Paramedic Services Week

During a health emergency such as the COVID-19 pandemic, when you call 9-1-1 a communication specialist (call taker) may ask you (the caller) a few unique and more questions than usual. While this might seem unusual and/or unnecessary, it is critically important to gather this information in ensuring the health and safety of those responding to you, like PARAMEDICS.

Why do we ask what we ask?

Most of why we ask what we ask when you call 9-1-1 is in an effort to best prepare those who are responding to your needs. Asking specific COVID-19 screening questions while the paramedics are responding to you will help understand what you are experiencing and how to best prepare and protect the patient, family members and the paramedics when they arrive.

While utilizing a (COVID-19) screening tool may add 30-60 seconds to call taking, the questions are just as important as any other interrogation questions call takers may ask. Medical Control Communication Centers (dispatch) have implemented a number of necessary protocols to focus on specific calls related to shortness of breath and general illness complaints that may require these additional screening questions.

Depending on the answers to the questions asked, the call specialist may be able to provide callers options to other non-urgent Health Information or Advice Lines if they don’t require urgent medical attention or transport to hospital.

Signs and Symptoms

Signs and Symptoms of COVID-19 may show 2-14 days after exposure. Severity of symptoms may range from mild to very severe and in many people they may have no symptoms at all. Some may not recognize their symptoms because they are similar to the cold or flu. It’s important to recognize that transmission of the virus is possible even if you are not showing any symptoms and practicing social isolation, physical distancing and proper hand washing is the best way to mitigate transmission.

Regularly experienced symptoms of COVID-19 include:

• Shortness of breath (not common in the common cold or flu)
• Cough (not common in the cold but can be present in the flu)
• Fever above 38 degrees Celsius (not common in the cold but can be present in the flu)
• Sore Throat (Sometimes evident in COVID-19 but most common in the cold)

Other symptoms are COVID-19 that are more typical in cold and flu:

• Fatigue
• Aches and Pain
• Runny nose or stuffy nose (rare)
• Headache

Children under 5 years of age may present with GI symptoms, such as:

• Diarrhea
• Vomiting

Paramedic Screening

• Communication specialist are trained to screen for these symptoms when taking any 9-1-1 call, and if any questions are answered “YES”, they will advise the paramedics to put on specialized personal protective equipment (PPE).
  • This is to protect both YOU and the PARAMEDICS who arrive to HELP YOU.
• When Paramedics arrive please do not approach them immediately, give them a few moments to put on the necessary PPE.
• Paramedics may then screen you again upon contact. Screening may differ slightly from province to province but they all require the same thing from each person asked:
  • COMPLETE HONSETY to screening questions.
  • You will be given the same high standard of care whether you screen positive or negative.
• Please give the paramedics space while they go through their screening, it will only take a couple seconds and remember, it’s for your safety as well.
  • There is NO EMERGENCY in a PANDEMIC.
• Some paramedic services have introduced infrared thermometers that can detect body temperature with no contact. This may be included in screening processes. Don’t be alarmed if a small ‘radar-looking gun-like’ device in appearance is placed towards your forehead or forehead. This type of no-touch thermometer uses infrared light to measure.

Self-Assessment Screening

In some non-urgent situations, if you or family members are not sure if you should call 9-1-1, there are self-assessment tools to help you in your decision.

Self-assessment tools are developed to help determine whether you may need further assessment for COVID-19 testing by a healthcare provider or at a local collection centre. You can complete assessments for yourself, or on behalf of someone else. Taking a self-assessment doesn’t mean you can’t still call 9-1-1 anyway, it again might help your decision.

Older people and people with a weakened immune system or underlying medical conditions are considered at higher risk of severe disease.

Note that self-assessment tools are intended for COVID-19 only. Your symptoms may not be related to COVID-19 and could require you to seek medical attention. If you are uncertain and/or feel very sick, contact your family doctor/nurse practitioner or call local non-urgent health advice lines.

COVID-19 self-assessment tool

Contact Tracing

Contact tracing is a process that is used to identify, educate and monitor individuals who have had close contact with someone who is infected with a virus. These individuals are at a higher risk of becoming infected and sharing the virus with others. Contact tracing can help the individuals understand their risk and limit further spread of the virus.

It is important that whether or not you have the virus or not at any time, you ensure you keep track of where you have been, who you have been around and where. This will help if you eventually do get exposed and carry the virus without any early symptoms and help determine how to trace your steps.

What is PPE?

It's an acronym that you've likely heard a lot in the past few week. It stands for Personal Protective Equipment, and it’s one crucial way to both stop the spread of COVID-19 and keep healthcare workers (paramedics, doctors, nurses, other caregivers) currently on the pandemic's frontlines safe.

PPE works as a barrier between an individual’s skin, mouth, nose, or eyes and viral and bacterial infections.

While there is a large diversity of PPE types that provide varying degrees of protection, they all have one thing in common, they are designed to offer a level of protection depending on the environment they may be used in.

