Terrence McGregor, NRP, LP, NCEE, heads the EMS program for the Los Angeles County Fire Department.
Working with five nurses and one physician, this first responder unit monitors and tests staff for COVID-19.
They also provide contact tracing and antibody testing via finger pricks.
McGregor jumps right in to keep those tests running smoothly.
“I put on my mask, gloves, and eye protection, and primarily work with our employees at six feet away,” McGregor said. “I text them a video of how to perform the test, send them outside to cough four to five times and they swab their mouth.”
His team tests people even if they are asymptomatic, including first responders and administrative staff.
The Los Angeles County Sheriff’s Department has their own COVID-19 testing operation that’s responsible for testing their employees, McGregor said.
At the onset of the COVID-19 outbreak, the county needed to provide added support to frontline workers. To meet this need, they re-skilled and mobilized a portion of their workforce.
“In LA, after the lockdown began, a lot of personnel were transitioned into a disaster service worker role,” McGregor said, adding any public employee can make this transition. “We had to put people in non-traditional roles to meet the public’s expectation for testing.”
For example, the county assigned 100 out of 650 lifeguards to roles that supported frontline workers at public testing sites. By Memorial Day weekend, lifeguards transitioned back to keeping swimmers safe, allowing other county employees to backfill those positions.
COVID-19 testing and first responders: Oral vs. nasal swabs
In cities across the U.S., first responders use nasal swabs for COVID-19 testing. LA County, however, uses self-administered oral swabs at public drive through COVID-19 testing sites.
“We were fortunate, a startup company was already doing other types of testing and got the emergency use authorization by FDA to use a particular [oral swab] test that is outside the normal FDA approval process,” McGregor said.
Curative Inc. is the LA-based start-up responsible for scaling up production of self-administered oral swabs.
By swapping out nasal for oral swabs, McGregor said it allowed for the “rapid deployment of public testing.”
This is because the oral tests do not require special licensure to administer.
The company produces thousands of FDA-authorized kits per day and processes lab results within 24 hours.
What happens when frontline workers test positive for COVID-19?
The next step is to identity which people they have had contact with — often considered a lengthy process.
Adequate contact tracing helps slow the spread of infectious diseases like COVID-19. It’s even more important with frontline workers at greater risk of exposure and transmission. Current contact tracing guidelines developed by the CDC are nothing short of extensive.
Contact tracing and COVID-19 testing among first responders
McGregor said LA County has adapted their version of contact tracing based on CDC training guidelines. When setting up contact tracing for your internal staff, it’s important to plan the operation based on finite resources. Make sure you have enough staff, testing kits, labs, training capacity and PPE.
“We have six personnel assigned to contact tracing for our approximately 6,000 fire and EMS employees. We are not performing contact tracing for the general public, that function is performed by the Department of Public Health.”
Contract tracing becomes even more important for first responders who contract COVID-19 or suspect they’ve come in contact with a sick patient, McGregor said. And because firefighters share community spaces with their fellow comrades, contact tracing is even more important because communal living spaces can morph into breeding grounds for infectious diseases.
“When we look at a workplace exposure, especially a fire department, our personnel live together, cook together, eat together, and share common sleeping areas,” McGregor said. “So if somebody is transmitting the virus at work, they are at higher risk of transmitting the virus to another coworker, more so than contracting the disease from a patient.”
Since large fire departments are comprised of large crews or multiple companies sharing one fire station, contact tracing is extended to a fairly large group.
“With our contact tracing, we create a ring around all the people they work with and we go back 10 days from symptoms and actively monitor for 14 days from their last contact,” McGregor said.