Boston EMS Crews Seeing Dip in Calls, But Exposure Risks Still Run Very High

When Boston EMS crews respond to the various neighborhoods for an emergency, the response is just as fast as normal, but the procedures are more deliberate and more carefully conducted.

EMS Chief James Hooley told the newspaper this week that while overall calls are down, the risks for EMTs to be exposed to COVID-19 during calls is increasingly high – and they’ve taken careful measures to protect those front-line workers so they can continue to address the emergency and not fall to the sidelines with the sickness or for quarantine.

“There are definitely less calls coming in,” he said on Tuesday. “However, we started seeing a steady increase in the numbers of calls where we were treating full isolation patients. There was that change where total calls went down, but the degree of difficulty and how we’re approaching every single call is challenging. You are being a little more deliberate and looking for more information from the time they call into 9-1-1…Now, every complaint of fever, aches, shortness of breath and cough, we would identify that as suspicious and to use caution.

“With more testing now, we would know some people who are home taking care of their symptoms (for COVID-19),” he continued. “We are also getting calls from people that say they have COVID, and their doctor said to call if they feel their condition was worsening. As a consequence, we would show up at folks homes, and before we come in, we would don the complete PPE gear.”

Chief Hooley said they have had eight EMTs test positive for COVID-19, though none were hospitalized, and they have worked hard to keep those numbers down by exercising extreme caution. One has returned to work, and two more are scheduled to return in the coming week.

When EMTs showed up previously in neighborhoods, they always had gloves and the sirens and lights attracted attention to be certain. Now, however, when EMTs show up, it resembles a type a type of extreme movie scene as EMTs move to protect themselves and those in the homes they go into.

EMTs now wear gloves, facemasks, face shields, full gowns, head coverings and shoe coverings. EMTs also now provide a mask to the patient as soon as they arrive, which is a protection to themselves and to those in the home.

“It’s for their protection, but also if the patient has no symptoms and is a carrier or maybe they are downplaying what they are feeling,” he said. “Now EMTs and patients all have masks immediately. It’s a good barrier for all of us. We would take these precautions and notify the hospital…The big thing is trying to prevent people from getting sick. We want to keep those numbers (among the EMTs) down and need to keep the disruptions to patient care to a minimum.”

Certainly the numbers of calls are down, as EMTs aren’t dealing as much with routine medical calls, violence, overdose or the normal things they might do. While there is some of that, it’s not at all what it was prior to four weeks ago. He said on a typical weekday, they might get around 355 calls for service, and transport between 230 to 250 people over a 24 hour period. Three weeks ago, the transport number was down to 160, and two weeks ago it was around 170.

Last week it also went up, and the numbers of those with COVID-19 symptoms were a vast majority of the calls.

“It takes a little more preparation on every call,” he said. “As it plays out now, last week we did 192 transports. The numbers are starting to creep up – even though they aren’t what they were – but 116 of those transports were calls where somebody probably had isolated.”

EMTs are called to be aware, he said, to use their PPE on every call, to have their trucks well stocked with PPE, to wipe down their truck with disinfectant after every call and to be careful when they get off of work as they go home.

“There is a lot of disease within the community,” he said. “We could take great protections at work and five minutes after work we run and errand and bump into somebody without taking the right precautions and all the protections are for naught.”

At EMS headquarters, all the call-takers wear masks and practice social distancing, and even Chief Hooley had a mask on for a portion of the phone interview with the paper. Despite the extreme environment and the risky nature of responding to calls at homes where patients are recovering, Hooley said it hasn’t affected morale. In general, he said, EMTs are the kind that would run towards danger to help, when others might be running away from it. That said, there is worry about how long this might last, and no one has that answer.

“No one is afraid of a challenge or scared to step up,” he said. “They’ve always stepped up for a difficult extraction of an individual in a car (crash) or using a sled to get somebody up a street that is snowed in. People here are amazingly resilient at adjusting and dealing with circumstances. What’s affected morale a lot now is just knowing this is going to be a long-term event. Typically if we’re working during the worst heatwave in the summer, eventually the heat will snap. It’s the same when he had that horrible winter in 2015 with so much snow and every call was so much more difficult. You knew it would melt eventually.”

With this event, there is just no idea when it might end, or if there could be a second round this fall, and perhaps a third next winter. All of it is unknown, and Hooley said that has worn on the EMTs in the field a bit. They have a standing peer support group that was already in place, and now it has moved to an online platform and is being used, he said. Those on the front lines in the ambulances are being brave, he said, and they are also human.

“When I talk to the EMTs, their concern is mostly about timeline and how long we have to sustain this pace,” he said. “They are stepping up. Our attendance is good. We’ve had some people cancel vacations. They wanted to make sure they were available and doing their part. We have people who are very dedicated here.”

•If you call 9-1-1 for ambulance service, make sure it is an absolute emergency.

Dispatchers may ask more questions than usual, but officials said to bear with them. You will likely be asked to put on a mask, or they will give you one to put on. Callers are asked to report every symptom they have, including coughs, low fevers or general body aches. They may ask callers to put on a fresh shirt before the ambulance arrives as well. All of it is out of an abundance of caution.

They may also ask those who are able to meet them on a porch or front stoop to prevent having to go into a home if unnecessary – thus limiting exposure for the EMTs and for those in the home. They may also want patients to get on a stretcher and they will wrap patients up for safety.

All of these things will help make calls safer and quicker.

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