Early in Wisconsin’s response to the COVID-19 pandemic, there were things Deer-Grove EMS was able to do to prepare, like source surgical masks.
Two months later, its staff and volunteers have come to understand that part of their job for the foreseeable future involves simply keeping up with the virus’ evolution.
“The symptoms and pathogens of this virus seem to change every day,” said Elliott Belden, a full-time paramedic with Deer-Grove, as emergency responders across the United States mark EMS week May 17-23.
Just one example in an ongoing response they admit is exhausting and different in so many ways from their normal operations: Deer-Grove in early June expects to take its protection to the next level, EMS director Eric Lang said.
About six weeks ago, the department ordered from an Illinois company, with which it already had a contract for turnout gear, 10 powered air purifying respirators (PAPRs) with 200 attachable, reusable hoods. With PAPRs, an air pump pushes filtered air around responders’ faces, protecting them from contaminated air and also keeping them cool, something that will matter as summer temperatures rise, Lang said.
Wearing a PAPR “will be less hot than an surgical mask or a face shield,” Lang said.
Each hood is good for 8-10 uses before being thrown away, he said.
Deer-Grove EMS covers the Cottage Grove and Deerfield areas, with ambulances, staff and volunteers responding from stations in both communities.
Lang said Deer-Grove has managed so far to meet one critical goal: none of its 40 members, about a quarter of whom are full-and part-time staff, with the rest paid-per-call volunteers, have gotten sick or otherwise been exposed to COVID-19 that has resulted in a missed shift.
They’ve “shown up and participated,” Lang said.
“What looks the same is the color the ambulance and the way it drives down the road and the names of the (responders) inside of it,” Lang said. “We still go out the door when the pager sounds.”
But, he said, “the way we go about our business has in many ways changed completely.”
Early on, Lang said, getting masks was a priority. Deer-Grove was able to tap into the Strategic National Stockpile for some of those, and had other sources, he said.
“We went very quickly to always wearing a surgical mask and to always putting a surgical mask on patients,” he said. “We need to protect our workforce.”
Dane County 9-1-1 dispatchers now alert emergency departments to suspected COVID-19 calls, based on new additional questions dispatchers ask callers, Lang said.
For calls that involve suspected COVID-19 symptoms like difficulty breathing, chills and fever, the PAPRs will be a game changer, Lang said.
“When we get information from the 9-1-1 Center that they suspect a COVID-19 infection, we’ll deploy these right away,” he said.
He said other steps Deer-Grove has taken include switching to hand-held, single-use nebulizers for patients who are having difficulty breathing. Breathing machines that might normally be used have been shown to push contaminated breath out from patients and into the air, more likely making responders sick, Lang said.
Ambulance crews are smaller now, typically two people instead of three in an effort to expose fewer responders.
“We’ve had to think about ‘the less people the better,’” said full-time Deer-Grove paramedic Seth Sanders.
Belden said everything is just more complicated, from assessing information being shared by 9-1-1, to suiting up, to making transport and care decisions for patients.
“There is a lot more decision-making and a lot more in-depth assessment you have to do prior to doing anything… a lot more mental gymnastics,” said Belden.
That it takes emergency responders longer to suit up now is one of many things that have been “difficult in our minds, to rationally make sense of,” Sanders said. “That is very hard, that we feel we want to explain to people… especially when someone is suffering a home health crisis. But there is no way to get around it.”
The additional gear, Deer-Grove EMS members said, protects patients and ensures that staff and volunteer responders remain healthy so they are available for future calls. They can’t afford to lose anyone, Deer-Grove EMS members say, even with recent stepped-up assurances from other area EMS departments that they would take over in the event that its department members became sick.
The broader community is trying to help.
Lang said community groups and even school districts have stepped up to keep Deer-Grove supplied. The Cottage Grove Chamber of Commerce has donated gloves and masks, local companies Paul Davis Restoration and Hydrite Chemical have donated masks and disinfecting solution and the Deerfield and Monona Grove School districts have donated disinfectant cleaner, gloves and hand sanitizer that otherwise would have gone unused after buildings were closed to classes in mid-March.
