Resident Eagle: Surge Protectors—How New Orleans EMS Coped With COVID

Resident Eagle is a monthly column profiling the work of top EMS physicians and medical directors from the Metropolitan EMS Medical Directors Global Alliance (the "Eagles"), who represent America’s largest and key international cities. For information on the Gathering of Eagles 2022, see useagles.org.

At the National Association of EMS Physicians’ 2022 annual meeting in San Diego, New Orleans physician Meg Marino, MD, will deliver a presentation called “Overcoming Obstacles in the Implementation of COVID Surge Plans: Lessons Learned for the Future.” As deputy medical director for New Orleans EMS (NOEMS), Marino will speak from experience: New Orleans was hammered early on by COVID-19, with its situation made worse by pandemic-induced budget cuts, employee sickness, and burnout/absenteeism.

“March 9th, 2020 was when we really started seeing several COVID-positive patients, and that was only because that's when we started really testing for it,” Marino recalls. “It became very clear that we'd had COVID in our community for some time before that. This is why we went from having zero cases to lots and lots of cases very quickly.”

To cope with this onslaught, NOEMS implemented some innovative surge plans to bolster its EMS response. Marino will discuss those in further depth at NAEMSP 2022. 

“We really looked at our surge plans as a series of levers,” Marino says. “They could be turned on or off as needed to deal with the heavy influx of patients.”

Volunteer Drivers

Relying on volunteers is nothing new for NOEMS. They often ride along as third persons in NOEMS ambulances to lend an extra pair of hands as needed. But when COVID-19 hit, the city gave NOEMS permission to train and deploy volunteer EMTs to join the team.

This helped NOEMS maintain service during the worst of the pandemic. “Instead of having two employees on each ambulance, we were able to have one employee and one volunteer EMT on board to stretch our workforce,” says Marino. “That was especially important because we had a large number of our employees out sick with COVID or COVID symptoms.”

Telephone Support 

Even during COVID-19, NOEMS had to field requests from minimally affected patients seeking ambulances. “We were getting a lot of 9-1-1 calls from people who just needed COVID testing or had very mild symptoms,” Marino says. “These are patients who really didn’t need an ambulance.”

To keep serving their needs while reducing demand on NOEMS’ fleet, “we quickly put some light-duty paramedics in dispatch and allowed them to talk to the low-acuity patients over the phone,” she says. “They referred these patients to local resources for COVID testing, helped them get in touch with their doctors, and things like that. This proved to be something useful we can turn back on whenever call volumes get high and our resources are relatively low. 

“We are hoping to expand this to include a telehealth triage-from-9-1-1 program to use year-round. I think teletriage from 9-1-1 would further reduce the number of low-acuity calls our crews spend time on and allow us to focus our resources on the patients who need in-person care.”

Surge Units

Surge units are staffed ambulances hired from other providers that can be deployed at times of excessive calls and low staff resources. “We were able to call in surge units to help us during the first wave in March–April 2020 and more recently during the delta variant,” says Marino.  “They have been invaluable in helping us cope.”

The downside to surge units is that FEMA and state units are not always available, and private units can be quite costly. NOEMS did receive some financial support for this through the American Rescue Plan.  

“We had our crews running more than 15 calls a day on 12-hour shifts,” Marino says. “This led to a lot of burnout, stress, and increased staff turnover. Having these surge units has not only increased the number of units on the street to provide better care for our patients and decrease response times, but it's also allowed us to provide just a little bit of breathing room for our staff.”

Extra BLS 

Until COVID-19 hit, NOEMS exclusively provided ALS services on its ambulances. Once COVID was in full force, the agency opted to add lower-cost BLS services to its lineup for those calls where BLS would be sufficient. “This allowed us to put more trucks on the street at a time when our resources were stretched very thin,” says Marino. “It's really made a big difference because a lot of our calls can be safely handled using a lower level of care. It’s another way we can conserve resources and decrease response times for higher-acuity calls.”

Reduced Time With Nonviable Arrests 

At the height of the pandemic, NOEMS reviewed its data for surge plan ideas. The agency had to balance resources in demand while also recognizing that for cardiac arrest patients, viability was significantly diminished after the first 10–20 minutes of resuscitation. Certain cardiac arrest patients meeting specific criteria who showed no response after 10 minutes of resuscitation were not likely to respond after 30 minutes, which was the NOEMS standard. 

Hence, during March–April 2020, when cardiac arrest cases were soaring, NOEMS opted to reduce resuscitation times in such cases to 10 minutes. 

Doing so just wasn’t only a matter of freeing up crews: “Every minute of CPR we were doing was putting our people at risk of exposure to COVID-infected bodily fluids,” Marino notes. “We wanted to make sure we were going the full 30 minutes only in cases where we were really able to potentially save somebody's life. As well, if you're running multiple codes back-to-back all shift, decreasing that time by two-thirds can actually make things just a little bit easier during a really terrible situation. It can also free up ambulance crews a little bit sooner for the patients we are able to save.”

NOEMS has returned to its 30-minute CPR protocol now that its case load has dropped.

If you're at the NAEMSP show in San Diego, catch Marino's presentation at 1:30 p.m. PST on January 13, 2022.

James Careless is a freelance writer and frequent contributor to EMS World.