911 responders using more protective gear

They’re getting more information from dispatchers; call counts are up

Emergency 911 dispatchers are asking for more information from some patients, and emergency workers are using more protective gear, as they respond to an increase in medical calls amid heightened worry about COVID-19.

“I think the fear is pretty real for everyone,” said David Mendonsa, operations supervisor for American Medical Response, which operates emergency medical services 911 ambulances in Maui County.

The police emergency dispatch center has implemented protocol to assess whether patients have signs, symptoms or risk factors for COVID-19. After the initial query about a patient, dispatchers in some cases are asking additional questions, including whether the patient has traveled outside the state and whether the patient has had contact with someone who has COVID-19, in keeping with national guidelines, officials said.

Assistant Fire Chief Michael Werner said “dispatchers are screening calls with the intent of identifying triggers that would indicate a high-risk candidate of COVID-19.”

“They have been doing an excellent job,” he said Monday.

Werner said firefighters in the field regularly deal with infectious diseases, such as meningitis, HIV, hepatitis and tuberculosis and have guidelines in place.

“However, due to this being a pandemic,” he said firefighters also are following guidelines for first responders from the Centers for Disease Control and Prevention and state Department of Health, as well as guidance from the medical director.

“It is imperative that we provide services to the community, and thus it’s imperative that we keep our firefighters healthy,” Werner said. “One of the ways we can do that is by limiting exposure.”

He said firefighters have made one change in the way they approach medical calls involving COVID-19 symptoms.

Unless a patient has any life-threatening symptoms that would require more assistance, “initial patient contact is made by sending two firefighters inside of a dwelling while two firefighters wait outside ready to assist if needed,” Werner said.

If assistance isn’t needed, the outside firefighters prepare to decontaminate the firefighters once they leave the dwelling, Werner said.

He said firefighters wear medical gloves, safety glasses or goggles and medical masks whenever blood or bodily fluid could be splashed, sprayed or become airborne.

“Gowns and face shields are worn when excessive amounts of bodily fluids are present and the risk of contact is high,” Werner said.

Asked if firefighters are reacting differently to some calls, Werner said, “The only difference is that firefighters are tuned in to the triggers that point to a high-risk COVID-19 candidate.”

The information gathered by dispatchers can help medics determine whether they need more than gloves and eye protection in treating a patient, Mendonsa said.

“When we get the initial assessment and history-taking, we try to assess how much more are we going to ramp up our personal protection,” Mendonsa said. “Yes, we are using a lot more respiratory protection.”

He said medics have expressed concerns and have been told that “if you want to take a higher protective posture, then do so.”

“That’s why we provide the equipment,” he said Monday. “Right now, we probably have been using a lot more personal protective equipment. Our normal ordering has been affected.

“Our providers are healthy. We haven’t had any exposures where we had to move them into isolation or self-monitoring. We hope that continues on.

“We’re trying to manage this crisis the best we can, and the best way is to ensure that providers are well protected.”

Medics also are providing masks to respiratory patients who could have been exposed to COVID-19.

“We have to provide the patient some kind of barrier device so they can contain their ability to contaminate,” he said. “They are more than willing to put a mask on. They don’t want to continue to spread it to family members.”

AMR has been monitoring the number of emergency medical calls, which recently increased from an average of 40 to 50 a day, Mendonsa said.

On Saturday, medics responded to 75 calls, up from 41 on a Saturday at the beginning of the month, Mendonsa said. On Sunday, there were 61 calls, compared with 43 the previous Sunday.

“The call volume has somewhat increased,” he said. “It just could be there are a lot more sick people during this time.”

Mendonsa said the call volumes in January and February were similar to the numbers for the same months last year.

Werner said “there have been a few calls of patients with flu-like symptoms where the patient’s travel history was of concern.”

“There have been a few patients who were thought to have been in direct contact with a person with COVID-19,” he said.

Mendonsa said some patients who call 911 are looking for tests to determine whether they have COVID-19. If patients don’t have symptoms, medics might suggest the patients call their private care physician rather than use ambulance service that could be needed by someone suffering from a heart attack or stroke.

“But we would like the public to know that we’re there,” Mendonsa said. “We’re supporting the mission from the Department of Health.”

* Lila Fujimoto can be reached at lfujimoto@mauinews.com.