- We spoke with Hanan Cohen, the director of corporate development and community paramedicine for Empress EMS, a partner of PatientCare EMS Solutions, in New York’s Westchester County, one of the most affected counties in the country so far with confirmed COVID-19 cases and deaths.
- He explained exactly what would happen should you call 911 for an ambulance within Empress EMS’s region with the suspicion that you may have contracted the COVID-19 coronavirus.
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Disclaimer: When in doubt, call 911 for any coronavirus or other medical concerns.
Following is a transcript of the video.
Narrator: What happens when you call 911 with suspicions of having the coronavirus? We spoke with a paramedic working in New York’s Westchester County to find out what happens after you make that call for medical assistance.
Hanan Cohen: First of all, we would get information from our 911 dispatcher.
Narrator: Hanan Cohen is the director of corporate development and community paramedicine for Empress EMS, a partner of PatientCare EMS Solutions.
Cohen: Quite frankly, at this point of time in our region, we suspect that everybody is either suspicious or positive, just because of the large volume of patients.
Narrator: When a dispatcher receives a call that might be COVID-19, they’ll ask questions, such as if the patient has a fever or shortness of breath and if they’ve potentially been exposed to someone known with COVID-19.
Cohen: Essentially all 911 dispatch centers are screening patients to see if they have any potential of being COVID suspicious or COVID positive.
Narrator: The information gathered in the call will be relayed to the responding crew, so they enter the scene with a heightened sense of awareness.
Cohen: As soon as we arrive on scene, we’re doing what we kind of refer to as a doorway assessment. We’re staying about, keeping our six feet of space between us and the patient, as long as their condition warrants it. Certainly if they’re unstable, that does not exist, and we immediately begin treating the patient. But we approach the scene wearing PPE based on our dispatch protocol. The higher level for the higher level of concern. So if this was a potential COVID patient, we’d be wearing an N95 mask, we’d be wearing eye protection.
As we approached, and from six feet away, we repeat the same, similar questions that dispatch had. Along with us wearing a mask all the time while at work is, on every patient, once we do that six-foot screening, we put a surgical mask on them for everybody’s protection. We’d ask them, of those top three or four symptoms, do you have fever, cough, shortness of breath, chest pain, or a loss of appetite? Have you been tested? Are you now or have you been in close contact with anybody who was suspected or confirmed?
Narrator: If the patient is stable, the crew will start their history and physical-exam portion.
Cohen: And that would be asking them for all of the standard symptoms again. Fever, shortness of breath, cough, have you had chills, aches or pains, any chest pain? Now we ask about pink eye. Pink eye is popping up on some radars as being a precursor to a rather, you know, nasty case of COVID-19. Loss of smell, GI symptoms. The list has been growing over the past few weeks, so we’re expanding that list as we go, as it’s verified by, you know, the CDC or other appropriate resources.
Narrator: Simultaneously, the paramedics are checking the patient’s overall condition, looking at their airway, breathing, and circulation.
Cohen: If they’re answering us in full, complete sentences without distress, we have a good idea that they’re in a certain level of stability. If they’re having to look for words or they’re pursing their lips or if they’re only able to speak in short, abbreviated words, we know that they’re having a work of breathing, we know there’s a level of respiratory distress we have to be concerned about and we’re gonna have to address.
And at the same time, we’re assessing their level of consciousness, how alert they are, how cognizant they are of their surroundings. Are they oriented to the date and the time and the place? Can they answer our questions correctly? So while we’re answering those first screening questions, we’re assessing multiple parts of a person’s neurological, respiratory, and cardiovascular status, all at the same time, without ever having touched the patient. So that’s a really quick first 15 to 20 seconds.
Narrator: If the responders are confident they don’t have to intervene with life-support procedures, they continue with more in-depth questioning.
Cohen: Whatever their symptoms are, we’ll try to ascertain when it started, how long it’s been going on, did anything predispose it, and does anything make those symptoms better or worse? Those are all valuable, you know, assessment tools.
