It’s April 2020. Some 1.5 million people worldwide are infected with the COVID-19 virus. Almost 84,000 people have already died from the disease. In South Africa, numbers of people who are infected, or have died from the disease, are climbing. Wash hands, stay home and stay away from other people (especially sick people) – that’s what we are told to do to protect ourselves and others.
Now, imagine a day in the life of a paramedic or other emergency medical service (EMS) practitioner at this time. Your day or night at work comprises a series of calls. Each call involves you being despatched to a scene in which someone is unwell. In many cases, the nature of the complaint is non-specific and you don’t know what to expect until you arrive on scene. Conditions on scene are often unhygienic and crowded, and may be unsafe at the best of times. Now, you have the added risk of exposure to Covid-19.
Apart from wearing basic personal protective equipment, such as mask, safety glasses, gloves and apron (if available), there is very little you can do to protect yourself. Maintaining distance from patients, and typically their families too, is not an option. Patient assessment and treatment in an outpatient setting is very hands-on and, unlike in hospitals, there is not a team of health personnel to assist.
Usually, there are only two personnel on an ambulance who must assess, treat, lift, carry, load and monitor the patient’s condition. Thereafter, one of the personnel remains in cramped conditions in the back of the ambulance (often with other patients and family members too). Patients may be bleeding, vomiting, coughing or sneezing.
Continued patient management in the back of the ambulance en route to the hospital may include intubating the patient, putting up drips, administering medication, physically restraining patients, stemming bleeding, performing CPR, manual ventilation, suctioning vomitus, turning patients laterally to prevent choking, and so on. This is typically managed by a single practitioner while her or his partner is driving. Under these conditions, self-protection against exposure to bodily fluids and airborne droplets can become extremely difficult.
On arrival at the receiving health facility, the ambulance personnel take the patient into the facility, often crowded with other sick patients, where handover to facility personnel takes place. Then, those same ambulance personnel are responsible for cleaning their ambulance (typically by wiping down surfaces) in time for the next call. And the whole process begins again.
When one speaks about “frontline” health personnel in the context of the Covid-19 epidemic, EMS practitioners are right in the front of the queue. Of all categories of health care personnel, I suspect that they are the most vulnerable to infection – or at least among the most vulnerable. It is little wonder that 20% of New York’s paramedics are currently on sick leave, mostly due to Covid-19.
At the end of each shift, the ambulance practitioner must return to her or his family – partners, children, parents and grandparents. They do so in the knowledge that there is a reasonable likelihood that they were exposed to Covid-19 (or a range of other infections), in the course of the day – and that they risk transmitting the virus to their families.
All operational health care personnel who continue to provide care under current pandemic conditions are heroes. But EMS personnel, given the exceptional conditions under which they work, deserve a special honour. To each one of you – whether basic, intermediate or advanced life support practitioners – thank you. I salute you.