10 TIPS ON NAVIGATING STAFFING SHORTAGES FOR EMS AND FIRE DEPARTMENTS

Fire department staffing and COVID. The outbreak of the novel Coronavirus continues to escalate around the world, with millions of people affected. In such unprecedented and challenging times, things are even more difficult for the Emergency Medical Services, Fire departments, and designated infection control officers.

Being a highly contagious virus, COVID-19 affects the respiratory system, with symptoms including sore throat, shortness of breath, cough, muscle pain, chills, fever, and loss and taste and smell. The worst aspect is that it is highly contagious, and the virus takes seconds for a person to catch one from another.

Maintaining the necessary staffing in fire and EMS departments are essential and creating a safe working environment for first responders, with minimal disruption to services and the personal lives of responders. With the pandemic raging out of control, staffing shortages are imminent.

The nature of EMS and fire is a family, we eat, respond, work, relax, and sleep under the same roof, commonly spending more time at work than at home. In such a scenario, the departments must prepare to navigate potential staffing shortages. Here are 10 helpful tips from Designated infection control officer training to creative staffing rotations with vaccinations.

EMT

1. Reduce Staffing Issues by Reducing Exposure Time

The departments must cancel all non-essential visits and procedures for the time being. This includes station tours, outreach events, and non-essential inspections. Take advantage of Zoom or similar services to inspect homes or buildings when appropriate. We know that the time spent with a COVID+ patient is proportional to transmission chances. The more time in a patient’s home or back of the truck (>15 minutes) increases the chances we will contract COVID.  Limit your assessment time on the scene to critical actions. Does this patient need intervention right now and do they need to be transported?

The departments must provide higher-level respirators or N95 or equivalent face masks for the employees to use during all hours of their duties. While this seems obvious, when crews return to quarters they should be wearing a cloth or procedural mask at all times, while living in a communal space. Your designated infection control officer should be taking the lead on exposure time.

EMT

2. Keep Fire Department Staff on the Same Shifts- Avoid Cross Shifting Exposure

At this point, the priority of the first responders is not only to keep appropriate staff on board but also to strive to limit the spread of the contagion. It is essential to stop shuffling workers between shifts to limit the spread of the disease. Avoid shift swaps and changing of crews limits cluster events, small group outbreaks. If you do have a cluster or shift that is all COVID+ consider keeping them together and working if possible. This will depend on the severity of illness and contract/union rules, as well as the willingness of personal.

3. Provide Time and Space between Shifts for Decontamination

Since EMS and fire departments work round the clock, where one shift ends, the other is immediately ready to take over. This pattern needs to change immediately, and authorities must ensure that the facilities are first decontaminated with disinfectants before the other batch can take up duties at the end of each change. The off-going shift should begin decontamination 1 hour prior to the end of the shift, including spraying crew quarters and bays. Equipment should be pulled out of the bay, once cleaned, and checked by on-coming crews. This physical separation allows the decontamination process to complete. Keep in mind that aerosolized disinfectant should remain in a room without personal for 23 minutes. If you need to enter the room prior, use an N95.

Consider having UV lights in vehicles and common areas that can be vacant prior to the end of the shift. There is no guarantee that this will prevent transmission, the goal is reducing the chances and opportunities for transmission and keep staff healthy.

Your department’s Designated Infection Control Officer (DICO) should be taking the lead on this, with a plan tailored to your department. All fire/EMS/law enforcement agencies are required to have a DICO and alternate per federal law. This ensures that safe practices are being meet for daily operations, including NFPA 1581, OSHA, and Ryan White Law. If you do not have a DICO officer, now is the time to complete a CAPCE accredited course.

COVID

4. Consider Communal Housing

The departments must also consider setting up immediate communal housing for fire-fighter and EMS personal. Although it is an unconventional strategy, it is, however, a potential. Communal housing will reduce the risk of exposure to their respective families. However, it provides an increased risk for a cluster outbreak. This is a difficult choice for administrators, how can we best protect our people and their families while maintaining mission readiness?

