In the early days of the epidemic, EMS dispatchers used code to forewarn EMS crews that a patient had AIDS. “Patient requires Universal Precautions.” The meant, we needed to be sure to put our gloves on. In time universal precautions became standard language for what you were expected to do on every call. Put your gloves on.
For years most in EMS routinely put their gloves on before encountering a patient. Some of us put our gloves on only when we expect to encounter fluids. I do not advocate this approach, but admit to being guilty of it at times.
We have carried decontamination/isolation packages for many years, but until recently, they were rarely used. The kit might include a gown, gloves, and maybe a hair net. Today with COVID raging, we are given a shopping bagful of PPE, ten gowns, four N25s, 10 surgical masks, two face shields. Many crews have to return to the base to get more in the course of the shift or require a supervisor to drop by and replenish their bag.
Yesterday, Connecticut saw its biggest drop yet in COVID hospitalizations. At the hospital I am doing far fewer COVID notifications for EMS crews, and yesterday when I worked in the city, I cannot say that any of my patients had COVID.
That said, I still had to put a few isolation gowns on.
As once we only selectively used gloves until they become the standard on all calls, I wonder if we are now approaching the point where we may have to wear them on all calls now.
For example, a patient can answer no to all the COVID screening questions when first asked, but they often change their answers with repeat questioning or their answers are suspect.
I picked up a homeless man who had had an alcohol withdrawal seizure. He denied a fever, trouble breathing or that he knew anyone who had COVID. Still he had a bad cough, which he said was chronic, and he had lived in a homeless shelter until the city put all the homeless people up in hotels to try to keep them safe from COVID. Another patient lived in an elderly housing building where there have been some COVID patients. She said she had asthma and was coughing up green phlegm. She felt hot to me, but her building is notorious for being hot with poor ventilation. She denied any COVID contacts. Can I feel safe that both these patients are COVID-free?
I masked these patients and gowned up myself. I even tried the fancy new mask my friend Jerry gave me. It was much more comfortable than an N95, but I admit I felt a little light-headed wearing it. I went back to the N95 for my later patients.
I primarily respond in the Hartford zip codes that have extremely high COVID rates. Who is to say that any of my patients are truly COVID free?
Where I might have used one PPE gown a year prior to COVID, I am going through four or five a day and if the precautions truly became universal, I will be using 9 or 10.
I hope that COVID just disappears, but the more I read and see, I expect it to be with us for a very long time.
I hope they are building more PPE factories.