ACEP COVID-19 Field Guide

Tips for Emergency Medical Services personnel

Developed by the Healthcare Resilience Task Force Behavioral Health Work Group; and adapted by the Prehospital (911 and Emergency Medical Services [EMS]) Team

This guidance applies to all delivery models including, but not limited to, free-standing, third-service, fire-based, hospital-based, independent volunteer, and related emergency medical service providers.

Day-to-day operations for Emergency Medical Services (EMS) in the prehospital care setting can cause stress and anxiety under normal conditions. During an emerging infectious disease outbreak, such as COVID-19, the number of individuals experiencing distress — and the intensity of that stress and anxiety — may be significantly amplified. This stress and anxiety can contribute to unwanted patient behaviors, increased calls from those who are anxious but not in need of emergency care, and a reluctance to follow guidance from EMS or other health care clinicians, which may ultimately contribute to an increase in mortality and morbidity. This section contains strategies that may be helpful in reducing patient and family stress.

The expected surge of health care utilization brought on by an infectious disease outbreak may make it necessary for EMS to modify their usual care practices. These modifications may be in direct contrast to the expectations that patients and families have about prehospital care and other health care and may therefore make their experience even more distressing. Listed below are steps that EMS clinicians and their medical directors can take to help patients and their families manage this distress more effectively. EMS clinicians are encouraged to adapt recommended actions based on their agency’s individual needs and practical considerations (eg, limited resources and staff) as approved by the medical director.

Communication: take time to hear patient concerns and worries

Patients may be scared for themselves or others and may feel guilty or stigmatized. They may be worried about not only practical issues (eg, who will take care of their dependents or pets, how bills will get paid, whether they will lose their job), but also if they will die from COVID-19.

• When talking with patients, speak to them directly and talk calmly and clearly.
• Acknowledge the challenges to effective communication presented by personal protective equipment (PPE) (eg, masks, face shields, and other barriers that limit nonverbal expression).
• Reassure patients that you want to minimize any discomfort or concerns they may have about the care they are receiving.
• Although there may not be clear answers or solutions, try to display openness and honesty to the best of your ability.
• Have difficult conversations with family members or patients as needed (eg, We cannot transport you to the hospital [or to the hospital of your choice] because you are not ill enough to go to the hospital).
• Reflect back what you have heard the patient say and identify the emotion that the patient is communicating.
• Patient: “I want my family to go to the hospital with me.”
• Provider: “It’s normal to feel scared in this situation, and it’s important for you to connect with your family. But at this time, it is safer for them to stay home while we take you to the hospital.” (If local hospitals have policies in place to not permit family or visitors in the hospital, explain that as well.)
• VitalTalk provides practical advice on how to have difficult conversations. The site provides tips and scripts specific to COVID-19, and these resources are also available on an app.
• Make sure to take time to speak with family members about care and treatments.

Social support: help patients stay connected with their social support systems

While in-person visits may not be possible, consider ways that patients can stay in contact with their social support systems (eg, family, friends, or spiritual support system).

• Consider strategies to promote social support for these populations.
  • Allow patients to bring their phone or tablet; and
  • Remind patients to bring the necessary chargers.
  • Do they have access to a phone or tablet to keep in touch with their social support network?
  • Do they have access to telehealth or telemedicine resources?
• If transporting patients alone to the health care facility:
• If patients are assessed and determined not to need transport, ask:

Resources for patients

The National Child Traumatic Stress Network’s “Parent/Caregiver Guide to Helping Families Cope With the Coronavirus Disease 2019”