Situation update from NYC Fire Wire on Facebook (April 4) “… at any given time, if you listen to FDNY radio, every 2 minutes or so another Engine company gives the 10-37 code 1 (DOA) or 10-99 CPR in progress. The other day, I looked up all Bronx Engine companies runs between midnight & 9am… more than half the boro did CPR or had a DOA, some companies had multiples. It is the same for all 5 boros.” Battalion Chief Simon Ressner, Battalion 57, describes his 24-hour tour last Friday for ProPublica.

The National Outlook: Current hotspots will peak in 6 or 7 days, new hotspots developing.

“The next two weeks are extraordinarily important,” said Dr. Deborah Birx, the White House’s coronavirus response coordinator during the Saturday briefing. “This is the moment to not be going to the grocery store, not going to the pharmacy, but doing everything you can to keep your family and your friends safe and that means everybody doing the six-feet distancing, washing their hands.”

Dr. Birx also said that Detroit, New York, and Louisiana — the current hot spots — will likely reach a peak in the next six to seven days, citing the Institute for Health Metrics and Evaluation’s predictions. New hot spots were emerging in Pennsylvania, Colorado and Washington, D.C.

The Agency Head Perspective: Quickly Revised Patient Care Protocols and Loosened Regulations

Aerosol concern

Patient care protocols and procedures have rapidly changed, reflecting concern that COVID-19 may spread as an aerosol instead of a droplet. While a droplet remains airborne for a few seconds, …

An aerosol is a wholly different physical state: Particles are held in the air by physical and chemical forces. Fog is an aerosol; water droplets are suspended in air. The suspended particles remain for hours or more, depending on factors such as heat and humidity. (Begley)

Organizations providing guidelines include:

• American Heart Association: Oxygenation and Ventilation of COVID-19 Patients
• The Resuscitation Academy: 10 Steps for Managing the COVID-19 pandemic.  I found Step 4 “Scout the patient” helpful.
• Centers for Disease Control and Prevention. Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19 in the United States

Staffing and Scope of Practice

Some states have allowed variances to the minimum paramedic and EMT ambulance staffing, going to a 1-and-1 configuration (NYC REMSCO). In New Jersey, the governor temporarily expands the scope of practice for Advanced Nurse Practitioners and Physician Assistants, also providing broad civil immunity to health care professionals.

No CPR Transports

Cardiac arrest patients who do not have a Return of Spontaneous Circulation (ROSC) after CPR and standardized treatment will be pronounced dead at the scene and not transported. New York City REMSCO, the organization that regulates EMS operations, made this same temporary change during the January 2011 blizzard.

In Southern California, EMS caregivers are directed to wait 5 minutes after achieving ROSC to see if the pulse will be maintained. If the pulse is lost, CPR is re-started at the scene and will continue until medical control terminates effort. Dr. Carl Chudnofsky, chair of clinical emergency medicine at the Keck School of Medicine of USC, says that 60% of the patients with ROSC will lose heart function in minutes.

CMS Waivers and Payments

The Centers for Medicare and Medicaid (CMS) provided waivers and new rules in response to the COVID-19 surge. For EMS that includes compensation when transporting to urgent care and ambulatory surgery centers – in addition to physician offices, as well as expanded telemedicine.

The View Through Company Commander’s Windshield – “A Sense of Looming Menace”

This isn’t firefighting, this feels more like the crew on a sinking ship desperately trying to load the boats while the water gets ever closer. (Chief Simon Ressner, Battalion 57 FDNY)

I was one of the thousands registered but unable to log in to watch Mike Taigman’s webinar “First Responders, Stress Management and Coronavirus” live last week. Typical of a Taigman presentation, he provides a thoughtful presentation with a rich link of resources.

Watching this 1 hour, 22-minute webinar that covers the neuroscience of resilience provides more value than anything I can write this week for EMS caregivers, firefighters, and medical providers.

