A dual-company fire station in a typical American city of 160,000 is fully-staffed 24 hours per day, seven days a week, 365 days a year. It includes two fire companies — a fire engine (pumper) with a crew of 3-4 and a ladder truck also with a crew of 3-4, for example. It might also house a Battalion Chief and an Air Van operator who provides the bottles of compressed air that firefighters rely on to survive in a smoke-filled environment.
In other words, the station has anywhere from 8-10 personnel present there at all times. In normal times, the crews there are not only busy each day running calls, hosting community events in the public community room, giving station tours, putting up smoke alarms in the community, and training; they also have a regular stream of visitors to the station that includes family members, citizens stopping in with problems, issues, or just to say “thank you” and to give the crews some homemade baked goods.
All of that — with the exception of running the calls — has come to a sudden stop. We are not living in normal times. The fire station is now a (hopefully) decontaminated safe zone in the middle of an infected hot zone. This is Pandemic America. No more community room events. No more unnecessary interaction with the public. No more visitors to the station, of any kind. We are hunkered down. We are holed up. We respond when we have to. Otherwise, we lay low.
When the tones drop, and we have a call to respond to, it feels like we are making excursions out of our safe zone, into the infected zone, to extinguish fires, treat car wreck victims, or care for patients experiencing medical emergencies of some type. People are still delivering babies in Walmart. They are still overdosing. They are still having heart attacks. They still need us, and we will respond, and with the same sense of mission and purpose as always. We know we are lucky to still have jobs that are paying us to do what we love and that people still need us.
A change has occurred, though, in our psychological responses to these excursions outside the wire. In normal times, medical emergencies from the firefighter’s point of view are the “routine” calls. They are the most frequent type of call, by far, and normally produce the least amount of adrenaline within each firefighter. They stimulate much less “excitement” in the mind of a firefighter, in relative terms, when compared to responding for a fire in a house, for example. They are — usually — just not that complicated and do not get us too mentally worked up (with the notable exception of delivering babies out in public: that is ALWAYS stressful).
Things have changed. In Pandemic America, in the time the of COVID-19, a responding firefighter hears a medical emergency call come in, and he or she waits with breath briefly held, and a burst of trepidation upon hearing that the patient has those worrying signs and symptoms. Cough. Fever. Trouble breathing. Aches and pains. Pneumonia. When the Dispatcher provides that information, it kicks the responding crew into a new type of response.
First, we initiate a decision matrix on how to respond. Are all of those signs and symptoms present? Has the patient traveled to a heavily-infected area? Have they traveled out of the country? Have they been in contact with anyone known to have the disease? Are they currently stable, meaning that they have adequate respiration such that their body is getting enough oxygen to prevent them from becoming unconscious and possibly entering cardiac arrest?
All of those questions are swirling around in the fire crew’s collective consciousness as it responds to the incident scene. The officer might even ask Dispatch some clarifying questions: “Is the patient outside the home? If not, can they come outside? How far out is the EMS (ambulance) unit from arriving on scene?”
The fire officer will be weighing whether the EMS unit is close enough to arrive in time to handle the call without unnecessarily exposing the fire crew to the patient. The ambulance crew cannot avoid contact, as they will likely be transporting the patient to the hospital. They are going to be in full personal protective equipment (PPE): face shield, N95 mask, gloves, gown. They will sterilize themselves and the ambulance between each transport. If we can avoid exposing the fire crew to the same procedures, that is all the better for the system as a whole. It saves PPE. It saves decontamination supplies. It potentially saves multiple members of a crew from contracting the illness. All of these considerations affect the city’s emergency response system writ large.
If the fire company does need to make contact — the ambulance might still be en route and the patient is showing signs of increasing difficulty breathing — then the fire officer will make additional decisions. How many of the crew will be exposed directly to the patient? What interventions will we perform? Can the patient remain stable until the ambulance crew arrives?
The officer might decide to leave the driver in the engine. He might tell the backseat firefighter to stay at the front door of the home, in full PPE, ready to enter if needed. The officer will likely enter the residence alone if the patient cannot come outside. The officer will hopefully see that the patient is stable, not yet showing the telltale signs of severe respiratory distress — a patient in the tripod position, with the whole upper body working to gasp for breaths, or heavy sweating and a panicked demeanor, indicating that the patient is fearful that he or she is about to suffocate.
If the patient is stable, the officer will acquire some information on the patient and their current condition and medical history — all from a distance of six feet, and wearing a mask and eye protection, gloves and gown. The officer will avoid touching the patient and any surfaces inside the house. The officer will likely not take blood pressure, nor will he or she place a pulse oximeter on the patient, to check oxygen saturation, unless the patient appears to be truly struggling to breathe.
In the latter case, the officer might need to call in the backseat firefighter to prepare to administer oxygen via a mask that will cover the patient’s nose and mouth and provide high-flow oxygen via a small tank that is carried in the crew’s medical bag. That mask will not only provide the oxygen. It will also keep the patient’s possibly-infected sputum from entering the air when they cough. That is important.
At this point, the ambulance crew should have arrived. They will come in and take over unless the fire crew can get the patient outside before they arrive. Again, not entering the home is best. They will prepare the patient for transport. The fire crew will retreat back to the fire engine, for the next step in this process of coronavirus response.
The fire crew will wipe down with alcohol wipes any piece of gear that came inside the home. They will wipe down their medical gloves, then the handles of the medical bags. They will wipe down the handles to the engine doors. They will then carefully remove their PPE for disposal in trash bags brought along for the purpose. They will double bag them. They will leave them in an outside compartment. They will then use hand sanitizer before they enter the fire engine. They will spray the soles of their boots with disinfectant. When they arrive back at the station, they will further disinfect the engine. They will leave their boots in the engine bay. They will wash their hands vigorously and thoroughly.
They will do everything they can to prevent bringing any contagion back inside the fire station. They will reset to do it all again during the next call. The station is the safe zone. They have to keep it contagion-free. It is the refuge inside of which the firefighters shelter between calls, the 8-to-10 of them waiting to respond to the next call, hoping they do not catch the disease and bring it home to their families and spread it even further than it has already spread.
The firefighters will hope that that next call is a fire, which is what they are comfortable with. It is what they know. It is the familiar; It is no longer the exceptional call. That perverse reversal has become the new normal in Pandemic America. We are living in far-from-normal times.