CPSE hosts a weekly forum among agencies in the CFAI accreditation process and officers that hold a CPC designation bringing together the most progressive fire and emergency service departments and officers in the world. During CPSE Exchange, attendees learn from each other.
The event is a facilitated attendee-driven info sharing session. Here is a summary of the forum held on June 10, 2020.
Has your agency implemented dispatch screening processes for COVID-19?
The Montgomery County (MD) Fire & Rescue agency considered the guidance for screening callers provided by the International Academies of Emergency Dispatch when assessing their current call handling procedures. The overarching goal was to provide current and specific information to responding field personnel as they assessed the need to wear PPE. At the outset of the pandemic, the department had a cache of PPE but, like many fire departments, it was encountering difficulty in restocking those supplies. The screening process was, in part, an effort to stretch out the existing cache of PPE until more could be purchased.
Initially, there were two screening questions, “Does anyone in the home have flu-like symptoms?” and “Has anyone in the home been diagnosed with Covid-19?”. The department is currently reviewing its initial approach to the pandemic and, in comparing the patient symptoms on arrival against their eventual diagnosis through the use of public health agency records, they have determined they missed about 50 percent of those patients with Covid-19 symptoms. In other words, the screening questions were not as effective in identifying potential Covid-19 patients as was hoped. Overall, the changes in call processing resulted in an increase of 40 seconds to the process.
The Houston (TX) Fire Department reported that it had modified its call processing process to include a question regarding recent travel by the patient.
How has COVID-19 affected HIPAA compliance in your agency?
The Houston Fire Department reported that compliance with HIPAA was not as much an issue as was the frequency of changes in the guidance issued by federal and state health agencies. This required frequent changes in the operating protocols and increased efforts to keep responders up to date with the changes. The agency’s medical director has uploaded the policies and protocols for Covid-19 response to the agency website at the following address: https://www.hfdmd.org/coronavirus-information/memorandums-documentation/
Montgomery County Fire & Rescue reported the pandemic impacted the ability of the EMS personnel to collect the signature of potentially infected patients. A larger issue for the organization, however, was the request by the collective bargaining unit (CBU) that it be informed when a unit member was exposed to a patient with a confirmed case of Covid-19. The agency eventually reached a resolution that provided the CBU with aggregated data of those cases in place of specific patient names, locations, or incident numbers.
What service delivery and clinical changes has your agency implemented due to COVID-19?
The Fairmount (CO) Fire Protection District reported the change in their culture of rapid service delivery has seen the most significant change. They explained that a response to a potential Covid-19 patient can take on the characteristics of a response to a hazardous materials incident in that units and employees respond in a measured and deliberate manner. They assess the situation, then the EMS responders form an “entry team” by wearing the appropriate level of PPE, they then access the location, and finally they assess the patient. This has required a change in the mindset of the field personnel and has required monitoring to ensure they follow the new procedures.
A second clinical impact has been the need to decontaminate the medic units on a more frequent basis. This has required finding the appropriate equipment and procedures, training the employees in the process, and monitoring compliance.
The Houston Fire Department reported it has changed its protocols to reduce, to the greatest degree possible, the frequency of contact with the patient by its responding employees.
Montgomery County Fire & Rescue reported that to keep the field responders up to date on changes to operating procedures and protocols the fire chief issued a general order requiring all employees to read the organization’s “Daily Briefing.” This was in reaction to the scope and frequency of the changes in their protocols and procedures. Follow this link to view an example: https://mcfrseidinfo.wordpress.com/
Like many fire departments that deliver EMS treat and transport services, Montgomery reported the daily request for EMS services has decreased since approximately the beginning of March 2020 and continues through today.
In the early stages of the pandemic in the United States, the department looked to the experience of the New York Fire Department (FDNY) to project the potential impact upon their existing resources. This may not have been as predictive of the eventual impact as they had hoped. During the peak rate of infections, the area hospitals were nearly overloaded. The department worked with those providers and the 9-1-1 Center was eventually given real-time access to the patient counts/bed availability. The supervisors in the Center used this information to direct transporting Montgomery County units to facilities that had the available patient capacity.
The staff is currently reviewing the steps that were taken since the inception of the pandemic to determine what worked and what did not work to provide effective services to the community.
Have any agencies implemented telemedicine type services in place of traditional EMS service?
The Houston Fire Department has had the ETHAN – Emergency Tele-Health and Navigation program in place for several years and reported that it has been invaluable over the last several months. Follow the link for more information: http://www.houstontx.gov/council/committees/pshs/20140821/ethan.pdf
What is your agency doing now to prepare for the strain on EMS services that may occur this Fall with the regular flu season coupling with a potential COVID-19 resurgence?
Montgomery County Fire & Rescue said the value of the relationships it has been able to establish with both public health agencies and local hospital staffs had a positive impact on its operations. They want to strengthen them in preparations for a second wave, should it occur. They also reported a clinical measure their field staff has reported from Covid-19 patient transports that might be a predictor for Covid-19 exposure and that is a pulse oximeter reading of less than 94 percent.
The Fairmount Fire Protection District observed that much of what they developed at the outset remains in place. The challenge for the organization is to keep them in place, in practice, and ensure the employees do not “let their guard down.