Narrator: On crews with more than one person, a partner will start to take the patient’s vital signs, such as temperature, pulse, and respiration. And then the head-to-toe examination continues. The head, eyes, ears, nose, and mouth all get examined.
Cohen: If the patient is of a certain age or is having any chest discomfort, shortness of breath, at some point in time, when appropriate, we’re gonna put them on a cardiac monitor. We’re gonna take a look and see their EKG. Just to have a better understanding at what level of time may we be able to intervene, or maybe we’d not have to intervene and just give the person a safe, comfortable ride to the hospital, or, under the current protocols, have them stay at home, monitor their symptoms, and reach out to their own healthcare practitioner for further advice should the symptoms be deemed mild enough.
We certainly look at all of their past medical histories, their meds, their allergies, their mood, their level of anxiety, and try to address any of those that we can, so as we get to the end of the exam, we can come up with a better overall picture of the patient and their stability and their true overall needs within the healthcare system.
Narrator: The responders will assess the patient’s age, past medical history, and vital signs to then make the next decision.
Cohen: Is it an urgent transport, is it a nonurgent transport, is it a treatment place at home, or, with some of our patients, is it the potential of a telehealth visit with a physician to see if they can do something to maintain the person in the home in a safe environment? We look to see are under 65 years of age as a starting point. We look to see if their temperature, is it greater or less than 100.4? Respirations greater or less than 22? Pulse oximeter of less than 95%. A heart rate that we’d consider fast, over 110. A blood pressure that would be considered on the low side of less than 100, and any possible neurological changes. And if any of those are triggered, then it’s an automatic follow our normal protocols and transport to the hospital.
Narrator: If patients are not exhibiting these symptoms or don’t have obvious risk…
Cohen: Then we can go and delve further into their history as far as any other chronic diseases, and if they don’t have a major secondary condition other than the fact that they may have an influenza-like illness that shortens the breath, febrile illness, then they can be considered for the treat-and-remain-at-home protocol. Then we can tell the patient that New York state has an existing protocol right now where, with their current condition, their current presentation, it’s our opinion that they are better maintained at the home.
The hospitals are bursting at the seams, they’re overwhelmed with high-priority patients, and if at this point in time you are not positive, you will be basically presented in an environment where multiple people around you may be. So it could actually be deleterious to your health as opposed to an improvement of your health. Patients have the right to say, “Absolutely not, I want to go to the hospital.” Patients always have that right, and we respect that right. Under this protocol we would speak with a physician at a hospital and just let them know that we’re coming, this patient is declining to stay at home. He or she may wish to speak to the patient further and try to convince them that it’s the more appropriate pathway at this time, but we’ll always take a person if their decision is they need to go.
Narrator: If the patient chooses to stay home…
Cohen: We’ll give them an informational handout from the Department of Health that explains what they should do next. They should take a fever-reducing drug, they should make sure they’re drinking OK, if they have any further concerns, to reach out to their own healthcare practitioner, and if at any time they feel their condition has changed or is getting worse, dial 911 immediately, and a response will be there in a matter of minutes. One additional thing we’ve started here, every following day, we have one or two of our community paramedics pull all the patients who were left at home under that protocol, and we call them to see how they’re doing.
Narrator: Oftentimes the first responders are putting themselves at risk on the job. Hanan was COVID-19 positive himself.
Cohen: We’ve been a combination of lucky and well prepared and well trained. Of our 600, I’m one of 30 that have tested positive. Of the 30, 14 have already returned to work. Of those that are out, only one has had a brief hospitalization. The rest are going through the home quarantine, taking the medication. We check with them every day, we follow up with them, we give them support, and when they’re ready to come back, you know, there’s a seat, an ambulance, and a uniform waiting for them. And, quite frankly, most of them can’t wait to get back. We’re not very comfortable sitting at home.