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The Roles of EMTs and Paramedics at COVID-19 Testing Sites
The benefits of drive-through COVID-19 testing are well-documented.1–4 The prehospital provider is uniquely equipped to staff, and in many cases lead, the operations of these testing facilities. Hundreds of the makeshift sites that have begun to operate nationwide are being staffed by EMTs, nursing staff, and similarly trained medical providers. With COVID-19’s persistence in the United States, we will likely continue to see EMT and paramedic involvement with these sites. It is important to understand the inner workings you are likely to encounter working at one.
There are varying leadership structures and operational plans at each of the roughly 780 testing sites across the United States.5 However, many share overlapping characteristics. You typically go through a training process before your first shift. Per several providers’ experiences and also from the Arizona Department of Health Services, this training is often minimal and offers the chance to ask specific questions to experienced site staff about procedures.6 The structure of staffing and individual roles is discussed by the CDC in a June 2020 guideline report.7
Find a range of drive-through testing procedures and resources via HHS’ TRACIE healthcare emergency preparedness information gateway. These detail typical flows of screening, registering, and testing patients. As with most recommendations, six feet of distance is advised between stations to promote social distancing. Oversight and staffing of these stations are usually carried out by advanced practitioners or officers from the U.S. Public Health Service Commissioned Corps.
Whether the site is a drive-through outdoor location or a makeshift area tented inside or close to an emergency department, a separate space for temperature checks is usually the initial point of contact with patients. CDC recommendations are for 2–3 providers to spearhead these screening areas.7
The patient’s testing process begins with the provider ensuring they are wearing a face covering, informing them of the general process for testing, and then directing them to registration. One or more providers (staffing depends on volume and bandwidth) then interviews the patient about travel history, potential exposure to COVID-19, and other general questions. After the interview patients are instructed on how to administer the nasal swab or the provider obtains the sample from the patient directly.
Operational Details
One interesting operational detail comes from a change in personnel: After initially relying on registered nurses and advanced-practice providers to staff stations, some federally funded testing sites have gradually transitioned to utilizing EMTs and paramedics.8 To accommodate this shift in personnel, they implemented more streamlined operational procedures—for example, instead of using nasopharyngeal swabs (which require RNs and APPs to administer), operations utilizing EMTs have switched to nasal swabs.
Because these are simple tests the patients carry out themselves, sites have adopted systems of passing prepackaged tests and instructions to the patients in their cars with six-foot poles. In addition, without the need to come into direct contact with the patients, the need for higher-level PPE (e.g., N95 masks, Tyvek suits, PAPR hoods, etc.) is greatly reduced. EMTs can expect to be provided with gloves, surgical masks, and disinfectant sprays in sites that have adopted similar operational procedures. Regardless of PPE standards, of course, regular disinfection of the workstation, including equipment, pens, chairs, and tables, is mandatory.
In addition to handling samples, EMTs have the added responsibility of managing other stations like registration. At drive-through testing sites, patients may simply roll down windows and verbally provide demographic information to EMTs. Alternatively, patients may hold up documents (e.g., a driver’s license) to the window, allowing EMTs to copy information onto registration forms.
Regardless of specific operational procedures, healthcare providers should feel confident they will be separated from patients through physical barriers or six feet of distance.
The process for COVID-19 testing is still evolving. As we seek to manage cases in the United States, it is important that EMTs and paramedics have a proper sense of the structure of mobile testing sites if they are to work in these environments. With greater familiarity of COVID-19 testing procedures, prehospital providers will be able to further contribute to the national effort of containing the virus.
References
1. Kwon KT, Ko JH, Shin H, Sung M, Kim JY. Drive-Through Screening Center for COVID-19: a Safe and Efficient Screening System against Massive Community Outbreak. J Korean Med Sci, 2020; 35(11): e123.
2. Ton AN, Jethwa T, Waters K, Speicher LL, Francis D. COVID-19 drive through testing: An effective strategy for conserving personal protective equipment. Am J Infect Control, 2020; 48(6): 731–2.
3. Flynn EF, Kuhn E, Shaik M, Tarr E, Scattolini N, Ballantine A. Drive-Through COVID-19 Testing During the 2020 Pandemic: A Safe, Efficient, and Scalable Model for Pediatric Patients and Health Care Workers. Acad Pediatr, 2020; 20(6): 753–5.
4. Molling PE, Holst TT, Anderson BG, et al. Drive-through Satellite Testing: An Efficient Precautionary Method of Screening Patients for SARS-CoV-2 in a Rural Healthcare Setting. J Prim Care Community Health, 2020; 11: 2150132720947963.
5. SoKat. Location of Drive-Thru COVID19 Testing Sites across America, https://covid19.sokat.ai/.
6. Arizona Department of Health Services. The Drive Up Model for Mass COVID-19 Testing, www.ncsddc.org/wp-content/uploads/2020/07/Drive-UP-Model-for-Mass-COVID-19-Testing.pdf.
7. Centers for Disease Control and Prevention. National Center for Immunization and Respiratory Diseases (NCIRD), www.cdc.gov/ncird/index.html.
8. Morrissey J. Proactively Expanding the EMT and Paramedic Scope of Practice. EMS1, 2020 Jul 10; www.ems1.com/ems-products/education/articles/proactively-expanding-the-emt-and-paramedic-scope-of-practice-AGaAY167MGfOqVCs/.
Joshua Yu, EMT-B, is a student pursuing BA and MD degrees from Rutgers University and Robert Wood Johnson Medical School, respectively. He is a clinical information manager at Monmouth Medical Center in Long Branch, N.J., and was actively involved with COVID-19 testing as an EMT in New Jersey.
Christopher Gaeta, EMT-B, is a student at Swarthmore College. He has been published in several peer-reviewed journals in the field of emergency medicine and has garnered one of the largest LinkedIn networks among individuals his age, with approximately two million professionals following his posts and updates.
