EMS Operational Adaptations to the COVID-19 Pandemic

ABSTRACT

Study Objectives: The COVID-19 pandemic presented new and unique challenges to EMS agencies. In the absence of a unified strategy to address COVID-19, agencies across the country made changes to routine operations to ensure provider and patient safety while providing life-saving care. We conducted a survey of EMS agencies in the United States to assess adaptations made in response to COVID-19. Method(s) A convenience sample of EMS agency leaders were provided a link to an IRB-approved survey by e-mail and/or social network. Survey results from responding agencies were analyzed using Microsoft Excel software. Result(s) Twelve survey responses were received representing agencies across six states (TX, MO, PA, WA, VA, NC). All respondents began using dispatch screening questions to identify patients with a potential COVID-19 infection. EMS call volume at the peak of local infections was somewhat or significantly reduced in all but one responding agency. Fifty-eight percent, however, reported increased call duration. Thirty-three percent reported lower than average unit staffing. Due to supply shortages, two-thirds of respondents reported often or always reusing PPE intended for single use. Oxygen delivery via nasal cannula or non-rebreather mask was unchanged in ninety-two percent of agencies, while two-thirds of agencies changed equipment for bag-valve-mask ventilation (eg addition of HEPA filtration). Only two agencies continued to use nebulized medications under standard protocols, while five ceased administration of nebulized medications entirely. Three of the five agencies which stopped using nebulized medications and the one agency which ceased use of CPAP began performing intravenous or subcutaneous beta-agonist (eg Epinephrine or Terbutaline) administration for respiratory distress. Seventy-five percent of agencies modified non-invasive positive pressure ventilation procedures. Eighty-three percent of agencies reported making significant procedural changes for endotracheal intubation while only fifty-eight percent altered their use of supraglottic airway devices. Sixty-seven percent of agencies modified cardiopulmonary resuscitation procedures. US agencies indicated that they took additional precautions when performing airway procedures such as halting or limiting certain aerosol-generating procedures (75%), limiting the number of individuals at the bedside (83%), and performing airway procedures in outdoor or well-ventilated areas (63%). Ninety-two percent of agencies began administering COVID-19 vaccinations. Conclusion(s) US EMS agencies around the country adapted their daily operations in response to COVID-19. The highly varied approaches highlight the lack of best practices or standard guidelines available for agencies to follow to mitigate safety concerns while maintaining the standard of care. Further investigation is needed to determine the clinical impact of these changes. No, authors do not have interests to disclose Copyright © 2022