St. Louis-Area FDs Improvising amid PPE Shortage

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ST. LOUIS — In the coronavirus pandemic, ambulance crews scramble to calls, sometimes from patients with mild symptoms who use ambulance crews as substitutes for primary-care physicians.

Some fire departments and ambulance districts in the region are short on protective equipment. In Black Jack, paramedics and EMTs ran low on medical gowns so instead wear rain ponchos when they respond to suspected COVID-19 cases.

An ambulance district in Union, Missouri, used plastic in its five ambulances to seal off a 2-foot-square space between the driver and sick patients.

On top of that, departments have adopted time-consuming routines to keep safe: disinfecting ambulances and trucks with ultraviolet sanitizers as soon as they return, showering and tossing their clothes into a washing machine at the station house.

It's an evolving and often scary world as these first responders react to the novel coronavirus.

"It’s truly crazy. A crazy situation," said Maynard Howell, assistant chief of the Robertson Fire Protection District. "And we haven’t reached the peak yet."

The coronavirus has changed Howell's profession "drastically."

St. Louis Fire Chief Dennis Jenkerson has said that ambulance crews in the city were running to two dozen calls a day from people who think they had the coronavirus. The city is using social media to implore residents to call a medical help line if they think they were exposed to the coronavirus and to save 911 for emergencies.

"A lot of people in the city don't have general practitioners. We're it," Jenkerson told reporters recently, adding that people are becoming more anxious about symptoms. "They get a sore throat, the sniffles, they start coughing, they call us right away."

By Thursday night, the St. Louis Health Department said, the city had 565 people testing positive for the virus, 13 deaths and more than 190 people quarantined because of exposure to the virus. In the St. Louis region, including Illinois suburbs, at least 67 people with the disease have died.

The coronavirus is expected to peak in the St. Louis area in the coming days. One of a dozen infectious-disease statistical models cited by the White House is the "Chris Murray model," designed by the University of Washington's Institute for Health Metrics and Evaluation. It projects deaths per day for every state, and its projections change based on mitigating factors. The latest report, issued Wednesday, projected the peak in daily deaths in Missouri would come April 22, with 17 COVID-19 deaths on that day. (The state reported 19 deaths on April 9.)

What Jenkerson said happens sometimes in St. Louis, with people turning to ambulance crews because they lack doctors, is seen by other agencies too, although not as intensely as in the city. They said it has happened for years, to a lesser degree, before COVID-19 in poorer communities.

Michelle Mayer, chief of the Union Ambulance District in Franklin County, said her ambulance crews run on two or three calls daily for patients who have a cough or aren’t feeling well and are fearful of the coronavirus. “They just don’t have a doctor and don’t know what else to do,” Mayer said. “They're afraid they have it.”

Mayer said her crews might come into the home and have the patient speak to a doctor on the phone about the symptoms.

Crews are worried about their own safety. Mark Woolbright, who is with the International Association of Fire Fighters, said he knows of at least 10 firefighters who have tested positive for COVID-19 in the 70 fire districts, fire departments and ambulance districts he represents in St. Louis County and St. Charles County. "Everybody is at home doing OK right now," he said. Thirty-three first responders have been quarantined.

Black Jack Fire Protection District's battalion chief Dave Schmidt said none of his colleagues has contracted the virus, and they're being vigilant about staying safe. But making sure they have enough protective gear is tricky. Emergency medical responders are supposed to wear gloves, masks, gowns and eye protection when they go on any medical call where someone has flu-like symptoms or respiratory issues.

“We need gowns desperately,” he said. “And we need N95 masks.”

Schmidt said he decided to buy rain ponchos for his crew. Some agencies are rejecting ponchos that open in the front as being more susceptible to virus exposure.

“It’s either that or nothing,” he said. “It’s not like we’re wanting to use them.”

