Five Questions With: Dr. Sophia Dyer on the Boston COVID-19 Response

Boston Emergency Medical Services, a bureau of the Boston Public Health Commission, is the primary 9-1-1 emergency medical services provider for the City of Boston. With a residential service population of approximately 700,000, which traditionally increases to 1.2 million during the daytime, the department is organized as a two-tiered system offering both BLS and ALS skills.

In 2019, the 399 clinical providers of the department responded to over 127,000 clinical incidents.

Beyond providing primary EMS coverage across all neighborhoods of Boston, Boston EMS has no jurisdictional boundaries within the city, and responds to both federal and state properties, including Logan International Airport, the Port of Boston, and Boston Harbor.

EMS World spoke with Sophia Dyer, MD, FACEP, FAEMS, to learn about the department’s innovative measures to maintain the health and safety of its staff and community in response to the COVID-19 pandemic.

EMS World: Can you describe your role with Boston EMS and a few of your specific responsibilities?

Dyer: As medical director for Boston EMS I am responsible for providing clinical oversight of our service. I am an active emergency medicine physician at Boston Medical Center with a specialty in EMS and toxicology. I also serve as associate professor of emergency medicine at the Boston University School of Medicine and co-medical director for the Boston Marathon.

Can you briefly touch on some of the initiatives that Boston EMS has instituted to care for patients in your coverage area in light of the COVID pandemic, as well as for the EMS providers who are caring for them?

Early in 2020, Boston EMS established a COVID-19 Response Plan with three priority goals: (1) personnel health and wellness; (2) patient care; and (3) medical surge. Recognizing that the ability to effectively care for our patients is contingent upon a healthy workforce, we were intentional about the order of our priorities.

With a focus on personnel health and wellness, the department emphasized the importance of enhanced PPE and the institution of protective measures. These included a transition to interventions that minimized the risk of exposure for patients, providers and bystanders. These included screening of all 9-1-1 calls for COVID-19 symptoms at the point of call-taking. Early in the pandemic, screening was more focused on travel screening. That quickly progressed to assuming that all callers could be at risk for COVID-19 in the community.

Of the more than 2,000 patient encounters with confirmed cases, 84% were identified during the call screening. For these encounters, crews wore additional PPE.

Further measures included the use of in-line filters as well as avoiding nebulizers and CPAP. Protective barriers were employed, such as drapes and intubation pods, for BVM and any airway interventions. Our goal was to reduce aerosolization, minimizing the risk of exposure for our providers and patients.

Your infection control measures include a dedicated control team. How does that operate?

Our focus on personnel health and wellness quickly emerged as a whole-team effort. Boston EMS’ Designated Infection Control Team (DICO) rapidly expanded to include three full-time nurses and one infectious disease physician. The team concentrated on reviewing potential personnel exposures along with following up on suspect and confirmed COVID-19 patients to ensure proper use of PPE.

Through the use of a chatbot designed by a local university, automated daily text messaging allowed the team to perform case management for personnel self-reporting symptoms. When necessary, the team was able to remove exposed and/or ill personnel from the schedule and arrange for testing.

Ill members (uniform and non-uniform), both COVID and non-COVID, receive support daily. A clinician, either physician or nurse, checks in via call or text. Additional resources consisted of peer support, drop-off of meals, groceries, and prescriptions, housing for those where home isolation is a challenge and care packages including acetaminophen, hand sanitizer, mask, thermometer, snacks, fluids, and finger pulse oximeter.

What were some of the positive results?

The role of the expanded DICO team, operating in a confidential capacity, allowed for quickly identifying potentially and infected members and allowed for more extensive support of those who are ill or exposed. The work of the team effectively mitigated exposures to personnel and their households. If necessary, through the work of the DICO team, members could also request housing at city-sponsored locations to achieve necessary isolation or quarantine settings.

As Boston EMS moves forward, the department continues to refine these functions. One initiative to come out of this work is the need to connect members to primary care physicians.

Which of these initiatives do you feel might have a long-term impact at Boston EMS?

COVID-19 will have many short- and long-term impacts on EMS. Boston EMS plans to sustain the expanded infection control support for personnel as we progress forward to a potential secondary wave, and as part of an essential function, recognizing the risks associated with this work even when not faced with a pandemic.

A comprehensive designated infection control program can be rapidly stood up. With the support from leadership, funding and the ability to adapt procedures, EMS providers will be supported as they deal with COVID in the community. This will allow our providers to better treat their patients with fewer outside stressors and risks associated with their own safety.

Look for an in-depth article profiling Boston EMS and its DICO team in our October issue.

Jonathan Bassett, MA, NREMT, is editorial director at EMS World. Reach him at jon@emsworld.com