Due to the highly contagious nature and potentially deadly outcome of exposure to COVID-19, and the need for first responders to adequately serve the public, modifications to the standard emergency response practices need to be designed and implemented by those charged with public protection. The purpose of a streamlined procedure is to ensure that all task and tactical operations achieve the intended benefits of a competent emergency response agency and provide adequate protection for the employees as well as those they serve.
Because the public safety community has not experienced such a catastrophic event as the COVID-19 pandemic, a model of best practices does not currently exist on the numerous issues relating to the specifics of this disease including contagion, protection and prevention. Further issues related to the management of labor contracts, treatment guidelines, and psychological issues outside of the normal business of daily emergency management serve to add to the complexity of a workable solution.
For the purposes of this article I refer to first responders as those whose employment is designated as a safety member by the State of California. Specifically, I will speak to peace officers, police officers, firefighters and ocean lifeguards. These employees constitute the lion’s share of those public safety members who respond to emergencies for service via 911 call or other notification avenue. Privately employed security, emergency medical service (EMS) or other initial emergency responder may benefit from this information as well.
The understanding and nature of Novel COVID-19 virus is developing rapidly on a daily basis. Each new understanding serves to challenge previously known information and can influence the belief of the public and first response personnel that officials charged with public safety are sufficiently able to meet the demand. The larger legal, economic, and policy issues will be determined over a spectrum of time but the procedures related to emergency response and protection of the public should be focused on all of the safety related components. This includes call taking at the public safety answering point (PSAP), resource assignment, and tactical operations when arriving at the scene as well as patient treatment and transport to a hospital or other care facility.
Time, Distance, Shielding
The primary consideration of public safety operations is force protection. This is consistent with the need to have a functional force capable of performing their sworn duty to protect the public. It does not suggest that first responders will not enter into harm’s way to take a calculated risk to protect a victim from harm. There is a tenet in the hazardous materials response discipline that applies to virtually all aspects of emergency response management. Time, distance, and shielding speaks to the three components of protection to be employed when dealing with a substance, or situation of known/unknown nature that could pose a health hazard to the public or responders.
The concept of time seeks to address the influence of time of exposure to activities that are, or could be, hazardous to human health. The more time a first responder is exposed to the hazard the greater the chances of harm to that rescuer.
For firefighters the concept of time is intended to limit how long of an exposure to toxic hazardous chemical substances, or poisonous biological agents in the immediately dangerous to life & health (IDLH) environment. For a lifeguard it could include operating a water rescue in open water at night, subsurface activities, or high surf rescue operations. In law enforcement it may include a felony car stop, high risk felony search warrant, or domestic violence response for service.
Distance refers to the distance between the hazard and the rescuer. A firefighter may increase the distance from a hazardous chemical fire liberating toxic smoke, or simply increase the distance from the radiant heat from a structure fire to limit injury. A lifeguard may modify open water rescue tactics away from the surf line and choose to place a victim into a rescue boat off-shore to avoid the challenge of dragging a victim through heavy surf. A police officer, when faced with overwhelming human force may add distance between criminal subjects to buy time to consider alternative solutions.
Shielding speaks to the personal protective equipment (PPE) used and provided by an employer for the purpose of protecting the wearer from the damaging effects of a specific insult. This can be as simple as a helmet to provide some form of protection to the head, gloves providing protecting to the hand(s), boots to protect the feet, etc… Firefighters wear structural protective coats and pants for thermal protection from fire, law enforcement officers don ballistic vests to provide protection from bullets projectiles, and knife attacks, and lifeguards use a personal flotation device (PFD) to help them stay afloat in open water.
Whatever the discipline it is likely that all first responders will come into contact with people during the course and scope of their work. It is also believed that some degree of these people will be carriers of COVID-19, and some will be symptomatic and others asymptomatic. Because we believe this disease to be highly contagious significant procedures, behaviors, and policies will need to be trained, practiced, and enforced for the safety of the public and first responders.
Recent information indicates that a significant number of people are silent carriers of COVID-19 and because of this all patients will need to be treated as a potential carrier. Further, awareness on how to disinfect the protein involved in the virus should be understood by all first responders so that efficient and effective measures are developed and learned properly by those who are expected to have public contact. Additionally, the life expectancy of the virus in all mediums that first responders are expected to operate should be known and understood so that the confidence of the health & safety of the force is well established.
Standard behaviors when operating in a confined space should recognize that the COVID-19 virus can stay atomized in an unventilated environment for hours. Because of this EMS care providers should take measures that would either minimize exposure time in that environment or remove the patient to a more controlled environment such as the outdoors or inside an ambulance where the air is constantly changed.
The treatment of a patient often involves intimate contact that enhances the potential for human-to-human transmission. Because of this distance becomes impossible for the patient woman/man. However, other EMS care providers can support the person providing treatment and still maintain six feet of distance. The use of a single EMS care provider entering a home so that the entire pre-hospital medical crew is not potentially exposed may hold promise, but fails to account for the realities of where all emergency medical calls occur and a stair-step approach should be considered so as to ensure adequate scene safety for responders.
Providing proper PPE, and the consistent use of adequate protective equipment on each EMS call will be necessary to prevent the transfer of the COVID-19 virus from a known, or unknown patient. This is the only shield that we currently have to prevent human-to-human transfer via personal contact. Because the protection of the force of first responders is paramount to the safety employee these measures are necessary in the near term until effective anti-viral, vaccines, and other solutions are developed for common use.