By Katherine Herrian
Fire and EMS personnel are good at change. They are masters at adaptability and changing course midstream based on a patient’s needs, response to treatments or new information. This is one of the many qualities that make them great partners in the delivery of social services.
Flexibility has proven to be a critical component during our current global crisis as well.
EMS services are being confronted with daily changes that require new levels of ingenuity. In the departments I serve, I see first responders taking on tasks thoughtfully and with caution to ensure they protect their communities and their families. They meticulously don and doff PPE because they know the importance of this equipment in protecting themselves and potentially vulnerable patients.
As fire and EMS personnel adapt to their new reality, so do I – an EMS social worker.
Serving low-acuity patients
Prior to the COVID-19 pandemic, my role as the social worker with the University of Texas (UT) Southwestern/Parkland BioTel EMS System consisted largely of completing home visits with patients. These patients were identified by front-line paramedics, and the referrals would vary from patients with frequent falls to a family struggling to care for a loved one with dementia to a citizen who needed to be connected to a community resource to meet their basic everyday needs. I detailed the role of EMS social work as a new way to serve low-acuity patients in a previous article.
COVID-19 changed my job significantly.
Home visits were no longer appropriate due to social distancing. Front-line paramedics and EMS leadership worked to keep up with the changes that accompany providing prehospital care during a pandemic.
Prior to COVID-19, I worked closely with facilities across the healthcare continuum to get patients the services they needed. This frequently involved referrals to skilled nursing facilities, acute rehab facilities and assisted living facilities. As the threat of COVID-19 moved closer to home and the communities I serve began to shelter in place, patients and their families became more apprehensive about pursuing services outside the home environment.
As I have watched the pandemic progress, it has challenged me to rethink how I can provide social work services to patients and continue to support my EMS agencies.
A shift in approach
I began talking with other social workers in the area who also were trying to find ways to reach patients. We all had the same goal: to empower patients with knowledge about how COVID-19 will change the way they can access healthcare.
COVID-19 ultimately sped up some difficult conversations. For example, during a phone call with an oncology clinic social worker, we discussed how to ensure that patients understood the visitation restrictions at hospitals and healthcare facilities. Visitation to these facilities was being increasingly restricted to prevent further spread of the virus. We talked candidly about what end of life in isolation may look like for some of the most at-risk patients. We committed to working together to problem-solve issues for patients and families who wanted to complete advanced directives and DNRs but lacked the resources or technology to get them done quickly. We discussed the benefits of in-home services, such as hospice care, that would allow patients to be with loved ones if they died during the pandemic.
My perspective became that anything I can do to keep the patient successful, supported and safe at home could not only benefit the patient but also reduce the risk of exposure to paramedics who may be called to transport the patient. The approach was now two-fold: helping patients understand how COVID-19 would change their interactions with healthcare providers and doing my part to protect paramedics by connecting patients to supports that would help curb 911 use.
In some respects, reducing 911 use has always been a key component of my job. A paramedic and I would complete home visits to help educate patients, connect them to the needed resources, and assist with navigating any barriers with the ultimate end goal being an overall higher level of functioning. This was done as a team approach to provide a well-rounded patient view and foster a deeper connection with the patient’s community. It was strength-based in nature. We wanted citizens to understand that their paramedics cared for them, were rooting for them, and were committed to helping them create long-term solutions.
I work with 12 different EMS agencies, and this model has proven to be successful over the past four years. However, with the spread of COVID-19, the urgency to keep paramedics from responding to non-medical or low-acuity calls became more crucial. Every patient contact could be a potential exposure for both parties and could result in the use of additional PPE. For the first time in my social work career, the key to keeping my patients and paramedics safe was to keep them isolated from each other. This was a difficult thought to reconcile because the majority of my work in EMS had been rooted in fostering the patient paramedic relationship.
During my time in EMS, I have learned the extent that paramedics serve as the safety net for their communities. In the midst of a pandemic, the best service I can offer my paramedics and my patients is my ability to be proactive. As such, most of my work these days happens over the phone or from behind a desk. I have used this time to seek out, establish and strengthen connections with other social workers, case managers and community contacts in hopes of pooling any available resources. Now more than ever it is imperative that we mobilize those resources to address potential needs.
From a community perspective, I have worked with EMS leadership to look for potential COVID-19 patient calls to identify any nursing home or supportive living environments, and determine if there are concerning patterns. The identification and tracking of these calls has helped EMS become more aware of potential increase in risk and take additional precautions. The community collaboration has been essential and has made me hopeful that post-pandemic we will collectively continue to lean on each other to better serve patients.
EMS as part of the recovery process
Although my work approach has changed due to COVID-19, it has only served to highlight how social workers can be essential to supporting EMS through times of crisis. The knowledge that my fire departments have shared with me about the communities they serve has helped me better understand the risk factors that their citizens individually face and the challenges they will have in the future.
Paramedics and firefighter-paramedics are first responders in battling the COVID-19 healthcare crisis but will also ultimately be the first responders in the rebuilding process. The fallout from this pandemic will be far-reaching, and through partnership with EMS agencies, we will identify and assist citizens working to recover physically, emotionally and financially from COVID-19.
I think about how my job will look post-pandemic and my transition back to my previous roles and responsibilities. My hope is that for my fire departments, EMS social work will be part of the recovery process for their communities. I believe that the partnership of a paramedic and social worker, although different during a pandemic, is valuable. The tools we have honed over years of collaboration can be applied on a larger scale in helping communities move forward from COVID-19. Our partnership will bring together the allies we found in fighting COVID-19 and build on a better community approach to holistic patient care.
ABOUT THE AUTHOR
Katherine Herrian is a licensed clinical social worker (LCSW) in the state of Texas. She holds a bachelor’s degree and a master’s degree in social work. She has extensive experience working with both the adult and pediatric population in the emergency room settings. Herrian is the first BioTel social worker and has been with the program since its formation in 2015.