EMS personal protective equipment (PPE) shortage – An introduction
We discussed shortages in EMS personal protective equipment (PPE) in my EMT program, but I never expected it to happen. Unfortunately, here we are, living it during the COVID-19 era.
How do we combat this? Unfortunately, we have limited options, but inventive minds have come up with some creative solutions. Many hospitals, including the one I currently work for, are partnering with large retail enterprises, such as Under Armour, and making their own PPE, such as masks.
As outlined in an article published in the Journal of Emergency Medical Services (JEMS), there are some primary ethical questions that we as EMS practitioners are facing. They include:
- What ethical duty do I have to my patients if I am not properly equipped with the right EMS PPE?
- If flagged as a high-risk group member, should I continue to work without proper EMS PPE?
- I live with someone in the high-risk group, should I continue to work without proper EMS PPE?
- If I might be spreading COVID-19 to patients, loved ones or colleagues/members of the public, should I continue to work without proper EMS PPE?
As outlined by the Centers for Disease Control and Prevention (CDC), fit-tested respirators (N-95 or higher), eye protection, a disposable gown and gloves continue to be recommended by clinicians who are caring for patients who are under investigation (PUI) for COVID-19 or are COVID-19 positive.
Ethics and legal obligations around EMS PPE
As EMS professionals, we took an oath to serve and protect. Though different from law enforcement, we came into the business to care for those who are sick and injured. When we let obstacles drive our abilities and hinder our care, we are not fulfilling those obligations.
If we do not utilize proper EMS PPE, we are going against every standing body that recommends and enforces personal protection. The CDC, the National Institute for Occupational Safety and Health (NIOSH), and state and federal governments outline how we are to protect ourselves, our families, the community and our patients from the spread of COVID-19. If we do not wear proper PPE, we are breaching proper infection control standards, opening ourselves up to civil liability.
Despite numerous regional movements, there has yet to be a national discussion about the protection of healthcare workers who refuse to act when not properly equipped. The legal ramifications are unknown and open for interpretation if someone takes this stance. This leads to a much bigger conversation that must take place before another pandemic occurs.
Our mental well-being
Making headlines recently in The New York Times is a well-respected ED physician who committed suicide amid the pandemic. Striking even closer to home for many in the EMS community, a rookie New York City EMT committed suicide less than three months into the job after working the front lines on a tactical response group that was running non-stop to areas with the highest call volumes in the city, many of which were COVID-19 related.
Only weeks before his death, the EMT was rumored to have told colleagues that he did not like the job and the death tolls from COVID-19 were weighing heavily on him.
It is strongly encouraged that we look after each other. Reach out for help and employ the Employee Assistance Programs (EAP) when needed.
Maintaining our safety among EMS PPE shortages
So how can we combat the EMS equipment/PPE shortages and stay safe at the same time? Some agencies have gotten creative. To help with this creativity and life extension of equipment, such as N-95 masks, NIOSH has released “Recommended Guidance for Extended Use and Limited Reuse of N-95 Filtering Facepiece Respirators in Healthcare Settings.” This guideline provides direction on decontamination of masks not used in “high-risk” situations where disposal is recommended. According to the NIOSH, we must dispose of N-95 masks immediately after the following scenarios:
- Aerosol-generating procedures (intubation).
- Contamination with blood, respiratory or nasal secretions, or other bodily fluids.
- Close contact with the care area of any patient co-infected with an infectious disease.
- A damaged mask or one that is hard to breathe through.
If N-95s aren’t available because of extreme shortages, what’s an equal or more qualified respirator for work with COVID-19 patients? This is where the powered air purifying respirator (PAPR) can be used. PAPRs have a battery-powered blower that extracts air through filters. When using the appropriate filter, they provide protection against the airborne particles that spread COVID-19. These devices also provide adequate protection when healthcare professionals cannot be properly fitted for an N-95 because of facial hair, facial features, etc.
This is an unprecedented time and for many in healthcare, uncharted territory. We cannot fix what happened in the past, but we can affect the future. Employ the necessary resources, be a legal aid for public health officials or other local, state or federal officials to make decisions that will impact the current state of COVID-19 and prepare our services for a bright future when another pandemic occurs.