Outside a hospital’s confines, providing medical care as a first responder in the wake of COVID-19 adds another challenge — an environment that can be as infectious as the patient. Homes can be potential virus-laden incubators. And its inhabitants, even the ones who aren’t showing symptoms, can carry the disease.
“We pretty much assume every surface in the house is contaminated,” Joshua Stilley said. “We may have to get on their bed to move them, or we’re hitting the walls in their house where they’ve touched.”
Stilley oversees nearly 100 first responders as chief of MU Health Care’s Division of Emergency Services. Three members of his staff were isolated for a short time after the first COVID-19 patient death March 18, but they are back to work. The division is now fully staffed; no one is quarantined or isolated. It’s the increased precautions, ones that differ from a hospital, that Stilley attributes to keeping the workers virus-free.
MU Health Care thus far has received only a few calls for known-positive COVID-19 patients since the virus crept into Boone County in mid-March, Stilley said, and its overall numbers have remained steady. Many callers have exhibited symptoms similar to those of the coronavirus. Without a rapid screening test, first responders have to take default precautions. That can be time-consuming.
Like any health care provider, first responders don appropriate masks, goggles and gloves. Once the patient is wheeled from the ambulance and turned over to the hospital, team members evaluate the next steps by risk level.
A low-risk patient — one who doesn’t fit the typical COVID-19 symptoms — doesn’t require more than the ordinary. But a high-risk patient triggers the need for personal decontamination. First responders take off their used equipment, shower and put on fresh clothes before they go back into the field.
The ambulance also gets a different treatment. It sits open to ventilate and then is cleaned twice. The process takes the vehicles out of service for longer than normal, Stilley said. With just eight or nine ambulances available, it’s vital that people call for service only if they’re having severe COVID-19-related symptoms.
“We’re still seeing car accidents; we’re still seeing heart attacks; we’re still seeing strokes. So all of the normal stuff that happens is all going on,” Stilley said.
First responders cannot test for the virus in an ambulance, he said. Those with mild or moderate symptoms should drive themselves in for testing.
Marc Carr, administrator of emergency medical services at Boone Hospital Center, said the same: Call 911 for “threatening emergencies only.” His team is also taking more precautions during the pandemic.
“The entire look and feel of a medical call has changed for our department,” Carr wrote in a Wednesday email.
Before the pandemic, Boone’s first responders would use nitrile examination gloves, adding other protective equipment only when necessary. Now, 911 responses require surgical masks, gloves and goggles.
Boone takes the same approach as MU Health Care to ambulance decontamination and staff sanitation.
Both hospitals said Boone County Joint Communications has been good about screening those who call with potential COVID-19 symptoms. It uses call-taking software ProQA to assist dispatchers with calls.
“ProQA uses some specific questions to try to identify people who may be at risk for COVID-19 but are not diagnosed,” Stilley explained. “So then we can let our providers know that they probably need to wear their personal protective equipment when contacting the patient to keep our people safe.”
Fire and police response
The Columbia Fire Department has fielded many calls from patients with COVID-19-like symptoms, but it has responded to just one call of a known-positive patient, Assistant Fire Chief Brad Fraizer said Wednesday.
Three first responders from the department were quarantined for a week after having contact with the same COVID-19-positive patient for which Stilley’s first responders isolated. They were released Tuesday. The department is back to a full staff of 144 badged and four civilian personnel. If it were to become short-staffed, Fraizer said chief officers and members of the training and fire marshal divisions are prepared to step into 48-hour shifts.
Firefighters’ assessments during a COVID-19 call differ little from other medical calls. Three first responders work in zones — cold, warm or hot — that are associated with the distance from the patient. In a hot zone, they wear personal protective gear, place a mask on the patient and maintain a 6-foot distance unless the patient needs care that requires closer proximity.
After handling a person symptomatic for COVID-19, crew members are not allowed back on the firetruck to continue their shift until they have removed the personal protective equipment used on the call and properly decontaminated the truck. They can return to service once they sanitize all their gear and ensure their masks didn’t fail.
Fraizer and Stilley said asymptomatic COVID-19 carriers add a layer of difficulty, which points to the importance of social distancing. The virus, spread by infected droplets that come from a cough or sneeze, doesn’t always present as a debilitating disease.
“That’s why the community spread is so difficult,” Stilley said. “It’s not just people who have high fever and feel really bad that are spreading the disease; it’s people who may feel even perfectly normal.”
As first responders are on the front lines of treating COVID-19 patients, the majority of the community is following new stay-at-home orders triggered by the city and county to help “flatten the curve” of the virus’ spread.
While the MU and Columbia police departments are helping to enforce the order through April 24, their officers are in COVID-19’s crosshairs. As of Wednesday afternoon, CPD was fully staffed and had no one in quarantine. Yet, MUPD officers have been affected by the virus.
Two MUPD officers tested positive for COVID-19 on Friday, which made a dent in its 50 commissioned officer workforce. They are being treated in isolation, according to a department news release.
It also noted that Columbia/Boone County Health and Human Services is investigating the two cases to assess the risk to those the officers interacted with.
On Wednesday, spokesperson Sara Diedrich said MUPD is closely following Centers for Disease Control and Prevention recommendations. MUPD has escalated its sanitation protocols for vehicles and officers in response.
Columbia police, however, have implemented more intensive procedures. Spokesperson Brittany Hilderbrand said the department is “reducing the amount of in-person calls officers are responding to.” This includes in-person reporting and community access to the police station lobby. People can file reports online at P2C.como.gov.
To enhance police officers’ safety, service calls are screened by a supervisor who decides whether an officer should respond in person. Calls are categorized as either life threatening or not.
Life-threatening incidents include:
- Domestic violence.
- Missing persons.
- Active assaults such as a robbery, a stabbing or a fight.
- Reports of sexual assault.
- Child abuse and neglect.
Nonthreatening incidents include:
- Peace disturbances.
- Theft of motor vehicles.
- Crashes without injuries.
- Vandalism or found property.
- Traffic complaints.
Hilderbrand said in a Wednesday email that officers responding in person are required to wear respirator masks, gloves and protective eyewear. Officers put masks on anyone they arrest. And once they’ve completed the call, officers will disinfect the surfaces the person may have touched.
Officers also need to assess suspects for any COVID-19 symptoms, specifically respiratory distress, to evaluate whether they need to be hospitalized. Anyone who has been released from the Boone County Jail must contact the jail if symptoms set in.
With the rapidly changing landscape of the novel coronavirus, first responders are focusing on thorough communication.
“We’re working daily with every other emergency service provider and health care provider in Boone County,” Fraizer said. “We’re collaborating with groups by sharing information on the types of calls that we’re running, resource needs and all of our resource needs have been met, by the way.
“We are very prepared for this event.”