Lang said since Wisconsin went into COVID-19 lockdown in mid-March, Deer-Grove’s total number of calls hasn’t gone up, though they have definitely been transporting suspected virus-infected patients.
There have been noticeably fewer car accidents because fewer vehicles are on the roads, responders said.
There have also been fewer non-COVID medical calls, a trend that in fact is worrisome.
Concerns about being infected with COVID-19 “have caused people not to call for ambulances and to not seek treatment,” for things they might in normal times reach out to 9-1-1- about, including worsening chronic conditions, Lang said.
“People are not calling until they’re very, very sick, and sometimes beyond help,” which is a problem, Lang said.
He urged people to “call 9-1-1 and seek help when you need it,” and to “not be fearful of going to the hospital.”
Hospitals, he said, have plans in place to protect patients coming in for reasons other than COVID-19.
EMS services, too, are taking steps to ensure ambulance rides are safe for all patients, including sanitizing the interior of ambulances after every call.
Belden said just lately, he’s begun to sense a little less fear in people in non-COVID medical emergencies, and he said he expects that will get better.
“We’re getting to the point, where we realize we know more about this virus,” and how to protect people from it, than a few months ago, he said.
“Our understanding of the problem is evolving,” agreed Sanders, including how COVID-19 puts some people at higher risk for complications like stroke and heart attack.
With a local, drive-through COVID-19 testing site now set up at the Alliant Energy Center in Madison, 9-1-1 dispatchers also now havea place to send callers who are worried they’re getting sick with the coronavirus and want to be tested.
Going forward, “it will be easier,” for people in non-COVID emergencies to call 9-1-1-and to take themselves to Urgent Care, Belden said.
“I don’t want someone to go for three days having a heart attack,” Belden said. “I want you to call and get to the place that you need to be.”
Belden also said that there’s been a troubling trend during the pandemic, of 9-1-1 callers not sharing their COVID symptoms with dispatchers, again because they’re afraid of an ambulance ride and/or going to the hospital.
“If you don’t divulge that information, then we show up without the correct (protective gear) and then we worry about exposing our crew,” Belden said.
Mental health calls
Belden said 9-1-1 dispatchers are also trained to connect callers worried about something other than being sick with COVID-19, with the best resources for their personal situation.
Sometimes that might involve an ambulance trip to the hospital and sometimes it might involve tying them into mental health, domestic abuse and substance abuse counselors they can talk to on the phone.
Belden said there has been an uptick in mental health 9-1-1 calls as the pandemic has stretched on.
“Something like this always exacerbates those kinds of issues,” Sanders agreed, including potential suicides.
Some people “are definitely in a more desperate situation than they otherwise would be,” he said.
Belden said especially in people with a history of mental health struggles, that is often due to “fear of not knowing what’s going to happen in the next week, the next month, the next year. Am I going to be doing this forever?”
“I think people in general are anxious,” he said. “When you have somebody with a previous history of mental illness,” worries often only ramp up further, he said.
“It’s okay to be mad about this, and it’s okay to be stressed about this,” Belden added. “But if you feel any sort of urge to injure yourself or someone else…we can help you get in contact with someone to talk to.”
Emergency responders are not immune to that stress, Sanders said; more may seek mental health care as the pandemic goes on.
“It’s a different level of exhaustion than we have been used to dealing with,” he said. “Me personally, I can say that I am needing to step more carefully through the rest of my life…because everything is ramped up at work.”
Lang said he’s prepared for a pandemic that lasts for six months more, and that comes in multiple waves.
“History tells us, when you look for instance at the Spanish flu, that there will be not just a second spike, but maybe a third,” Lang said.
Loosening Safer-At-Home restrictions will have an impact, he said. “When we open things up more people will be exposed,” he predicted.
“We don’t know what’s going to happen through the summer,” Sanders agreed.
Eventually, though, “we will get back to some semblance of normalcy,” Belden said.
In the meantime, “we are all in this together,” Belden said. “We need to be good to each other and to be good to our neighbors, try to be kind and to look out for each other.”