Strained Rural ME EMS Agencies Brace for Pandemic's Impact

Police, firefighters and emergency medical technicians across Maine are adapting to the heightened risk they face as coronavirus spreads, but fear they may not have enough protective gear to keep front-line workers safe.

And in rural areas, where ambulance departments were already struggling to hire enough qualified staff, the potential of emergency workers contracting the disease could leave communities with few or no responders able to answer calls for help.

“If there are too many ill people, I foresee times when we will not be able to even staff the ambulance,” said Bill Jarvis, chief of the Jackman-Moose River Fire and Rescue Department.

Under daily guidance from the federal Centers for Disease control and state emergency officials, city and town rescue and fire departments are taking steps to seal themselves off from unnecessary contact with the public, institute new practices on emergency calls and make plans for when workers do get sick or need to quarantine themselves as a precaution.

The state now recommends daily temperature monitoring of fire fighters and EMTs to catch early signs of infection. Dispatchers are asking screening questions to all callers in an effort to identify who may present symptoms and pose an extra risk. And the state is designing an algorithm to equitably distribute limited supplies of protective equipment based on the number of calls a department receives annually.

Officials are urging the public to be candid with emergency dispatchers about whether they have experienced symptoms or feel they are at a heightened risk for infection, officials say.

“We’re advertising the fact that it’s super important for us to stay healthy so we can take care of other people,” said South Portland Fire Captain Robb Couture. “It’s helpful to know what we’re walking into, and if we don’t know what we’re walking in to, we’re going to err on the side of caution.”

Departments are using protective masks, gowns, and clear plastic face shields or glasses for any emergency calls that present a heightened risk of coronavirus exposure. EMTs and firefighters are even changing how they approach patients and physically interact with people who need their help.

The changes include fire calls, as well. When in the past, four or five firefighters may have been the first group inside a building to investigate a call, now departments may send only two. In other cases, volunteer EMTs, who often respond directly to a call in their personal vehicles, will have to wait for the ambulance to arrive before contacting a patient.

Fewer first responders are entering homes before they know what risks the situation may pose. On high-risk calls, a single EMT may be responsible to make the first contact with a patient while their partner waits outside. Other departments are counseling firefighters and EMTs to ask people to come outside to meet them, or to speak first through doors and windows to assess risks. Patients may also be asked to put on a mask.

It is a delicate balance between maintaining social distancing to protect front-line workers, while also providing the intimate medical care that effective emergency response requires.

“We’re the ones coming into first contact with these cases,” said Portland Fire Chief Keith Gautreau.

Gautreau said he believes it is only a matter of time before a member of his department falls ill or has to step back to self-quarantine. He applauded his staff for adapting so quickly and for digesting huge amounts of new information each day about best practices.

In Portland, which has full-time firefighting and EMT staff, most everyone in uniform has some certification for emergency medical response, meaning a fire fighter can seamlessly step into an EMT’s role. That flexibility will become more important when staff eventually get sick, or have to attend to family or childcare needs that might prevent them from coming to work.

“My two biggest concerns are staffing … and PPE supplies,” Gautreau said Tuesday, referring to personal protective equipment. “Although we have all put the requests in (for more protective gear), we’re in the queue, or we’re in line, and the state will prioritize where they go first, second and third and so on. That’s one of the unknowns that has me a little concerned.”

Those requests are being handled by the Maine CDC, which worked with the state’s EMS department to develop a formula that will guide officials to prioritize distributing protective gear based on a department’s call volume and other attributes, said J. Sam Hurley, the dection of the Maine EMS Service, which supports various ambulance serious throughout the state.

While large departments such as Portland and South Portland stand a good chance of receiving backup supplies sooner, smaller agencies that might fall further down the list face a waiting game.

Those concerns are haunting Eddie Moreside, the director of Downeast EMS, which has nine ambulances and 45 first-responders who must cover hundreds of square miles of territory around Lubec, Eastport and coastal areas of Washington County. Moreside said last week that he’s almost drawn down his limited stock of protective equipment that was leftover from other health scares. He has no idea when the state will send him more supplies of masks, gowns and face shields.

“They keep having us fill out these surveys,” Moreside said. “I filled out three of them now, and I still ain’t seen any supplies that they said they’re going to be distributing. I ain’t seen nothing here in Washington County.”

Moreside said that during a recent visit to Bangor, he was not permitted to buy extra Clorox wipes to help disinfect ambulances after calls, and was subject to the same limits imposed by retailers on all customers, despite being in charge of an emergency agency.

