They say necessity is the mother of invention, and that certainly appears to be the case for medical transport providers as their practices evolve in response to the coronavirus pandemic.
Kolby Kolbet, vice president of clinical services for medical transport company Life Link III, said he views COVID-19 as the “new universal precautions springboard” that will lead to permanent, positive changes in the industry — despite the monumental challenges it’s presented. He sees it much in the same way as the AIDS epidemic, which led to changes that remain today.
“The AIDS scare, that’s really what changed EMS to wearing gloves and goggles for if you’re going to encounter splashing or aerosolization of infectious particles,” he said. “It changed how we approach patients and how we protect ourselves. I think COVID is the new universal precautions springboard, if you will, and how we approach patients that have respiratory illness, with a fever or without a fever.”
Preventing spread, improving outcomes
The approaches to patient care and personal protection are some of the areas seeing a drastic change in the age of COVID-19, both Kolbet and Kevin Lee, manager of North Memorial Health ambulance service for the Brainerd region, said last week.
A focus on equipment to help mitigate the spread of the virus came early for both companies. It was an evening news broadcast in March that sparked an idea in Kolbet — could a space-age looking helmet used in Europe play a role in reducing coronavirus risk while transporting patients in the U.S.? Months and many hours of testing later, the Sea-Long helmet worn by COVID-19-positive patients is now part of Life Link III’s standard operating procedure when transporting those requiring oxygen.
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Kolbet, said he believes the company with several air bases in Minnesota and Wisconsin, including Brainerd, is the first in the country to utilize the helmets as part of medical transport and he hopes others follow their lead.
The helmets didn’t only increase the safety of Life Link III employees by containing respiratory droplets, Kolbet said, they’ve also shown improved outcomes for patients during transport. Of more than 30 transports during which the positive pressure helmets were used as of late November, Kolbet said all patients showed improvement in their vitals.
“All in all, we’ve been extremely impressed with how well patients do on them and how rapidly they improve with the Sea-Long helmets,” Kolbet said during a virtual interview Nov. 30. “The next rendition is to bring more exposure to it and bring more attention to it, so the hospitals can begin using the Sea-Long helmets more upon our arrival. It’s not unusual for a therapy to come from EMS (emergency medical services) into the hospital sector.”
The Sea-Long helmets are just one example of adaptation and innovation in response to COVID-19 taking place among ambulance personnel, faced with the dual challenge of preventing spread within their ranks while also caring for patients.
Lee said early on in the pandemic, North Memorial Health realized it would need to treat every patient as a potential exposure risk.
“This means that the crews wear PPE on every call, regardless of how the patient is presenting,” Lee wrote in a Dec. 1 emailed response to interview questions. “This approach has kept our crews as safe as possible.”
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Both Lee and Kolbet noted minimal impacts on staffing levels because of required quarantine for exposure or isolation for positive tests, and both said the goal is to keep it that way. As pressure has mounted on the hospital system and medical transports between facilities increased this fall, keeping crews intact is one cog in the complex machine of responding to the pandemic.
“The biggest challenge has been the wait time for COVID tests to come back,” Lee said. “Sometimes crew members miss several days of work … even if they don’t have COVID, since we have to wait for the COVID tests to come back before they can return to work.”
Kolbet said another lesson learned early on was the importance of not only wearing personal protective equipment, but doing so properly.
“COVID taught us one thing, and that’s that we really didn’t respect or truly understand how to put on or take off PPE appropriately or correctly,” Kolbet said. “You just assume that, you know what, I’m going to put this protection stuff on, it’s going to protect me, and then I’m going to take it off.”
A simulation involving luminescent powder and a black light quickly showed there was room for improvement when staff members were asked to take off the PPE following exposure.
“The black light showed how they contaminate themselves when they remove the dirty PPE,” Kolbet said. “So we changed our practice and education on that in March and April, so very early on, because we didn’t know how else to prepare for COVID other than focus on the basics.”
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About the same time this spring, facing shortages of N95 masks and other PPE, Kolbet said they looked for alternatives that wouldn’t require staff to reuse masks for multiple days. Along came the Tiger respirator mask designed for in-flight use. The masks have filters requiring changes about every 30 days, but otherwise are reusable and alleviate a lot of concern surrounding PPE availability, Kolbet said.
The Tiger masks also solved another problem — communication difficulties. Plugged into flight helmets, the masks facilitate communication between the pilot, flight nurse and paramedic on the aircraft. External speakers amplify speech from behind the mask as well.
“It allows them to talk when interacting with EMS on a scene or at a receiving hospital when you’re giving a report. It amplifies the sound so it’s not just this muffled voice and it eliminates the risk for miscommunication and misunderstanding,” Kolbet said. “The biggest thing is we want to prevent a drug error or some interruption of the communication.”
Caring for the caregivers
Equipment and patient care aren’t the only areas requiring adaptation. Both Lee and Kolbet discussed the adjustments they’ve made to support employees during this time — not only logistically but also emotionally.
“As you can imagine, working as an EMT or paramedic is a very challenging job without having to worry about COVID,” Lee wrote. “At this point, we are transporting several COVID patients every day. This adds to the stress of an already difficult job. Our team members continue to show up every day, ready to face any challenge, even though they understand they are putting themselves at risk.”
Lee said North Memorial Health recognized this additional stress early on and in response, it developed peer support groups within the ambulance division. The groups are peer-driven, according to Lee, and can access professional help when needed.
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The lakes area community has also been very supportive of personnel, he said.
“We have received donations of PPE and cleaning solution. We have also received cakes, pies, and other food. All of this is greatly appreciated,” Lee wrote.
Kolbet said ensuring the protection and safety of staff goes a long way toward providing a supportive environment to help ensure the organization can carry out its mission. No cases among employees have originated from the transport of patients, he noted, which shows the measures they’ve taken are working. But the company also played an active role in accommodating employees’ needs outside of the workplace.
“Employees need to be able to live their lives and their kids need to be able to do their sports or school or have interactions with family as their secondary caregivers, like grandpas and grandmas and aunts and uncles, during a time of homeschool,” Kolbet said. “ … Being able to help our staff achieve that balance between being able to live their lives as a professional fulfilling their career and being able to be a parent and making sure that the needs of their family are met first — that’s the challenge that we have every day.
“You always say, if you take care of your own staff, they’ll take care of your organization. … And when the mission needs to be carried out here at Life Link III, those are the same people that are fulfilling it and carrying it out.”
With vaccines inching ever closer to distribution, Kolbet and Lee both noted it offers them hope to know frontline medical staff, including their employees, will be among the first to gain its protective effects while putting themselves at risk every day.
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“We see other members of the health care community work tirelessly to take care of COVID patients,” Lee wrote. “These dedicated people work in assisted living facilities, nursing homes, clinics, and hospitals. There are also many first responders in our area that continue to respond to medical emergencies to help us care for our patients, despite the added personal risk. The Brainerd lakes area is lucky to have these great people working to make life better for the population we serve.”
CHELSEY PERKINS may be reached at 218-855-5874 or chelsey.perkins@brainerddispatch.com . Follow on Twitter at twitter.com/DispatchChelsey .