Understanding what, when, how and why to wear any level of PPE is important to ensure misuse of it as well as protecting yourself when putting it on and off.

Why Do Paramedics (and other healthcare professionals) Need It?

Humans produce droplets in various ways (e.g. sneezing, coughing, and even talking) and these droplets vary in size. Large droplets (> 5 µm) comprise most of the volume of expelled respiratory droplets and they tend to fall rapidly to the ground (usually less than 2 meters). Droplets smaller than 5 µm are referred to as droplet nuclei and may remain suspended in the air for significant periods of time and move with air currents. Respiratory viruses, including COVID-19 viruses are usually transported in large particle droplets.

These droplets may be loaded with infectious particles and can infect another person if the bacteria/viruses contact their eyes, nose or mouth. They may also fall on surfaces and then be transferred onto someone’s hand who then rubs their eyes, nose or mouth.

Airborne transmission occurs when bacteria or viruses travel in droplet nuclei that become aerosolized. Healthy people can inhale the infectious droplet nuclei into their lungs.

COVID-19 cases and clusters demonstrate that droplet/contact transmission are the routes of transmission. The majority of cases are linked to person-to-person transmission through CLOSE contact. There is NO current evidence that COVID-19 is transmitted through airborne transmission.

How long coronaviruses -- the family of viruses that includes the one that causes COVID19 – can live on some of the surfaces you probably touch on a daily basis can vary form hours to days on surfaces like countertops and doorknobs. How long it survives depends on the material the surface is made from.

Keep in mind that researchers still have a lot to learn about the new coronavirus that causes COVID-19. For example, they don't know whether exposure to heat, cold, or sunlight affects how long it lives on surfaces. They also don’t know how much of the virus it takes to cause an infection. But remember, you’re probably more likely to catch it from being around someone who has it than from touching a contaminated surface.

Within 3hrs

• This is the most amount of time known the coronavirus can survive and remain infectious in airborne droplets.

Up to 24 Hours

• This is the amount of time it took for many researchers to find no more viable traces of the virus on cardboard and many other porous surfaces like paper and fabric.

Up to 72 Hours

• This is the amount of time coronavirus can stay active on hard, shiny surfaces like glass, countertops, plastics, play equipment, door and public transport surfaces, your phone.
• The virus does degrade over time, but you should avoid touching these surfaces in shared spaces, and if that is not possible, avoid touching your face until you can clean your hands.

How to protect yourself against this type of transmission?

• Wash your hands often, with soap and water for at least 20 seconds, especially after using the washroom or blowing your nose, coughing or sneezing; before preparing food; or after you have been in a public place. You can use hand sanitizer with at least 60 per cent alcohol if soap and water aren't available.
• Avoid touching your eyes, nose and mouth with unwashed hands.
• Clean and disinfect frequently touched surfaces daily. The surfaces that the Public Health Agency of Canada recommends cleaning most often are: toys, toilets, phones, electronics, door handles, bedside tables and television remotes. The CDC also recommends cleaning tables, light switches, countertops, desks, faucets and sinks.
• In public places, you should avoid touching surfaces. If you have to touch something, you can use disinfectant wipes to wipe off surfaces that are touched frequently by other people.

Paramedics face the unknown every day, entering a stranger’s home, sometimes with very little detail regarding the emergency or dangers ahead. Now, facing COVID-19 that risk has increased substantially, not knowing what they may or may not be exposed to can be a concern for those on the front line of a pandemic.

COVID-19 has dramatically affected the way Paramedics keep themselves and the public safe and healthy. Every call a paramedic goes to has the possibility of being a COVID-19 patient. While several paramedics in Canada have tested positive for the virus, it’s difficult to say if they contracted it on the job, but it is likely within the environment they work in. Others have had to take time off work and self-isolate due to close contact with patients who tested positive for the virus.

The problem is not every patient is forthcoming with information early in the assessment, and sometimes by the time they are it can be too late. Across the country paramedics have struggled with patients who change their story about travel history and symptoms after calling 911. This puts everyone at risk. Paramedics will respond even if you’re at risk for COVID-19 so please be honest so they can take the proper safety measures. A sick paramedic CANNOT help you.

So What Can YOU Do?

• Be honest with the 911 call specialist and Paramedics about travel history, close contact and symptoms.
• Give Paramedics 6 feet distance when they arrive so that they may perform their screening assessment.
• If Paramedics request you wear a surgical mask or gown, do so if you are able.
• Only call 911 if it is emergency, this is not a phone line to ask how/where to get tested and calling 911 will not help you get tested quicker.
• Leave the personal protective equipment (PPE) for healthcare workers.
• If you are sick; self-isolate, practice proper hand washing and monitor your symptoms.
• BE PATIENT, paramedics are learning a lot right now on how to protect themselves and you during these unprecedented times.

WE GO to work FOR YOU, please stay home FOR US?

