ARLINGTON — Amidst challenges faced by first responders during the COVID-19 global health pandemic, like balancing mental health needs and maintaining personal protective supplies, support from both their co-workers and the communities they serve has proved vital for staff at Armstrong Ambulance.
While finding a “new normal” has required operational changes, it has created an organic and meaningful connection among those in the EMS community, strengthening their allegiance to one another, as well as to their patients and their mission. The goal of ensuring the safety and care of patients by all clinicians throughout a time where there are ever-changing variables is nothing but inspiring and touching.
Once the first cases in Massachusetts were discovered in February, healthcare professionals have found themselves on the frontline of a rapidly evolving crisis, with the commonwealth among the hardest hit states early on. Middlesex County alone, where all but three of Armstrong’s nine bases are located, has been the hardest hit in the state, requiring Armstrong staff to adapt rapidly to evolving public health guidance and best practices.
To cope with the unprecedented challenge that remains before them, Armstrong’s first responders have been finding the support they need in numerous ways, whether it be from a member of the team, those working in a similar industry, or members of the many communities they serve delivering food and messages of encouragement to local bases.
At many of the Armstrong bases, food has been delivered, notes sent and signs affixed. “I don’t think I’ve ever had more free food in my entire life, which I really appreciate,” Medic Supervisor Kyle Vieira said. “People have been really friendly too, waving to us as we go by.”
Managing the Stress of a Pandemic
Sarah McClellan, who has worked as a paramedic at Armstrong for the last year and a half, said collaboration has allowed her to keep track of both her and her coworkers’ mental health needs, and the toll that the pandemic can take.
McClellan has dealt with disaster responses before. During the aftermath of Hurricane Harvey in 2017, McClellan spent days working to help those affected by the storm. While the emergency response then might have been more condensed, the prolonged uncertainty of the pandemic is likely to have a lasting effect on those confronting it on a daily basis.
“It’s an uneasy feeling, not knowing what’s going to happen,” McClellan said.
Understandably, there is a deep sense of uncertainty in everyone’s lives as the world navigates through a deadly disease unlike any before. For EMS providers, that feeling is compounded by layers of previously unheard of unknowns that now await them on every call; the unknown of the patient’s condition, the unknown of the patient’s COVID status, the unknown of the environment in which the patient is living, the unknown of family dynamics involved, to name some.
Regardless of these unknowns, McClellan and her fellow EMS professionals “reset” after each call and start the next call from step one, even though these experiences can have deep impacts.
Throughout all of this though, McClellan said her peers both at Armstrong and in the field have been vital, checking in with and looking out for each other. Some shifts can be up to 24 hours long, allowing crews to bond and learn from each other through their shared experiences.
“It’s been pretty helpful to talk to people about it,” McClellan said. “Fellow EMS professionals have become really good at being able to talk to each other about everything.”
Partners and colleagues support each other in other ways as well.
McClellan’s own shift partner, Kris Smith, often volunteers to ride in the back of the ambulance with patients in an attempt to minimize her risk of exposure to COVID-19, since he knows she has young kids at home to care for and he doesn’t. This kind of selflessness and concern for colleagues is common throughout Armstrong.
“Armstrong has been making sure our needs are met,” McClellan said. “We had an off-duty supervisor drop off supplies once just to make sure we had enough.”
Keeping Everyone Safe
For many in the healthcare field, ensuring crews have enough supplies of personal protective equipment (PPE) has been a core responsibility throughout the COVID-19 crisis.
First responders use the equipment to protect themselves from exposure to the virus as they respond to calls involving people who may be reporting symptoms associated with COVID-19 or who may have been in contact with a positive COVID-19 case. As the virus can easily spread, keeping personnel healthy is the main goal so they can not only continue to serve the community, but also not transmit it to others such as their family or fellow healthcare workers.
