective equipment (PPE). In
the US especially, these problems have
only exacerbated longstanding concerns
about how departments are staffed,
supplied, and funded. As they await an
easing of the current pandemic, some
safety professionals are looking ahead
to what they hope can change in order
to put agencies in a better, more resilient position when the next large-scale
public health emergency hits.

"One of the main lessons so far is
that we need to lean harder on our
emergency management systems
much earlier in the process," said John
Montes, a specialist at NFPA with
extensive experience in EMS management and planning. "We need to treat
public health emergencies the same
way we treat natural disasters."

MAKING DO
WITH LESS
The sidelining of thousands of personnel just as calls skyrocketed has
wreaked havoc on an emergency
response system that, even in normal
times, is designed to operate as efficiently as possible, Montes said.
"During a disaster, we generally bring
in extra units from places around the
country to meet the need, but this thing
is so widespread that sharing resources
from unaffected areas hasn't always
been possible," he said.
As a result, departments around the
world have shifted into crisis mode,
adjusting or even discarding longtime
codified regulations and enacting
untested methods that would have
seemed unthinkable just weeks ago.
These crisis standards of care, as they're
known, have included everything from
reducing the number of personnel
required on an ambulance to extending
expired medical licenses, having doctors
screen and prioritize emergency calls,
and even refusing to bring patients
to the hospital if the situation isn't
deemed serious enough. Alternative

procedures like these have
now been implemented by
more than 80 percent of US
fire departments, according
to a survey of 400 departments conducted by the IAFF.
The changes are meant
to stretch the limited capacity as far as possible, said
Aaron Burnett, Minnesota's
state EMS director. "Some
of the regulations that are
suspended are things that
are almost considered sacrosanct-like requiring an
individual on an ambulance
to have a certification-but
this is designed to allow us to
be very nimble," Burnett explained on a
recent webinar hosted by the EMS office
of the National Highway Traffic Safety
Administration. "If regulations aren't
able to adapt to the changing situation
on the streets, those regulations can
start to become a barrier to effective
patient care and can actually get in the
way of providing and protecting the
health and safety of the citizens."
While many of these adjustments
are planned and rehearsed specifically
for such extraordinary moments, other
changes have been made unwillingly,
often out of sheer desperation. Shortages in medical-grade face masks,
gowns, and other protective gear,
for instance, have forced responders
to take risks they would never have
considered during normal operations.
Nearly everywhere, masks intended
for a single use are now being worn
for days or even weeks to extend supplies. In some places, paramedics have
resorted to sewing their own protective
gowns out of shower curtains, coats,
or rain ponchos; others are wearing
3D-printed face shields donated by
volunteers or cloth masks knitted
by church groups. Some states have
even put out guidance instructing fire
departments to wear turnout gear and
self-contained breathing apparatus
(SCBA) on COVID calls.
"We're in disaster mode," Pieter
Maes, a firefighter and emergency
medical technician with the Brussels
Fire Department in Belgium, told
NFPA Journal in late March. "We have

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NFPA Journal - May/June 2020

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