Searching for supplies

Keeping supplies in stock has been a big issue. Some departments bought equipment early on while others search for equipment in stock online, from third-party sellers and often at exorbitant prices. "It’s almost like every man for himself," said Woolbright, who is a Pattonville fire captain.

Mayer scored 1,400 of the coveted N95 masks from the state’s cache for her ambulance district. But she and other employees had to do their own legwork searching online for gowns and ended up buying 400 off-label, non-medical gowns in a pinch.

“It's just doing web searches for days, for hours, to look for stuff that looks comparable,” she said.

Howell said the Robertson district is saving supplies by having only one crew member suit up in the full protective gear on a sick call. The driver doesn't, but can don the gear in a hurry if needed. Despite that, the crews might burn through six or eight pairs of gloves on every sick call because of the cleaning process involved. Howell purchased 140 face shields from local companies and hopes his crews can wash and reuse them.

"It's fending for yourself, in a sense," Howell said.

Shortage of protective gear has been felt nationwide, and Missouri Gov. Mike Parson acknowledged delays in getting the products to first responders because of high demand. Parson said some materials -- masks, hand sanitizer and gloves -- were delivered to nine distribution points across the state Wednesday and promises more to come. State officials said they are asking 300 Missouri manufacturers to see if gear can be made in the state.

Decontaminating trucks and equipment because of the coronavirus is a time-consuming routine for paramedics and EMTs. They wipe all exposed surfaces in the patient compartment of an ambulance, use virus-fighting sprays and allow the vehicle to air dry. The ultraviolet disinfecting takes about 20 minutes. The process prolongs the time before a crew can take another call.

That's why Florissant Valley Fire Protection District announced Thursday that it was temporarily halting taking patients to hospitals that are farther away, such as in Creve Coeur or St. Charles. Because the COVID contamination cleanup is so time-consuming, Fire Chief Jason Hoevelmann said, ambulances will only be taking patients to the district's three usual destinations: Christian Hospital, Northwest Healthcare and DePaul Hospital.

Taking patients to other hospitals has turned a 30-minute trip into something that can last up to two hours because of the decontamination duties, Hoevelmann said. The fire protection district has rejected longer trips before on a rare occasion, such as in bad weather, but Hoevelmann said this time it's because of the pandemic. He said there will be a few exceptions, such as if a patient needs to go to a burn unit or pediatric hospital.

John Nowak, ambulance operations manager for MedStar EMS, said at a recent St. Clair County briefing that most people with COVID-19 symptoms drive themselves to the hospital. Some people with other ailments are avoiding a call to 911 for an illness because they are worried they will end up going to a hospital and being exposed to the virus there, Nowak said.

Others just don't want to bother busy first responders, Nowak said. On a recent night, an elderly woman called MedStar two or three days after falling in her home, Nowak said. "She had three broken ribs and was laying at home, suffering in pain, and her reasoning to me was because she did not want to put the burden on us, she knew that everybody was inundated, from the EMS to the hospitals," Nowak said.

Coronavirus calls

Statewide stay-at-home orders mean fewer people on the roads, which translates to fewer vehicle crashes. But some first responders say the sick calls are on the rise. Pattonville's overall call volume is down about 20%, the district says, because of such things as lack of commerce, vehicle traffic and sporting events. But 911 calls for people with COVID-19 symptoms now make up 80 to 85% of the EMS calls.

Howell said calls to 911 are up in his Robertson fire district, which covers parts of Hazelwood and Bridgeton. Many patients, he said, have a cough or a bit of a fever and don't know what to do. He said his crews have transported people who tested positive for COVID-19, and dispatchers have now flagged their addresses in computerized records so crews sent to those homes again know what to expect.

"I’m afraid that this is the new norm that we’re going to be facing," Howell said. "That we’re going to be dealing with on an annual basis. We’re going to have a flu season and a COVID season. Hopefully they come up with a vaccination. And what we don’t know is, will the flu season and Covid season run parallel? It’s the whole ‘what will it be?’"

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