We are all familiar with the flashing lights of ambulances rushing to sites to save lives. All other vehicles give way to these teams of highly trained paramedics, emergency medical technicians (EMT), and emergency medical responders (EMR). We rely on these agencies and personnel in times of medical crises. During the pandemic, however, they have not been spared from harm.
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According to government data, an emergency medical service (EMS) is an organization that provides immediate medical care out of the hospital setting in emergencies and transports the patient to the hospital through an ambulance. The team often responds to 911 calls. An EMS team can also provide inter-facility transport from one hospital to another for critically ill patients.
There are various types of EMS agencies. Some receive funding from the federal or state government. Some are private companies that work under contract with the state or federal government. There are also non-profit organizations or charitable organizations that set up EMS agencies. Also, hospitals usually have their own EMS teams and vehicles with emergency lights.
EMR, EMT, and Paramedics
People working in EMS teams need special training and several levels of certification. The first level is the EMR, also called the first responder. They can perform basic life support (BLS) procedures such as cardiopulmonary resuscitation (CPR), spinal stabilization, and hemorrhage control.
The second level of certification is for an EMT, also called an EMT-Basic. They can do what the first responder does, plus spinal care, oxygen therapy, and defibrillation.
The third level of certification is for advanced EMT or AEMT. This has replaced what was previously called the EMT-Intermediate certification. They can do everything that the EMT-Basic does.
They can also insert intravenous lines (IV), insert intraosseous (IO) cannulation, apply continuous positive airway pressure (CPAP), do cardiac monitoring to a limited extent, and administer particular medication. This certification will be phased out in the next couple of years so that training goes directly from EMT-Basic to paramedic certification.
Paramedic licensure is the highest level needed for emergency care outside the hospital in most states in the U.S. They can perform advanced life support (ALS) beyond what the AEMT can do. That includes transcutaneous pacing for abnormally slow heart rates, needle or surgical cricothyrotomy, needle decompression of a tension pneumothorax, and intubation.
They can follow the protocols for Pre-Hospital Trauma Life Support (PHTLS), the American Heart Association (AHA) Advanced Cardiac Life Support (ACLS), and the AHA Pediatric Advanced Life Support.
The Financial and Other Impacts of COVID-19
The National Association of Emergency Medical Technicians (NAEMT) conducted a study on the impacts of the pandemic on EMS agencies. The study was conducted in April 2020, with a follow-up in April 2021. The study showed that almost 27 percent of EMS personnel had to undergo quarantine at various periods in the pandemic. Meanwhile, more than 18 percent were infected by COVID-19, and eight percent died from COVID-19 in line of duty.
Agencies reported that their personnel was fatigued, burned out, and fear COVID-19 infection. Mental health problems highlighted by suicidal ideations increased significantly. Around one-third of the volunteers in one agency quit. All these result in personnel shortages and increase the burden on the remaining staff.
The pandemic had a negative financial impact on 66 percent of EMS agencies in the U.S. In April 2020, more than 50 percent of EMS agencies in the study stated that they applied for local, state, or federal grants for pandemic-related expenses but were denied. In April 2021, the respondents reported some improvement but only 50 percent of those who applied for government funding received any.
In the meantime, EMS agencies are faced with the need to purchase medical supplies specifically for COVID-19. There are shortages in these supplies, and prices are soaring because of the high demand. Prices are driven even higher because many unscrupulous suppliers take advantage of the crisis by resorting to price gouging.
For instance, N95 mask prices already increased by more than 33 percent but increased further by 55 percent because of gouging. The cost of gloves already increased by more than 31 percent but increased further by more than 56 percent with gouging.
EMS agencies also had to respond to communities nationwide that set up their own treatment protocols for COVID-19 cases. This was necessary to allocate the limited number of hospital beds for the more serious COVID-19 cases. Most or 86 percent of the EMS agencies who provided treatment in place in communities were not reimbursed by the government for their services. They are entitled to this reimbursement with the CMS waiver.
EMS Agencies Need Help
While they continue to provide much-needed aid to the public, EMS agencies also need support from the government during the pandemic. Funding must be increased, and reimbursements must be released immediately for community-based treatment in place, community paramedicine, and the facilitation of telemedicine.