Increase in call volume in areas hit hard by COVID-19 are putting an added strain on those paramedic services. Calls are also taking longer because paramedics need to be careful not to expose themselves to the virus and risk spreading it across the community. It means wearing numerous kinds of Personal Protective Equipment (PPE) several times per shift which is a necessary but time-consuming effort. Listening to and complying with your local government’s regulations for social distancing and protective measures is the best way to protect your frontline workers, as they put their health and safety on the line for you during the pandemic.

There are many sources of information on health, more specifically on COVID-19 these days: websites, television shows, magazines, news media, social media such as Twitter, Facebook, etc. Consistency and accuracy are imperative to communicating the right message. Some suggestions to educate the public at large at communicating this might be:

1. Communicating sources of information considered reliable in your provincial and local municipality; encourage to visit and say up-to-date as it changes regularly.

2. Communicating “myth-buster” sources of information. Dispel misinformation. Circulate different “myths” throughout the day or week to help educate the “real” information versus “myth”.

3. Publicize the things paramedics are doing differently, what and why:

• For the safety of the public (health system), i.e. community recovery
• For the safety of the paramedic responding, i.e. PPE
• For the safety of the patient, i.e. treatments

4. Social Media Polls on “Did You Know” facts about COVID-19 to engage followers to be educated and learn the latest.

5. Encourage making health decisions on reliable and creditable information. Use secondary sources to validate if you are unsure.

Paramedics, like many health professionals have a difficult job under normal circumstances, more so currently on the front line of the COVID-19 pandemic.

Good health is about more than just the absence of sickness. Focusing on wellbeing and building resiliency is important in establishing a holistic approach to health, addressing both physical and psychological states.

The World Health Organization defines wellbeing as “the state in which an individual realizes his or her own abilities, can cope with normal stresses of life, can work productively, and is able to make a contribution to his or her own community”. Wellbeing involves having positive self-image and esteem.

Resilience, which is directly related to wellbeing, is about having the ability to cope with and adapt to new situations. Having a sense of resilience and positive wellbeing enables a person to approach other people and situations with confidence and optimism, which is especially important for health professionals given the enormous changes that are currently happening.

Health professionals, both clinical and non-clinical, operate in high stress environments, which can be under-resourced and under strain. This environment negatively impacts their mental health and wellbeing, with a substantial body of literature indicating high levels of stress and burnout, indicators of low wellbeing, as well as more serious symptoms pointing to mental illness in this profession. The adverse consequences of stress, burnout, overall low wellbeing and mental health on individuals are well known and include diminished physical and psychosocial functioning. Additionally, these outcomes can result in higher rates of absenteeism and when on the job, can lead to reduced professional functioning and presentism. This in turn can lead to lowered quality of care for patients that receive treatment by health professionals with low wellbeing and mental health issues. For instance, major medical errors, a leading cause of preventable death, increase with higher rates of burnout and depressive symptoms.

Saturday, May 30 - Paramedic Services Recognition Day

Paramedics, like any other professional, respond to appreciation expressed through recognition of their good work because it confirms their work is valued by others. When providers and their work are valued, their satisfaction and productivity increases and often motivated to maintain or improve their good work and in turn, feel good and do better both physically and mentally. While appreciation is a fundamental human need for everyone, many individuals in healthcare don’t do their duties for the recognition; though certainly appreciate it when it is offered.

Add into the current situation the inherent risk on the front lines of a pandemic like COVID-19, and the recognition becomes much more important because of that risk.

Recognition does not have to be extravagant or “flashy”. It can be the simplest of gestures that have the biggest impact. In a pre-COVID environment, it was easier and could have been as simple as a handshake, high-five or hug in appreciation as physical connections demonstrated appreciation much more than just words…actions always speak louder than words. In a COVID-19 world, it may be harder but no less important.

Some simple benefits include:

• Increased individual/organizational productivity—the act of recognizing desired behavior increases the repetition of the desired behavior, and therefore productivity; win-win!
• Greater satisfaction and enjoyment of work—more time spent focusing on the job and finding solution during any increase in stress can be important and the difference between critical errors
• Higher satisfaction increases commitment, collaboration and advocacy
• Teamwork between employees is enhanced
• Teamwork Makes the Dream Work!
• Better safety compliance and safer environments; in a pandemic, critical
• Lower negative effects such as absenteeism, physical injury and/or stress related wellness

During Paramedic Services Week (PSW-2020), as we promote the profession and work being done, it will undoubtedly prompt many people to reach out and say “THANK YOU” in a variety of ways. While many people do it every day beyond just this one week, we remind Paramedic Services to take the extra time and effort this week to recognize ALL paramedics within their respective services, jurisdictions, and province and across Canada and beyond!

The last many weeks, now months have been increasingly difficult with many new and challenging risks to mitigate. Now is the time to shine a light on success and remind paramedics, and all health professionals that YOU are VALUED, the work you do is IMPERATIVE and we ALL THANK YOU for it!