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COVID-19 Ambulance Frontline Response
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Written by Callum Shepherd is an Aussie paramedic working with the NHS in London. He is currently a Hazardous Area Response Team Paramedic.
Hazardous Area Response Team (HART) Paramedics work under the Department of Resilience and Special Assets for United Kingdom Ambulance Services, forming the frontline of Hazardous Area Responses. HART Paramedics have additional training and qualifications in water rescue, working at height, high risk confined spaces, urban search and rescue, marrauding terrorist attacks, major incidents, breathing apparatus and chemical, biological, radiological and nuclear responses.
In early March 2020, the initial stages of COVID-19 hit London hard – London Ambulance Service had several days where over 8,000 calls were made to our control room. Service demand was at the highest it has ever been, and the public’s need for an ambulance was unprecedented. Many Londoners waited for 5 to 10 minutes for their call to even be answered by our extremely busy Emergency Operations Centre, and many patients waited hours (some over 12) to get ambulance care.
London Ambulance Service increased our Emergency Medical Dispatcher (EMD) capacity, so that more calls could be answered and triaged, and increased the number of the fleet within the service so that more ambulances could be sent. Call volume has reduced now (I purposely didn’t use the Q word), back to what we consider to be ‘normal’ – roughly 4,000 to 5,000 calls to 999 per day.
Pre-hospital ambulance care and healthcare as we know it has changed. When we arrive at a scene, we no longer just open the door and jump out of the cab of the ambulance, we spend a few minutes donning additional personal protective equipment (PPE). Current National Health Service (NHS) England’s guidance for contact with any patient during the COVID-19 pandemic includes surgical face masks (FFP2/N95), plastic apron, eye protection and gloves. For Aerosol Generating Procedures (AGPs) NHS England’s guidance is to don coveralls, face shields, eye protection, FFP3 and gloves.
Working in PPE all the time has had its challenges – the aprons that are supposed to ‘protect us’ fly up in the wind as we leave patients houses, which can contaminate our arms and face. Some ambulance clinicians are unable to achieve effective respiratory mask seals, resulting in lots of our workforce off sick. Out-of-hospital Cardiac Arrests (OHCAs) are now even more difficult to manage, as we are now doing Cardiopulmonary Resuscitation (CPR) whilst wearing essentially a coverall plastic bag. Our goggles fog up which makes cannulation and managing an airway quite difficult.
We’ve learnt a few things from this pandemic. Firstly, that people never washed their hands or used toilet paper before COVID-19. Secondly, that stockpiling household items unnecessarily creates chaos amongst the world and ultimately leaves vulnerable people without food or toiletries to stay healthy. Thirdly, that the general public’s knowledge on what we consider basic healthcare is alarmingly low. And lastly, that the government’s message to the general public to #StayHome has not been heard by many.
Our spirits are not broken, and in fact, there is a new level of comradery and care for our colleagues. The support from the general public with #ClapsForTheNHS and other appreciations has been overwhelming and makes us very proud to work in the healthcare industry. We have lost some colleagues, friends and family along the way as they have put their lives on the line doing the job they love. Unfortunately, some people have been scrutinising healthcare workers for not practising social distancing – although, I argue that it’s quite hard to do this when we work in ambulances together or at patients besides together…
So, from the frontline, we remind everyone to:
- Keep ambulances for life-threatening emergencies only – you never know when you or your family member may need one. Inappropriate calls can tie us up and we may be unable to help you or your family member who needs our care.
- Keep the emergency departments for emergencies only – there are other brilliant non-emergency treatment options such as urgent care centres, GP’s and plenty of online healthcare advice. If you have any concerns, remember to ask your friends and families – one of them might work in healthcare or have some great healthcare advice for you.
- #StayAtHome and practice #SocialDistancing. This will #FlattenTheCurve and reduce #CrossContamination. If you’re in the United Kingdom, this will help #ProtectTheNHS
- Please do not follow Donald Trump’s advice on drinking or injecting disinfectant products – this will cause you severe airway burns and gastrointestinal problems which may result in a thick plastic tube being inserted down your throat.
At the time of writing this, in-hospital COVID-19 deaths in the United Kingdom (UK) have surpassed 30,000. Unfortunately, out-of-hospital statistics are not available, as only symptomatic people and essential workers are allowed to be tested.
To check out the HART teams socials go here