NFPA Journal - May/June 2020 - 41

to improvise and think outside of the
box." Maes has created a new website,
covidfirstresponse.com, to collect
and share information submitted by
responders around the world about the
creative ways that they are stretching
their limited resources, even if it means
those solutions lack code compliance
and come with a use-at-your-own-risk
caveat. It includes crowdsourced information about crafting filters for SCBA
masks, methods for disinfecting PPE,
instructions for 3D printing gear, and
much more.
To aid in the effort, NFPA has also
released a tip sheet with guidance
drawn from NFPA 1581, Standard on
Fire Department Infection Control Program, which outlines several measures
that responders can take to minimize
their exposure while also conserving
PPE. This includes having dispatchers ask patients to meet responders
outside, if possible, where the risk of
virus transmission is lower, as well as
instituting protocols to save the most
high-level PPE, like N95 respirator
masks, for the highest-risk calls.

LESSONS LEARNED
While these crisis standards have been
necessary to get response agencies
through this unprecedented moment,
most experts believe that the normal
routine protocols for staffing and caring
for patients will mostly return once the
pandemic is over. That does not mean,
however, that everything will or should
go back to how it was, Montes said. As it
has done with so many other aspects of
society, the COVID-19 crisis has illuminated some of the pain points inherent
in the US emergency response system,
and onlookers are hopeful that this
could lead to several systematic changes.
One fissure that's been exacerbated
during the pandemic is the inadequacy
of how emergency medical services are
funded, Montes said. Unlike hospitals
and the rest of the health care system,
which receive funding from Medicare/
Medicaid and private insurance for care
given to patients, EMS and fire-based
EMS are paid in most cases only for
transporting patients to the hospital.
However, during the pandemic,
paid and volunteer EMS agencies have

stepped up by offering free COVID19 testing and by caring for patients
outside of hospitals to ensure that
medical facilities don't collapse under
the volume. A survey published April
21 by the National Association of EMTs
found that more than 60 percent of
EMS agencies are using these treatand-release protocols rather than

"FIRE DEPARTMENTS
AND EMS PROVIDERS ARE
BLOWING THROUGH
BUDGETS BUYING PPE AND
DOING ALL OF THESE THINGS
THAT HELP THE HEALTH
CARE SYSTEM SURVIVE,
BUT THEY'RE GETTING
NOTHING FOR IT, WHICH IS
WILD. IT IS NOT RIGHT. "
transporting, but that an astounding 87
percent of those agencies are not getting paid for those services.
"This has been a huge issue that
responder associations are battling,"
Montes said. "Fire departments and
EMS providers are blowing through
budgets buying PPE and doing all of
these things that help the health care
system survive, but they're getting nothing for it, which is wild. It is not right."
Another longstanding issue that has
only worsened under the weight of the
pandemic is the plight of volunteer
fire and EMS agencies, which make up
about 80 percent of departments in the
United States and service about a third
of the population. Departments already
suffering from shrinking membership
and growing demand for services have
been crippled further by an inability
to hold fundraisers or recruit and
retain new members during the current emergency. "Some departments
may not have the savings to continue
to operate," Jonathan Dayton, the
vice president of the Allegany-Garrett

Volunteer Fire and Rescue Association,
told a local newspaper in April. Calls
for more state and federal funding for
these agencies will likely grow louder,
especially as residents see how indispensable these services are during the
pandemic, Montes said.
Lastly, one of the most visible failures in response to the COVID-19 crisis
has been the inability to procure and
distribute enough equipment to supply
frontline workers. In the recent IAFF
survey, 58 percent of fire departments
reported that state officials are unable
to supply them with needed PPE.
Although researchers and academics
will debate the many causes for this
shortfall, the importance of having a
cohesive strategy from the get-go is
already a clear lesson, Montes said.
Response experts think in the future it
would be wise to handle the response
to public health emergencies much like
we do natural disasters and implement
longstanding emergency management
systems much sooner in the process.
Typically, when a disaster like a hurricane hits, state and federal emergency
management systems are activated,
triggering a systematic approach for
collecting and allocating resources to
the affected areas, as outlined in NFPA
1600, Standard on Continuity, Emergency, and Crisis Management. If run
as designed, the federal government
leverages its substantial buying power
to procure equipment at the best prices
and then distributes it down the chain
in a targeted way based on needs data.
That approach has been implemented
only sporadically during the pandemic
and much too late, Montes said, putting
federal and regional emergency managers at a significant disadvantage.
"Instead, we have a system where
entities are bidding against each
other-health care networks are bidding against states, and government
entities like fire departments are bidding against private EMS providers for
needed PPE," he said. "Where the PPE
goes isn't necessarily based on who
needs it the most. The lesson for the
future is to treat these public health
emergencies like disasters and engage
emergency operations-the FEMAs of
the world-sooner."
N F PA . O R G / J O U R N A L * NFPA JOURNAL

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NFPA Journal - May/June 2020

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