Link to the webinar: https://info.lexipol.com/webinar-coronavirus-stress-management-ty

Link to the research page: https://info.lexipol.com/coronavirus-stress-management

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NYC Fire Wire Accessed April 4, 2020: https://www.facebook.com/nycfirewire/  

Ressner, S. (2020 April 5) “Dead on Arrival”: A N.Y. Fire Chief’s COVID Journal.
As New York firefighters respond to coronavirus emergency calls, an FDNY battalion chief and 9/11 survivor confronts the city’s latest mass tragedy. ProPublica. Accessed 4/5/2020: https://www.propublica.org/article/dead-on-arrival-a-ny-fire-chiefs-covid-journal

Collins, M. Fritze, J. & Jackson, D. (2020 April 4) Dr. Deborah Birx warns hotspots will see a spike in coronavirus deaths over next 6-7 days.  Washington Times.  Accessed April 4, 2020:  https://www.usatoday.com/story/news/politics/2020/04/04/coronavirus-trump-pence-birx-warn-jump-deaths-coming-week/2949219001/

Schleunes, A. (2020 April 3) The COVID-19 Coronavirus May Travel in Aerosols
Several studies have indicated that SARS-CoV-2 might be spread through air, but not all experts are convinced. The-Scientist.com Accessed April 4, 2002: https://www.the-scientist.com/news-opinion/the-covid-19-coronavirus-may-travel-in-aerosols-67380

Service, R. F. (2020 April 2) You may be able to spread coronavirus just by breathing, new report finds. Science. Accessed April 4, 2020: https://www.sciencemag.org/news/2020/04/you-may-be-able-spread-coronavirus-just-breathing-new-report-finds 

Begley, Sharon (2020 March 16) The new coronavirus can likely remain airborne for some time. That doesn’t mean we’re doomed. STAT. Accessed April 4, 2020: https://www.statnews.com/2020/03/16/coronavirus-can-become-aerosol-doesnt-mean-doomed/

American Heart Association (2020 April 3) Oxygenation and Ventilation of COVID-19 Patients.  Accessed April 4, 2020: https://cpr.heart.org/en/resources/coronavirus-covid19-resources-for-cpr-training/oxygenation-and-ventilation-of-covid-19-patients

The Resuscitation Academy (2020 April 3) 10 Steps for Managing the COVID-19 pandemic. Accessed April 4, 2020: https://www.resuscitationacademy.org/downloads/covid19/covid.pdf

Centers for Disease Control and Prevention (2020 March 10) Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19 in the United States. Accessed April 5, 2020: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html

Marshall, L. W. & Schenker, J. (2020 April 2) Press Release: The Regional Emergency Medical Services Council of New York City, Inc. (1+1 ambulance staffing and Cardiac Arrest procedure change.) Accessed April 5, 2020: http://www.nycremsco.org/wp-content/uploads/2020/03/Press-Release-04-02-2020-Official.pdf

Ros, S. (2020 April 2) Gov. Murphy Temporarily Expands Scope of Practice for Advanced Nurse Practitioners and Physician Assistants, While Also Providing Broad Civil Immunity to Health Care Professionals Aiding With the COVID-19 Pandemic. The National Law Review. Accessed April 5, 2020: https://www.natlawreview.com/article/gov-murphy-temporarily-expands-scope-practice-advanced-nurse-practitioners-and

Mason, M. & Karlamangka, S. (2020 April 4) L.A. County tells paramedics to delay transporting cardiac patients amid coronavirus. Los Angeles Times. Accessed April 5, 2020. https://www.latimes.com/california/story/2020-04-04/l-a-county-911-patients-hospital-coronavirus

Staff (2020 March 30) Trump Administration Makes Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge (press release). CMS,gov. Centers for Medicare & Medicaid Services. Accessed April 4, 2020:  https://www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid-19

Taigman, Mike. (2020 April 2) First Responders, Stress Management, and Coronavirus. Frisco, TX: Lexipol. Accessed April 5, 2020: https://info.lexipol.com/webinar-coronavirus-stress-management-ty 

Featured Image: Ambulances line up outside the emergency entrance of the Wyckoff Heights Medical Center during the outbreak of the coronavirus disease (COVID-19) in the Brooklyn borough of New York City on Saturday. REUTERS/Andrew Kelly

Picture from Borter, Gabriella (2020 April 4) Coronavirus wreaks grimmest toll yet in New York state: 630 dead in a day. New Hampshire Union-Leader. Accessed April 4, 2020 from: https://www.unionleader.com/news/health/coronavirus/coronavirus-wreaks-grimmest-toll-yet-in-new-york-state-630-dead-in-a-day/article_b31692fe-0db7-55dc-b01c-aebbf61a088d.html