Ed Kelly, a 30-year veteran of Armstrong, spends the majority of his day ensuring his coworkers have the equipment they need. As a compliance supervisor, the first thing Kelly does every morning is make sure the ambulances at the Woburn base are stocked, sterilized and running properly before crews head out for a call. After that, he’ll travel around to the other satellite locations to deliver any supplies or make any repairs they might need or address any PPE or equipment needs they may have.
“When this first happened, everybody was having an issue keeping up from a supply standpoint,” Kelly said. “We are focused and committed to taking care of our vehicles as we have been and getting them ready for the next emergency or transport, whatever it might be.”
Kelly said his actual day-to-day work hasn’t changed too much; he’s still performing a lot of the same checks and tasks as he did before the pandemic. However, he’s now coordinating those tasks around the clock and with more precautions built-in.
“Now crews require more equipment than before COVID-19, such as masks, gowns, gloves and eyewear,” Kelly said. “Normally, crews would don those protective items when there was a potential for an infectious exposure. Now every call requires protective gear for potential infectious exposure.”
Securing adequate PPE is a challenge that all healthcare providers in Massachusetts have struggled with. Armstrong continues to work tirelessly to secure supplies that keep not only their staff safe, but also protects patients and providers at medical facilities Armstrong staff visit while carrying out their responsibilities.
Another effect on operations is the added process of crews bringing ambulances to one of nine satellite bases after every call to have the vehicle sprayed down with a sanitizing liquid. This disinfecting process is done as a precaution, even if the patient last transported is not believed to have had the virus. Since the pandemic started, Armstrong has purchased additional sterilizers to ensure that vehicles are able to decontaminate and get back on the road quickly to prepare for the next call that will come in.
The pandemic has helped to shine a light on the role private EMS companies play in the community, and the challenges they face, some of which differ from those that municipal systems may face. Private EMS companies often have to fight their own battles to secure PPE, for example, even though they are first responders. Vieira said the awareness has helped to bring the challenges and dangers private EMS clinicians face, like exposure to viruses and other communicable diseases, patient violence and needle sticks.
“A lot of times with police and fire departments, those dangers are obvious,” Vieira said. “But I think ours are coming into the spotlight. We’re facing the same stuff, we’re just in different uniforms. We’re all in this together.”
This sense of connection is a vital part of the work done by Armstrong employees when responding to calls as well. With changes to patient care necessitated by the pandemic, crews have adapted in order to achieve this connection in new ways. When face coverings prohibit a patient from seeing a calming smile, crew members may squeeze their patient’s hand with their gloved hand as a way to ease fears or maintain stronger eye contact, making patients feel more secure.
Due to COVID-19 precautions, only the patient can be transported in the ambulance; family members must be left behind. Once the patient arrives at the hospital or medical facility, family members are not allowed in either, a hardship that creates stress for both the family members and patients alike.
Crew members make sure that they also provide emotional care and support to the family members which is now being done under more intense circumstances, knowing full well the responsibility of caring for a family’s loved one and make it a priority to show compassion while answering each call.
“Even with non-COVID-19 calls, we have to tell people they can’t come with us,” Vieira said. “We make sure the hospitals have all the family’s contact information so they can communicate with them. But I understand, it’s definitely hard to watch.”
Armstrong staff’s strong professionalism and grace helps many families understand the reasons for these necessary changes.
“You want people to feel at ease and you want them to feel safe,” McClellan said. “I make sure I’m doing everything I can to help people. I want to make sure the people I help look back on the experience and think, ‘I’m so glad this person came.'”
Even with some of the challenges and uncertainty over the last few months, McClellan said there are still some victories to celebrate throughout all of this.
One came while McClellan scrolled through her Facebook feed and happened upon a video of a woman in her 90s that she’d brought to the hospital a couple of weeks prior. Surrounded by cheering nurses and hospital staff, she was healthy and headed home after recovering from the virus.
Not knowing what happens to a patient after they’re brought to the hospital is common and something McClellan is used to, so any updates — whether intentional or coincidental — can be monumental.
“I got to see one of my patients leaving the hospital,” she said. “That was really awesome, that was probably the coolest thing that has happened throughout all of this.”
And just like that, the next call came in.