While in the past Moreside’s crews would transport anyone who asked to be taken to the hospital or needed emergency care, he is instructing his staff to call ahead to hospitals and check with doctors to make sure that patients are appropriate for hospital settings. The small hospitals in Calais and Machias are already easily overwhelmed, he said.

“My outlook is it’s going to be a long, drawn out process and I don’t see any relief, from the ambulance point of view, for months. so be prepared for the long haul,” Moreside said.

At the Jackman-Moose River Fire and Rescue Department, nine EMTs use two ambulances to serve about 1,100 people who are essentially landlocked by vast forestland in all directions, said Chief Bill Jarvis.

Jarvis said his all-volunteer department is also facing another quandary: A majority of the volunteer members on both the ambulance and the fire units are over 50 years old, and some EMTs or their spouses are high-risk for COVID-19, meaning they could not respond to a call for help even if they wanted to.

Jarvis said his department’s capacity to respond to emergencies was already on the brink before coronavirus. Now, the disease is magnifying every weakness in the system.

For instance, he said, the community health center in Jackman is 75 miles from the hospital in Skowhegan where many patients are taken, and Jarvis’s staff rely on another, larger ambulance service to meet them half way to transport patients south. If that second ambulance service is not available and the local crew has to drive the whole way, it effectively sidelines half of the area’s ambulances.

There is a closer hospital, in Greenville, Jarvis said, but the roads are in such poor condition that in an area posted for 55 MPH speed limit, his driver could only go 15 MPH — “and even that might have been a little bit too fast,” he said.

And even at the destination hospitals in Greenville, Skowhegan and Lewiston, capacity limits and risks of infection to his staff may bring local ambulance service to a halt altogether, he said.

The Biddeford Fire Department is making arrangements to house EMTs who get sick or need to be quarantined away form their families.

The department has secured the use of space to accommodate up to five people and is in talks to find more beds, said Biddeford Fire Deputy Chief Kevin Duross. The department asked that the location not be published to prevent unnecessary attention and to maintain social distancing.

“We’ll be looking to have fall-backs if need be,” Duross said. “Any space that is a reasonable accommodation is absolutely under consideration.”

In some cases, the virus has already moved faster than government’s ability to respond.

In Falmouth, two EMTs were placed under home quarantine after they came into close contact with a person from the OceanView retirement community who later tested positive for coronavirus, one of the state’s earliest cases.

Falmouth Fire Chief Howard Rice Jr. said the call that generated the quarantine was not known to be coronavirus related when the EMTs responded. The patient was transported to a hospital for another, unrelated reason and did not have corona-like symptoms, but six days after the transport, the person tested positive for coronavirus, Rice said.

The EMTs were not wearing the full CDC-recommended protective equipment, but were doing fine late last week and were scheduled to return from quarantine in the coming days, Rice said.

Rice said his department had a small stock-pile of N95 masks, gowns and face shields leftover from the H1N1 flu pandemic in 2009, and has literally dusted off the old supplies in recent days.

“We’re still prepared for this to potentially to get worse,” said Rice.

Rice and other chiefs are also canceling training sessions and staff meetings, postponing public events and limiting the number of first responders who can be in a single room together at one time. Public access to police and fire stations have also been curtailed in many cities to keep the public at arm’s length.

South Portland Fire Captain Robb Couture said his department purchased about 1,000 N95 masks following the H1N1 infection, and are redistributing those reserves to fire trucks, fire stations and ambulances.

In general, as long as a first responder is wearing appropriate protective gear and maintains social distancing, they will not be considered for quarantine after handling a coronavirus-positive patient, Couture said.

Couture also highlighted a potential issue with the sharing of health information among agencies. Privacy laws prohibit sharing personal health information without express patient consent, meaning that after a department transports someone who may have the coronavirus, the department might not find out if that patient tested positive.

Police are making changes to how they conduct business, as well.

In Portland, Chief Frank Clark issued a special order to all police personnel outlining the agency’s plans. The department has confirmed one confirmed infection of a police officer, who was quarantined out of state.

Along with ordering officers to wear N95 masks, safety glasses and gloves when they interact with someone experiencing symptoms, or who believes they were exposed. Clark has outlined contingencies for handling police calls if an outbreak emerges among police ranks.

If 10 percent of essential police employees report becoming infected, all employees who are able to telecommute will be ordered to work from home, and work stations at the police station will be physically separated.

If 20 percent get sick, the department will activate its emergency staffing plan and call on specialized teams to supplement the patrol division, including calling in detectives, traffic cops and others to patrol the streets.