Some hindsight from a HEMS/Retrieval and EMS coordinator physician from northern Italy that I hope will be useful: ICU management of COVID-19 gets a lot of attention but the disease will swamp EMS and EDs first.
#Covid_19 #EMS @cliffreid @DrHowieMell @karelhabig
#Covid_19 #EMS @cliffreid @DrHowieMell @karelhabig
Once EMS is swamped you run the risk of fatalities secondary to system failures (no ambulances available for cardiac arrests ecc).
Get your EMS crews to familiarize with PPE early! Get your ambulances stocked with lots of PPE. Ensure you have an easy protocol for when to don PPE
Once the disease hit you will experience a huge increase in call volume; make sure you have the capability to increase your dispatch center and ambulance staffing levels or you risk not being able to respond to priority calls in a timely manner
At any cost avoid having emergency number (911/999) respond to calls for info or medical advice about COVID-19. We (well the politicians) made this mistake here and were literally swamped to the point to grinding to a standstill in a couple days
Keep your dispatch center staff separated from your street responding crews or you risk losing your dispatchers to mandatory quarantine after they get in contact with a positive EMS provider
If you don’t have a regional coordination center that tracks ICU beds availability start organizing it NOW. A time will come where most hospitals will be searching frantically for beds
Plan what to do if one of you referral hospital get closed down for quarantine and you need to reroute your time critical patients (STEMI, neurosurgical, stroke, trauma) to other hospitals.
Consider dedicating some ambulances to COVID-19 transfers and strip them of all that isn’t essential (for example trauma equipment) to make disinfection easier and quicker
Any ambulance that transport a patients with ILI or SARI symptoms (everyone with fever, malaise, cough, respiratory distress) will need to be decontaminated and it takes at least 30 minutes! Increase your fleet to compensate as it will reduce hourly availability of ambos
Also try to organize so that decontamination can be carried out at the hospital rather than needing to get back to stations as the ambulance won’t be available for a call until decontamination has been completed
You will have A LOT of youngish people calling in with mild symptoms. If you can, consider organizing teams of advanced practitioners (Advanced Paramedics, Nurse Practitioners) that can visit and leave these patients at home as most of these patients do just fine at home
Point of care blood gas would definitively be an asset in this scenario in deciding who you can leave at home, as well as point of care ultrasound. This way you can avoid bringing lot of patients to the ED, reducing hospital overcrowding and social contacts.
COVID-19 patients don’t fly unless with special precaution. Arrange for alternative (road) methods to transfer these patients. If you absolutely can’t avoid using helicopters, select a single asset that can have the cockpit separated from the patient compartment (AW139 can)
Keep your flight crews separated as much as possible from your health care providers or you risk having your fleet stuck on the ground
Ask your crews to avoid social contacts as much as possible as they’re essential workers and they’re impossible to replace once they get sick.
