There are no known cases of COVID - 19 in the Lincoln area yet, but as the number of cases increase throughout Montana, Lincoln's emergency medical services are changing how they respond to calls in preparation for the likelihood coronavirus will come to the Upper Blackfoot Valley.
"A trauma call, anything, we have to treat them as if they have COVID-19," Lincoln Volunteer Ambulance President Aaron Birkholz said.
With only about a half dozen EMTs available to respond to calls in Lincoln, precautions are paramount, since even suspected exposures could deplete their ranks rapidly.
"We have a plan that only one person goes in and makes contact. That person has to be completely gowned up," Birkholz said. That includes gloves, a mask, face shield and a medical gown for the EMTs. Patients will also be masked, gloved and wrapped in a blanket to further limit possible exposure. "As soon as you get a mask and gloves on that patient, your risk of exposure is really low because you're stopping the way it spreads."
Trauma calls or accidents will provide additional challenges, but Birkholz said they will do their best to limit exposure on those as well.
Ambulance and QRU members are also required to sanitize themselves and their equipment as soon as they return from a call, which means washing clothes, showering and disinfecting their shoes before heading home.
The measures may seem a bit extreme, but Birkholz explained the use of full personal protective equipment is vital, given Lincoln's limited pool of medical responders. If an EMT comes into contact with a suspected COVID-19 patient without the proper equipment, or feel they may have been exposed to someone with the virus, they have to go into a 14-day quarantine.
Potential exposure can be difficult to gauge. Testing in the state has been increasing, but Birkholz said the only people currently being tested for coronavirus are those showing symptoms, and he explained they can't afford to take chances. According to the Centers for Disease Control and Prevention, people can be contagious for up to 14 days before symptoms show up. The CDC recently warned that as many as 25 percent of infected people may not even show symptoms. "That's why we're treating every patient like they have it."
The precautions kick into a higher gear with additional protocols if they find themselves treating a suspected COVID-19 patient who's exhibiting symptoms such as respiratory distress and high fever.
They've designated one of their ambulances solely for use in transporting symptomatic patients. The ambulance is being modified with a Plexiglas barrier between the cab and the patient compartment to help protect the driver, and it features a cot outfitted with a shroud - a frame of PVC pipe covered with plastic sheeting – for an additional layer of protection. As an additional safeguard against unnecessary exposures, only one EMT will ride in the back with the patient.
The change in approach means a substantial increase in use of protective gear and sanitizing products, which brings with it the challenge of having enough equipment on hand to ride out the pandemic.
"We're in desperate need of Lysol spray. That's the only way we're able to completely sanitize our ambulance," Birkholz said. They have a variety of sanitizing wipes they use for the hard surfaces in the ambulance, but some of their equipment needs to be disinfected with a spray. They would normally just go to the store to buy more, but after the Gov. Steve Bullock's stay-at-home order was announced last month, disinfectant sprays have been sold out.
They are currently well stocked on N-95 masks and gloves, but need face shields, standard cloth masks that incorporate some type of filtration and gowns. Standard medical gowns, or even gowns sewn by local volunteers, can be used, but Birkholz said they've been looking for Tyvek suits that provide full-body protection.
The supplies have been nearly impossible to come by. Although volunteer ambulance services play a vital role in rural communities, the high national demand for PPE has seen suppliers, including Amazon, giving priority to hospitals.
"Any other place we've gone to doesn't have any. Our normal EMS distributors, they are out of everything," Birkholz said. During a meeting with the state Friday, he requested equipment, but learned they're sending it all to the hotspots in the state. "All of us little volunteer EMS, ambulances, we're on our own."
People who have learned of the challenges faced by Lincoln EMS have begun to come forward to help. Birkholz said Roger Brandenberger with the Lincoln Sewer District donated several Tyvek suits, and five more came from Sherwin Williams in Helena. Meanwhile Dena Hooker in Ovando is making 25 masks for the LVA, and Jackson Orthodontics in Helena offered to donate masks as well.
Lincoln Fire Chief Zach Muse is also working with the county to get supplies. Lewis and Clark Public Health is looking to source face shields, masks and hand sanitizer in bulk for county agencies, including Lincoln Fire Rescue.