PACE ambulances

NORWAY — Coronavirus has arrived in Maine. It has come from a variety of places – first with a National Guardsman returning from overseas. Some young Mainers were exposed while in Massachusetts when they came in contact with someone else visiting from Washington state. There have been cases of “community transmission.” The number of cases started multiplying in recent days as more test kits have become available and results are provided within hours instead of days.

State officials have acted quickly, instituting safeguards and cautions for Mainers to protect themselves. Schools have closed, businesses are heeding the warnings and toilet paper has become the hottest of commodities. But even as it scrambles to prepare, Maine has held its collective breath, afraid about what it may not be able to control. What if the healthcare system gets overwhelmed?

When the report came that two paramedics in southern Maine had been directed to self-quarantine for 14 days after transporting a COVID-19 patient from his home to the hospital it seemed that fear may come true, sooner than later. There are only so many first responders, after all.

But, not so fast. Established and evolving safety protocols make it unlikely that the kind of exposure warranting the quarantine of those first responders will repeat often. Robert Hand, Chief Paramedic and Director of Paramedic Alliance for Community Emergencies (PACE) in Norway says that before leaving for every call, first responders should know if a patient is a potential risk for coronavirus.

“When calls come to us from the dispatcher, we are made aware if there is risk of infectious exposure,” Hand explained on Tuesday. “Dispatch does pre-screening about the patient’s recent travel, of their symptoms and potential previous exposure. They relay to us if the risk is positive, negative or inconclusive. Inconclusive may mean the patient may not have been able to answer or they may not have processed the question. When we hear ‘inconclusive’ we treat it as a positive risk.”

If the call indicates a positive risk, paramedics and EMTs make sure they have donned the proper protective equipment (PPE) – N95 masks and eyewear, gloves and gowns.

“We do everything we can to mitigate exposure,” said Hand. “Only one person makes the initial approach to assess the patient and he does that from a distance of six feet. Once that step is taken, other members of the team are able to start appropriate treatment.”

Hand said it’s hard to say what might have happened that made it necessary for two first responders to be quarantined after a call but that is not the normal outcome. That other rescue members at the same scene have been cleared to continue working underscores that the protocol was correct and some other factor must have been in play.

“We drill for these scenarios,” Hand said. “We practice and train for any potential situation, and that includes being overwhelmed and handling it.”

PACE, a division of Stephens Memorial Hospital, provides rescue services for at least 10 Oxford Hills communities and partial service or support for others. With a crew of close to 50 paramedics, advanced EMTs and EMTs and a total fleet of six ambulances, Hand is confident that as long as the public heeds the advice and directives of state and federal health officials that Oxford county will weather the COVID-19 pandemic effectively.

Hand says that so far the state has handled preparations for coronavirus very well. He and other Maine rescue units are receiving regular bulletins on developments and updates on protocols. The guidance PACE follows comes from the state Center for Disease Control and is filtered through officials at SMH who apply their own standards. He also receives directives from Maine’s Emergency Medical Services.

“EMS Director Sam Hurley has done an excellent job managing everything,” Hand said. “We get continual updates to improve our operations. They provide suggestions. I just received one advising to check employee temperatures as they start their shift, one more layer for monitoring even if someone feels no symptoms.”

Equipment supply is an issue that has challenged healthcare officials in other parts of the country but Oxford county rescue chiefs are preparing for that too.

“Some supplies have expiration dates, so of course we can’t maintain an excessive inventory during normal times,” Hand explained. “We are scrambling to make sure we have enough, but each state maintains a stockpile.”

Over in Oxford, Fire and Rescue Chief Paul Hewey has the same assessment.

“We may be looking at back orders for some things,” Hewey said. “But we have a decent supply and the Emergency Management Agency has been able to keep it at sufficient levels.”

Oxford is one of the region’s few fully equipped rescue departments, with a staff of 17 EMTs and two ambulances in service daily.

Oxford Rescue

“We follow the EMA’s guidelines which right now are continually updating,” said Hewey. “The codes dispatch gives on each call triggers how we respond. “We know before we leave if we will be required to suit up in full gowns and protective gear.”

The basic procedures following positive risk calls requires proper handling of disposable protective equipment (PPE), and disinfecting all other gear, ambulance and equipment. An ambulance is taken out of service for one-half to two hours to be completely decontaminated and aired out.

The newer protocols requiring distance assessment are in place for police departments as well.

“We will continue to provide assistance as Rescue requests,” said Oxford Police Captain Rickie Jack. “But we have to stand back six feet. We do have our own protective gear – masks, gloves and gowns.”

Like Hand, Hewey is confident that the ever-improving protocols issued by the CDC, EMA and EMS will help first responders from being overwhelmed by COVID-19, as has been the case in other countries and some parts in the U.S. that were heavily affected before officials were prepared to respond.

Hand noted that it’s hard to deal with the rumors that stoke fears of the pandemic.

“We heard that in Minnesota there were warnings that patients experiencing distress may not get an ambulance to respond,” Hand said. “But we’re ready to get creative if necessary. To keep infected people from exposing others at urgent care or doctors’ offices, maybe paramedics will go to those patients and treat their symptoms in their own home.”

Equipping paramedics with swab test kits may be another way to contain the spread, Hand suggested. Of course, with the kits still in short supply that is not an immediate option.

“The steps we’re going through right now, it seems too extreme to some,” said Hand. “But if people take them seriously we will be able to spread the infection rate out. Social distancing, avoiding crowds (even family crowds) will help keep COVID-19 from putting an overwhelming demand on the healthcare system. And on first responders, too.”

 


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