We had the pleasure of hosting Bill Salmeron Chief of New Orleans EMS and Medical Director Dr. Emily Nichols to discuss their department's response to COVID-19. New Orleans garnered National attention as a COVID-19 hotspot, suffering some of the highest mortality rates in the country. They spoke about what they faced and how they handled (and are handling) the challenges, here are some of the lessons we can all take away from their presentation.
The first lesson from this talk was to be nimble and don’t be afraid to iterate changes. Dr. Nichols talked about some of the changes they made in regards to airway management and cardiac arrest. These changes were initially made with the best information available but as information changed, and with input from their crews, they refined their protocols to match their needs. We have a desire to make decisions that are right the first time and under ideal circumstances this may be possible, but in times of crisis that is not. If you wait to make decisions until all of the information is known you will be too late. As a system leader you can’t be afraid to change your strategy and as a provider, prepare to be flexible.
At one point, over 20% of their staff was out, which required drastic changes to their staffing. New Orleans, which is traditionally an ALS system, suddenly needed to staff BLS level ambulances. They had a volunteer system designed to provide area EMTs with a third ride opportunity for experience. This forced them to turn this volunteer force into second providers on their ambulances. As a system, are you prepared to make a significant change like this on the fly? Decisions like this can only be made with planning, and that planning requires that you recognize the problem as it’s coming. Both Chief Salmeron and Dr. Nichols discussed the changes they made early in the crisis and made clear they recognized the potential impact early. If you wait until the problem overwhelms you it’s too late. It’s better to have an action plan that you never use than to never make a plan and try to act.
Our next take away was that this is a team effort. Dr. Nichols talked about the constant interaction they had with crews in regards to training, clinical, and operational changes. This was a first for everyone and expertise does not only lie at the top of an organization, a great suggestion and feedback can come from anybody. You can also look outside your local agency, talk to contacts in other healthcare settings and around the country to see what they are doing to manage. Ultimately, you should do what’s right for your agency but that can include information learned from other sources.
They had implemented an “Exposure Control Team” led by their Deputy Medical Director. This tems role shifted as the crisis went on but focused on the well being of employees who were sick or otherwise quarantined. They ensured those employees had housing, food, and their health needs were met. Aside from physical well being, there was a strong focus on mental health and making sure that all employees were mentally fit to work as well.
We also need to be prepared to support other public safety and city departments. Our presenters discussed the training and support they provided to the police and fire departments and the collaborative effort to modify responses to reduce exposure. It’s not just public safety, your community will look to EMS as the local health experts. Prepare a strategy to assist other areas of the community while not depleting your precious resources.
Finally, we want to get out in front when it comes to information. This was the only media story for so long that EMS was put in a position to help drive the story. The media wants to know how you are protecting the public? Are staffing shortages affecting public safety? Is our community facing the same issues we see nationally in regards to PPE? Even for media shy organizations, you need to get out ahead of the story and reassure them that everything is working as planned. EMS has a real opportunity to show our communities what we do and why we are important, we don’t want to waste that.
Beyond the media, we need to keep our staff informed. Chief Salmeron discussed some of the ways NOEMS did this. They implemented roll call for the first time, making sure that providers were receiving the most current information. They moved training online to keep their staff progressing forward. They also reassured staff that they had a plan and weren't afraid to adapt.
Dr. Nichols ended the talk by saying this is not over, we need to stay vigilant. We have all been dealing with this for so long that it is now just routine. Just because it is routine doesn’t mean it isn’t still a problem. Keep preparing for COVID-19 to spike again and use this as an opportunity to rethink your disaster planning. We mostly think about a disaster as a single event that happens and then it’s over, COVID-19 has made us reevaluate that way of thinking.
You can watch the entire recording of “New Orleans EMS: COVID-19 Lessons Learned” free on Prodigy.
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