Texas’ healthcare workers have seen their workplaces transform into de facto war zones as the global pandemic has continued to spread.
Emergency Medical Services (EMS) workers are oftentimes the first in line.
Austin EMS has 37 24-hour ambulances, nine 12-hour daytime trucks, and two day-time paramedic response units that focus outside city limits. Four of those 37 are considered “special operations” units — three of which are considered “rescue” trucks. Those rescue units have been on the frontline of this pandemic for some time now.
The Texan spoke with Phil Barquer, a clinical specialist with Austin’s Rescue Team and is also a part of the Central Texas Infectious Disease Response Unit.
All specialists first must start out in the field as a regular EMS responder. But after some time and specialized training, individuals can join these specialty units.
The department receives about 112,000 calls a year for anything ranging from cardiac arrest to a homeless person overdosing on K2.
Barquer’s unit gets dispatched to a lot of unknown situations, but ever since getting state-assigned to the Diamond Princess cases in San Antonio they’ve been on the front line of this pandemic in Texas.
“Now that we have the community-acquired spread of the disease, we’re more at-risk from getting it anywhere, not just at work,” said Barquer.
Contracting the disease not only would limit their ability to treat people who need it, if symptoms don’t develop quickly, it could be spread to their patients or colleagues unknowingly.
Selena Xie, president of the Austin Emergency Medical Services Association (EMSA), spoke with The Texan about how things have changed over the past month. “Everything has changed. We have basically recreated an entire EMS agency from scratch.”
Xie doesn’t go out on calls, but in her role as association president, she fields calls constantly and does what she can to support her members to complete their responsibilities in the safest and most efficient way possible.
Austin EMSA had its first medic test positive for coronavirus last week. Even despite all the precautions taken — such as the masks, eye shields, full-body suits, gloves, and more — this was almost bound to happen because of their outsized exposure.
“As the virus has spread into the community, all of our units are taking care of coronavirus patients rather than just the specialty units,” she continued.
Circumstances have escalated, Xie stated, from first taking care of the Diamond Princess patients at Lackland Air Force Base in San Antonio, to focusing on the few cases within the community, to now shifting care to the entire community.
“Our policies and procedures change almost every day dictating anything from what level of personal protective equipment we’re wearing to protocols for caring for patients,” she added. The department provides all the personal protective equipment (PPEs) the medics need.
Another complicating factor is the rapidly-changing body of research on the virus — there is still confusion about whether it is an airborne disease or solely a droplet-transmitted one.
According to Xie, this depends wholly upon the size of the droplets, and she stated that while it may be somewhat in between, it can be considered droplet-based. Still, the EMS workers are approaching precautions as if both are the case to be on the safe side.
“Factors like these and more are constantly in flux.”
Barquer described the high level of caution required after a shift, saying, “We must ensure the gowns are contained when removed to prevent any splash or splatter from the gown onto other surfaces that can be transmitted. It’s not as simple as pulling the gown and gloves off and throwing them in a trash bag.”
And when sanitizing their ambulances after a shift, methods are used such as the typical disinfectant wipes (known as “gross decon”) to aerosol-based methods (known as “technical decon”). Gross decon occurs after every call and technical decon is used for more serious cases, including COVID-19 calls.
Decontamination can take anywhere between 15 and 30 minutes to sufficiently sterilize the units.
When calling 911, Xie stressed how important it is to convey accurate information to the dispatcher so the correct decisions can be made on how to proceed.
If inaccuracies are conveyed, that can lead to time lost, or worse, the transmission of the disease.
For Barquer personally, the rise of the disease has stressed his personal life — not only because of his job but for his wife, who is an ER nurse.
He stressed, “The two of us both go home after a shift and wonder ‘Is today the day we’re getting sick or is it just allergies?’”
Both Barquer and his wife take their temperatures every 12 hours to monitor their health.
After his call down to San Antonio, Barquer caught the flu, but because of the similarities between that and COVID-19, it had to be initially treated as if it was the latter. He was isolated accordingly until it was determined not to be COVID-19.
“Probably 95 percent of my waking moments, I spend worrying about my staff, trying to make improvements for them,” Xie said. As the coronavirus situation has developed, Xie has been working 16-hour days.
Xie continued, “For frontline staff, it has changed the way they view the job. It’s always been dangerous, but now they are some of the most at-risk and it has really changed their conduct.”
Some medics, she stated, are sleeping in campers to mitigate the chance of infecting their compromised family members.
“It has turned how we do EMS completely on its head,” Xie underscored.
More and more of Barquer’s colleagues, including himself, have been tested for COVID-19 as their exposure increases. This test, which Barquer described as painful, involves deep nostril swabs.
To the public, Barquer stressed, “Make sure you adhere to the social distancing guidelines as best you can to keep the rate of the spread down. Together with that, we’ll all get through this.”
“A lot of people are concerned that the streets are empty, but we view it as a sign of the community coming together to fight through this disease and ensure we come out stronger as a community,” he concluded.
Ever since the disease began surfacing in China, Barquer’s superior had game-planned in case it reached closer to home. This preparation has saved them countless hours adjusting to the new normal, but all the precautions in the world cannot fully prepare one for a global pandemic.
“I’m really proud of our medics for adjusting so quickly to this new world we live in,” Xie emphasized.
Mitigation is the name of the game, and Austin’s EMS has readily prepared to take this mission on.
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Brad Johnson is an Ohio native who graduated from the University of Cincinnati in 2017. He is an avid sports fan who most enjoys watching his favorite teams continue their title drought throughout his cognizant lifetime. In his free time, you may find Brad quoting Monty Python productions and trying to calculate the airspeed velocity of an unladen swallow.