What does COVID-19 Phase 2 mean for fire chiefs?
Fire agencies should encourage members to get vaccinated, prepare their response plans for vaccine distribution, and remain vigilant
In early March 2020, former IAFC President Gary Ludwig introduced the IAFC Coronavirus Task Force composed of fire service leaders to address the issues the coronavirus was having on the fire service. Fire Chief John Sinclair, IAFC president (2016-2017), was appointed as the Task Force Chair.
The early work of the Task Force focused at the system level, with guidance on how fire service leaders could participate in the larger public health system response. IAFC leadership and the Task Force developed early approaches to supply shortages and the impact of community shutdowns and healthcare disruption.
Much more importantly, the Task Force began to develop and share information that allows fire departments to protect firefighters and EMS personnel from contracting COVID-19 and deliver outstanding (but safe) emergency care to patients of all types.
As the dangers of the disease became clearer, and many fire EMS personnel were exposed or became ill with the disease, the Task Force worked collaboratively with the International Association of Fire Fighters (IAFF) members of the Task Force to craft safety plans and best practices for quarantine.
The IAFC’s accomplishments in preparing the fire and emergency service for the pandemic’s challenges became wrapped into the challenges of civil unrest, a vicious early wildland fire season, and a record-setting tropical storm year. Plans to protect wildland firefighters have to incorporate infection control and updated personnel monitoring systems.
Over the last few months, the Task Force has focused IAFC efforts to monitor the impact of the pandemic on fire and EMS services and positively influence how the federal and state governments have provided funding, resources (especially PPE), and regulatory support. This also includes prioritizing COVID-19 vaccine administration when one (or more) pass their safety testing and become available.
IAFC MEMBER VALUE
IAFC leadership and staff provide extraordinary support to members who are in the hot zones of the pandemic response. These efforts have included:
- Hosting webinars to provide weekly information as the pandemic evolved and early impacts on fire departments occurred.
- The “Coronavirus Disease 2019 (COVID-19) Factsheet for Firefighters and EMS Personnel” was published and disseminated.
- Weekly updates are provided regarding medical best practices; safe applications of PPE; updated information on the events impacting our critical supply chains; disseminating best practices on the mental health aspects of the pandemic; continually updating the best practices for personnel quarantine and isolation, and monitoring the changing use of COVID testing.
- The Task Force has shared strategies needed to integrate the fire service with the larger public health system response and the regional efforts to keep the health system functional.
- The IAFC Government Relations Department has had a critical role in gaining federal funding to support decimated state and local budgets. A timely second task force (Economic Crisis Task Force) was convened by President Ludwig to address the economic impact to fire departments and their communities due to the pandemic.
IAFC surveys collected and reported data on the economic impact of the pandemic, the impact on personnel, and the PPE needs of agencies. The surveys were displayed using useful dashboards. The Task Force regularly updates the COVID-19 webpage.
HOW THE COVID-19 SECOND PHASE WILL BE MORE DIFFICULT THAN PHASE ONE
The next few months will be challenging as seasonal respiratory illnesses appear in North America, and COVID-19 is moving rapidly through younger populations who were not impacted by the first 10 months of viral spread. Many people of all ages have delayed their routine medical care, and the effects are beginning to manifest beyond the virus’s direct impact.
There is more stress on the health system, particularly emergency care personnel (like our fire/EMS members) who manage higher acuity patients while trying not to get infected themselves. While there have been some improvements in supplies, PPE and disinfecting materials, the risk of personal exposure is still genuine. Many persons infected with COVID-19 have no symptoms, or ones that mimic seasonal allergies or the common cold, so universal precautions are necessary for virtually all patient contacts and still in the fire station’s common areas.
It will be necessary for fire service leaders to understand and support vaccination programs over the next year. The immediate vaccine need is in regard to seasonal influenza. It is appropriate for us to ask our personnel to get flu vaccines and to do that soon. The current recommendation is to allow about 30 days between vaccines, to get the maximum effect from them. If members of your team haven’t done so, strongly encourage them to take this seriously.
The pandemic can only end when either enough humans have become ill and built an immunity to the disease, or a vaccine is disseminated that protects humans from the disease. The COVID-19 vaccine development process is going well, with two vaccines being distributed as of mid-December.
All COVID-19 vaccines require cold storage and that will require special transport and short times out of their freezers. Public health will be organizing that process. Any work by the fire service would be in assistance to public health. Fire agencies should prepare their response plans for dry ice incidents and exposures, as the vaccine transportation and storage will no doubt result in incidents where storage containers are breached.
Screening and testing processes are still a work in progress. With significant improvements in manufacturing across the globe, there should be adequate availability of reliable testing for the population at large. Ideally, testing for COVID-19 will be a point of care test. The test should have a very high sensitivity, and results should be available within minutes to hours, not days.
THE SURVEILLANCE PROCESS FOR OUR MEMBERS
The Centers for Disease Control and Prevention (CDC) updated its guidance several times over the last eight months on the exposure of essential workers, reducing the quarantine burden by substituting a 14-day monitored period for the quarantine at-home process.
By now, most fire departments have implemented a personal screening process. It will be needed to maintain healthy on-duty forces and have fewer personnel in quarantine. Frontline officers need to be diligent in checking fire personnel and rapidly identifying anyone who is sick.
THE PUBLIC WE SERVE
The fire service must continue to provide support and education to communities. The efforts at keeping people safe include showing them good behaviors like social distancing and the use of masks in public, and the correct use of PPE.
The nation’s 911 centers should have the opportunity to talk to a prepared public, to let them gather and report the information needed by fire/EMS responders to serve the public safely and without delays. The public also needs to know that their providers will show up wearing a different outfit and starting an interaction six feet away, using a single “scout” provider.
There is still a significant risk at congregate care sites, such as jails, nursing homes, senior centers, and group homes. Public Health must take the lead in assisting their containment efforts, but they may need assistance from the fire/EMS personnel who visit those facilities and can recognize situations where infections may be brewing. Some fire agencies have also assisted public health in doing on-site testing to improve infection control.
The need for a well-designed and stable communication system has never been greater. It should support new forms of telemedicine provided across the community by capable EMTs and community paramedics. Many regions are investigating elements of a plan for “non-transport” and even “no response” should volumes get that high. There are now good models to serve as a template for our communities in both of these areas. We will need to partner with our Public Health and hospital systems in a very new way if we are to move into a “no response” mode for lower acuity calls. There are great examples of patient instructions for a non-transport interaction.
There is a 10-year shortage of basic medicines for emergency care. It is now even worse, and available medications are ever more expensive. There will continue to be shortages of epinephrine, inhalers, dextrose, cardiac meds, and some sedative medicines. EMS providers must update the medicine substitution programs for implementation at any time.
Finally, fire/EMS leaders must be building durable systems of interaction with the hospitals in their service area. Understanding and managing capacity issues on both sides are critical, and fire/EMS leaders are much better at reaching out to hospital leaders than vice versa.
The work of management for the pandemic, plus our other hazard situations, will continue for the fire service. The IAFC leadership and the Coronavirus Task Force will lead efforts to address the next wave of the pandemic, which will likely go well into 2021. It is expected that the Task Force work will help to bring clarity to fire service planning for the path forward and the need for continued coordination across the country and the world.
Editor's note: This article has been updated with current vaccine information.