You may recognize this line from the 1980 comedy "Airplane!" when Lloyd Bridge's character used it several different times about a bad habit; he quit "that week." He said it each time after another stressful event occurred while trying to solve the problem of landing a commercial aircraft. With COVID-19, I found myself jokingly saying the same thing as challenge after challenge arose concerning the pandemic.
Before the pandemic, we, like most agencies, had an infection control plan in place that addressed how to deal with suspected communicable diseases. We had the appropriate PPE on all apparatus. Our personnel had been trained on when to use and correctly wear it, and we generally followed our standard operating guideline. In most instances, masking the patient would suffice in providing protection for the patient and the provider. Occasionally, additional provider PPE needed to be worn for the more significant cases. The arrival of COVID-19 changed everything.
Due to the many unknowns associated with the virus, we relied heavily on information from the National Institutes of Health (NIH) and the Centers for Disease Control (CDC). Since the virus seemed to be easily transmitted, we adjusted our level of care and increased our use of PPE, and then watched our burn rate of PPE rapidly increase. With the worldwide pandemic and everyone following similar guidelines, the PPE shortage quickly developed, and this caused us to look at other options.
Utilizing resources from the IAFC and other agencies, we found "best practices" to decontaminate PPE to extend the life with the primary focus on N95 masks. We developed worst-case scenarios of what to use if we could no longer get any PPE, and I would have never thought that two-piece rain suits would serve in this capacity.
We also were concerned with the contamination of our medic units and the potential for contamination of our stations. To minimize medic unit contamination, a reserve medic unit was placed in service to serve as the "COVID" transport.
We stripped the unit down to the bare minimum of equipment, sealed the remaining compartments, staffed it with a single driver/operator, and sent it on all possible COVID calls. This was based on our dispatch center's information during the call-taking process in which specific COVID questions were asked of the caller.
Once on scene with the other responding units where we limited patient contact, if possible, to a single provider; if the patient was exhibiting signs and symptoms, the patient would be loaded into the COVID transport. The first provider would continue to care for the patient, and the assigned driver/operator would transport to the hospital. This allowed us to minimize the other crew members' exposure and limited vehicle and equipment exposure to a single unit. After patient care was turned over to hospital staff, the unit was immediately decontaminated, the primary provider was dropped off at their station, and the unit was placed back in service for the next call.
Decontamination of stations proved a little more challenging.
Fortunately, our building maintenance personnel had previously acquired a decontamination machine that would aerosolize a Clorox solution that could then be sprayed on hard surfaces. Since the other town facilities were closed, we borrowed the machine and then had the COVID transport go to each station at shift change and decon each station. Eventually, we were able to acquire additional machines and solutions for each station to perform decon instead of waiting for COVID transport.
As did every other agency, we implemented signs and symptoms checks for our personnel, established guidelines on handling suspected exposures, and continued to monitor the information from the CDC and NIH.
Early on, this information was sometimes changing daily, so we needed to adapt to the ever-changing situation quickly.
While we have continued many of these practices, we have adjusted some of our operations, again, based on best practices. As our COVID calls decreased, we placed the COVID transport into ready reserve status. We improved the ability to decon all apparatus, PPE, equipment, and stations. We have refined our ability to gather information to improve our situational awareness. From now on, many of these actions will remain in place as we have determined these to be the "new" best practices.
Looking back to the beginning of this pandemic in the United States, I was asked if I would "fight" it differently and what would be my top three recommendations. Hindsight is always 20/20, and there are some things that I would have done differently.
First, I would have ensured that our supply of PPE was much more robust. While we had a significant amount of PPE in reserve based on our experience from 2009, we had never considered encountering a situation where our burn rate far exceeded anything we had seen in the past. We also did not expect not to acquire the necessary PPE, so developing a Plan B on the fly was pretty challenging. This just further demonstrates the need to look at every possible situation, determine the absolute worst-case scenario, and plan appropriately.
Second, I should have listened to all of my peers about the potential significance of this situation. Early on, I read or heard about several different actions recommended in reference to PPE, decon, patient care, and most importantly, care of our members. Some of these recommendations seemed to be pretty extreme, but many came to fruition as time progressed, i.e., rain suits for PPE. Suppose I had listened to some of these "extreme" recommendations early on. In that case, we could have been better prepared and a little bit ahead of the curve as the pandemic worsened, and the overall situation deteriorated. Use any and all information you can to improve your situational awareness, and don't discard an idea because it seems too extreme.
Finally, I would have worked harder on, surprise, improving communications. We had good communications within our department, our local and state-wide departments, our hospital systems, our local and state public health agencies, and our national partners. However, there was so much information (and there still continues to be) that we found some items slipped through the cracks. Developing a more robust communications plan to receive and disseminate information will only benefit everyone in the long run. And most importantly, we need to keep our members informed every step of the way while being careful not to inundate them with too much non-relevant information.
This pandemic has challenged many of our beliefs and assumptions. As we have seen in the past, the fire and EMS service always adapt to the situation at hand.
Whether it is terrorism, active killer events, natural disasters, or pandemics, we must continue to learn from each of these to be better prepared for the next time. Yes, we all know there will be the next time, so hopefully, it won't be "that week."
Norris W. Croom III, EFO, CEMSO, CFO, is the Fire Chief for the Castle Rock (CO) Fire and Rescue Department. He's been a member of the IAFC and EMS Section since 1998 and currently serves as the International Director representing the EMS Section on the IAFC Board of Directors.