Fire and EMS agencies across the nation have been affected by medical PPE shortages during the COVID-19 pandemic crisis. It is critical, as fire service leaders, to develop systems quickly to address logistical needs. Our department worked from a systems approach that addressed:
- Planning
- Policies and Training
- Personnel Tasking
- Supply Logistics
- Communication was instrumental in our agency addressing a severe initial shortage and building our medical PPE inventory to operationally sustainable levels
At the outset of the crisis, our agency identified a serious shortage of medical PPE that would be needed during the COVID-19 pandemic. This was exasperated by long lead times and backorders of orders placed with our regular vendors and the small quantities we received from the Strategic National Stockpile. Our team immediately began tiered contingency planning based on the anticipated PPE shortage.
Plan A operated under the assumption that we would be able to utilize full medical PPE that consisted of N95 respirators, gloves, eye/face protection, and gowns. Plan B utilized the full medical PPE of Plan A but utilized commercially available Tyvek suits instead of medical gowns due to the difficulty in acquiring medical gowns. Plan C operated under the assumption that supplies of N95 respirators, eye/face protection, gowns, and Tyvek suits were exhausted. This plan utilized gloves, SCBA face pieces with 40mm cartridge adaptors, 40mm HE/P100 cartridges, and hazardous materials level “B” suits.
COVID-19 required our team to rapidly source the best information possible and implement a host of new guidance from our state department of public health and EMS system. It is essential to utilize a team approach and working groups as checks and balances to ensure personnel feel part of the process and quality assurance. Our agency provided education, training, and policy guidance as follows:
- COVID-19 EMS Response Protocol changes to reduce potential personnel exposure and
- PPE contamination
- COVID-19 PPE Use Policy
- COVID-19 PPE Re-Use Guidance
- COVID-19 Cleaning and Disinfection of Personnel, Equipment, and Apparatus
- COVID-19 Exposure and Quarantine Protocol
Once it became evident how widespread the medical PPE shortage was nationwide, it became clear that personnel would need to be tasked with identifying PPE sources and acquiring PPE. Additional duties were assigned to our EMS Bureau Chief and Community Risk Reduction Bureau Chief, as well as utilizing personnel on light duty. This sort of personnel tasking greatly enhanced our ability to source, acquire, and track PPE for the department.
Fire departments discovered how bad the shortage of medical PPE was, and we were no different. Our PPE Supply Logistics Chain consisted of the Strategic National Stockpile, donations, procurement from our usual vendors, procurement from local businesses, and grants. As PPE had become high-demand, low-supply equipment, its accountability and tracking became critical. Establishing real-time inventory and usage of our PPE supply to calculate item burn rates aided in our logistics planning and became valuable information for an AFG grant application.
Early on, our team realized that the Strategic National Stockpile (SNS) would not address our PPE needs, so it was decided that any items received from the SNS would be considered “bonus.” Procurement and donations would be the primary means of acquiring PPE. Large orders were placed with multiple vendors under the assumption that vendors would not be able to fill our full orders and that lengthy backorders would exist.
Our department also joined with several mutual-aid departments to file a regional AFG grant application for COVID-19 related PPE expenses and new PPE acquisition. Every department should take advantage of available grant opportunities. Our personnel tasked with sourcing PPE used positive relationships with local businesses to permit our department to purchase PPE items before those items were placed for public sale. Our agency also received unsolicited donations of PPE and personnel sourced PPE through donations from non-profit organizations and nationwide commercial businesses. It is imperative to inspect the condition and age of the items with any donations, as well as suitability. Several boxes of KN95 respirators were not from CDC-approved manufacturers and were removed from our supply.
The importance of communication cannot be stressed enough during a crisis. Department personnel must know how the crisis is affecting the community, department operations, and what department leadership is doing to keep them safe. Visible leadership and a regular flow of information can go a long way to ease anxiety. Our team sends out a daily update through email to all department members with COVID-19 community statistics, the status of apparatus, personnel, and PPE. Command staff has also increased visits to fire stations to talk to personnel face to face, answer questions, and listen to suggestions. Several sources of PPE were identified from these interactions due to members having personal relationships with business owners or suppliers.
The COVID-19 pandemic crisis has become our generation’s most significant fire service challenge. Keeping our personnel safe is every chief’s priority, and PPE is a critical element. Tackling shortages head-on and with a systems-approach can be the key to success in acquiring and maintaining PPE. Eventually, the supply chain will rebound, but until then, a multifaceted approach to acquiring PPE will be needed. Our fire service has been challenged in the past and overcame those challenges. This will be no different.
Mike Mavrogeorge is the Fire Chief of Oak Lawn, Illinois, in Cook County, where he leads an agency of 69 personnel in delivering pre-hospital emergency medical care, community risk reduction, and fire protection service from three stations to a community of 60,000. He serves as the President of the IAFC Great Lakes Division. He also serves as the Vice Chair of the IAFC’s Emergency Management Committee. .