5. Have a Testing Process in Place and Regular Checks of Employees

Facilities must arrange for testing processes and regular checks of the employees. Regular testing is necessary so that the authorities can identify infected persons as early on as possible. Repeat testing and regular checks are also mandatory because the very early stages of infection may cause a person to show negative but manage to transmit the virus to others.

Every employee should undergo a regular temperature and symptom check when starting and ending each shift. Testing poses unique challenges. Many people are asymptomatic and test positive and therefore they may not want to get tested as they will lose income. You may have union/contract rules that need to be upheld when testing. As a general rule, symptomatic first responders should be tested and anyone who was in close contact (on-shift/station with) someone who tests positive.

6. Remove People from Duty who are Suspected to be Sick

Regardless of how severely short-staffed a department is, it is crucial for authorities to take the initiative of removing workers from duty immediately if they exhibit any symptoms. If a worker displays any health issues, even mild ones, they should be asked to stay off work till they recover completely or have a negative test with another likely cause. We tend to think everything is COVID. If you decide to gas station sushi and have diarrhea and a low-grade fever, this is probably not COVID and you should be able to return to work when you are able to leave the bathroom. In case a worker develops the virus symptoms or tests positive, management should ensure they are quarantined and conduct tests of the others who were exposed to him/her.

7. Discuss with Neighbouring Departments on Mutual Aid of Staff

Departments must also prepare a plan for help in place. They must communicate with the state, federal, and local healthcare coalitions, as well as local public health organizations. This will help them prepare additional HCP in case a crisis does arise. Large departments may be able to access cadets of personal in training for additional support. Another option is using existing mutual aid agreements for firefighters and paramedics.

8. Use recently retired to fill in fire department staffing emergency gaps

Should departments fall severely short of staff if the virus spreads further, it will help to establish a call-back system for the recently retired members.  Allowing the recently retired individuals would increase their risk of infection, however, they would increase staffing to safe levels. Set some minimum requirements when asking for retired volunteers to help, including an age cut-off and sound health status. This is a risk versus benefit situation for both the individual and the department. Departments could deliver a quick refresher for the experienced members to launch them into duty right away. EMT and Paramedic refreshers may be completed completely online.

Firefighters

9. Set Realistic Expectations with Department Members

At this point, it is imperative for departments to take care of their first responders and families. Setting unrealistic expectations, such as mandatory attendance even if a worker displays any slight symptom, expecting workers to put in extra hours due to staff shortage, and others are unjustified. Each department needs to understand what is realistic for them on a daily-weekly basis.

The departments must address the individual members while recognizing the strain upon them in such crucial times. Hazard pay and additional benefits should be part of the compensation plan, be careful not to alienate employees during a time of crisis.

Monitor the mental health of first responders during this time with regular checks, using a standardized approach. A mental health screening form should be completed at regular intervals as well as peer and individual consoling when appropriate.

10. Have a vaccination plan for your department

The FDA has approved one vaccine for the prevention of (SARS CoV2) COVID and the second is likely to gain approval this week. The Pfizer vaccine requires 2 doses 3 weeks apart with specific storage requirements. We have seen an amazing response from military FedEx and UPS in making the delivery of the vaccine possible. While states have different mandates, each fire department must consider staffing when scheduling vaccination. Before starting your plan consider how many people are willing to take the vaccination. As an example, we will use a department with 100 members. Individuals with a history of anaphylaxis or pregnant patients should not take the vaccine. Some members will decline for various reasons. If 60 people are signed up, schedule in 1/3 increments, more than 1/3 of a shift should take the vaccine at the same time. This will reduce fire department staffing shortages in the event of vaccine reactions, which are unlikely.

Conclusion

The spread of the deadly pandemic has forced every organization and department to alter the course of their actions. While others could easily switch to the work-from-home model, EMS and fire departments cannot.

Fire department staffing shortages are imminent at this time. Chiefs and management can devise and implement effective strategies and policies to safeguard the health of their employees as they attend work.

Departments need to anticipate issues and have a plan ready to combat them as (before) problems arise. First responders need to have ownership in changes made by the department. Direct change without their input is likely to cause a rift and distrust between management and frontline personnel. Now is the time to devise, mobilize, and implement backup and alternative procedures for EMS and fire departments.

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