Editor's note: Find Firehouse.com's complete coverage of the COVID-19 pandemic here.
On March 13, two days after the World Health Organization declared the novel coronavirus a pandemic, senior staff from the San Diego Fire-Rescue Department held a meeting to discuss the city's emergency response.
Attendees included personnel from the department's Emergency Medical Services division, health and safety program, incident management team and representatives from American Medical Response, the private ambulance company that contracts with the city.
It started at 9 a.m. and was supposed to last an hour. Instead, it ended around 10 p.m., Battalion Chief Dave Gerboth, the incident management team's director, recalled Friday in a phone interview.
"This is the largest and most complex incident of our careers, no doubt," Gerboth said of the pandemic, noting that some of those involved in the response went to New York after 9/11 and Louisiana after Hurricane Katrina.
The day after that marathon meeting, on March 14, the Fire-Rescue Department established an incident management team — much like it would for large wild fires, mass casualty events or natural disasters — and began making changes to how firefighters and medics respond to emergencies.
Among those changes, which are ever evolving: the questions dispatchers ask every 911 caller; the questions firefighters and medics ask when they assess patients in the field; and the way first responders protect themselves, both with equipment while treating patients and with twice-daily screenings and temperature checks.
Tracy Lynn is a dispatch administrator at the Fire-Rescue Department's Emergency Command and Data Center. Lynn, whose daughter is also a dispatcher, said that since March 14, dispatchers are asking all 911 callers three sets of questions, no matter the reason for the call, to determine if the person might be positive for COVID-19.
"We ask if they have a cough, fever or muscle aches," Lynn said in a phone interview April 2. "We ask if they've been diagnosed with COVID-19 or had contact with anyone who's been diagnosed. And we ask if they're in isolation or quarantine."
Dispatchers pass those answers along to firefighters and medics, helping to inform them whether the call they're responding to might be a COVID-19 case.
Dispatchers have also recently started to ask 911 callers if they, or the person for whom they are calling, can meet the first responders outside "to avoid cross-contamination in the house," Lynn said.
Dallas Higgins is a fire captain on Engine 17 in City Heights, one of the two busiest stations in the city. He said that per Department instructions, firefighters are taking more precautions.
Gone are the days when a four-firefighter engine crew would enter a home or apartment at the beginning of a call. Now, if the patient can't meet them outside, the crew's firefighter/paramedic will enter first and begin assessing the patient, while the other three crew members maintain at least a six-foot bubble, Higgins said.
Like the dispatchers, firefighters have their own new set of questions they ask each patient, Higgins said. They want to know if the person has had flu-like symptoms, including coughing and difficulty breathing; whether they have a fever of more than 100 degrees; whether they have traveled outside of the country, or been around anyone else who has traveled internationally; and whether they're under quarantine or under suspicion of being COVID-19 positive.
"We all utilize surgical masks, gloves and glasses," Higgins said. "If we rule the patient in (as possibly having the disease), we use additional personal protective equipment — a hair net, booties and a gown."
Higgins said the approach is not unlike the one firefighters and medics have used for people with other highly infectious diseases like tuberculosis or meningitis.
"Now we're just using it more often, with more people experiencing symptoms," Higgins said.
Another big change for firefighters and medics: encouraging some patients to avoid the hospital. Beginning around the start of April, and under the guidance of the city and county medical directors, first responders are advising suspected COVID-19 patients in stable health to stay home.
"If they go in an ambulance to a hospital, they have the potential to expose themselves to the disease if they don't already have it, or expose others if they do," Higgins said. "It could also overload the emergency medical system and hospital system."
Those suspected COVID-19 patients with mild cases who are asked to stay home and self-quarantine are remotely monitored for 72 hours by members of the incident management team, according to Higgins and Gerboth.
While Higgins and the city's other firefighters are the "boots on the ground" responding to the pandemic, it's the incident management team that's making the big decisions.
That March 13 meeting happened the same day President Donald Trump declared a national emergency. At the time, there were 19 confirmed cases in San Diego County. As of Wednesday, about three and a half weeks later, there were 1,530 confirmed cases in the county, with more than half of those among city of San Diego residents, and at least 36 deaths countywide connected to the disease.
"When we first met, we started discussing the potentials, there were a lot of 'what ifs?'" Gerboth said, noting that at the time, Washington state had the nation's worst outbreak. "It was, 'What if a lot of people get sick? What if our staffing levels are challenged? How do we decontaminate? Will our normal cleansers still be effective? How will we decontaminate our firefighting breathing apparatus? If we're short on personal protective equipment, how do we respond?'"
Gerboth said that ideally, the department would have months to answer those questions, but now they're doing it on the fly. That included finding new cleaning products for the self-contained breathing apparatuses that firefighters use while battling a fire; the old cleaner did not kill viruses.
One of the newest safety directives, issued Monday, has firefighters wearing cloth masks at all times while at the station and out in public, while saving medical-grade surgical masks for use with patients, according to department spokeswoman Mónica Muñoz.
Among the other new programs or changes the incident management team has implemented across the department:
- Twice-daily screenings and temperature checks for firefighters
- Ambulances disinfected after every patient transport
- All equipment that touches a patient is disinfected
- A call-in center for emergency responders who think they may have been exposed to the coronavirus
- A system to handle and provide care for those first responders who become sick, develop symptoms or require testing
- Daily written updates distributed to the entire Fire-Rescue Department, plus daily morning briefings via a department-wide conference call
- Decontamination and disposal guidelines for personal protective equipment
- New uniform guidelines, including extra uniforms, washing uniforms multiple times per shift, and arriving and leaving work in fresh, clean civilian clothing rather than a uniform
- Social distancing in fire stations, which Gerboth called a "total cultural change" from the family-like atmosphere fire crews build by working 24-hour shifts together
Gerboth acknowledged the worldwide shortage of personal protection equipment and said that is another duty of the incident management team — to procure, by basically any means necessary, more protective gear.
"Our logistics section has members searching the planet for personal protection equipment," Gerboth said. "Every day, they're researching where we can get more."
He said, for now, the Fire-Rescue Department is keeping up with demand, but the department is weighing its options for the future, including looking into decontaminating, sterilizing and reusing equipment.
Higgins, the captain who works in City Heights, said Fire-Rescue Department management have asked them to do their best to conserve protection gear. So far there have been no shortages.
He also knows that on the front lines of the pandemic, even the best equipment might not protect him from becoming ill. As of April 2, Higgins said he knew of about 20 fellow firefighters who were COVID-19 symptomatic and quarantined.
The specter of the disease haunts even the most well-equipped firefighters and medics.
"It hangs in your mind... there's obviously that mental stress, with the potential for this to be life-threatening," Higgins said. "And the last thing we want to do is bring it home to our families ... the spread can be so rapid ... But when we have that 24-hour shift ahead of us, we just put our heads down and take care of the calls."
———
©2020 The San Diego Union-Tribune
Visit The San Diego Union-Tribune at www.sandiegouniontribune.com
Distributed by Tribune Content Agency, LLC.
