The most important thing an emergency-services agency can do to improve its effectiveness in a disaster is to guarantee the survival of its own staff. Without firefighters, police officers, emergency medical technicians (EMTs), and paramedics the fire trucks, police cars, and ambulances sit in the station; it is the staff who do the work.
During a disease-based event such as a bio-terror attack or an influenza pandemic any reduction in the staff that provides mass vaccinations and/or prophylaxis would be one of the most significant shortfalls affecting the medical response. One of the highest priorities for the staff is and always must be the vaccinations and/or prophylaxis that provide force protection for the first responders themselves.
Seen in that light, it becomes obvious that force protection is more than purchasing personal protective equipment (PPE), masks, ballistic vests, and/or turnout gear; it is also, and of even greater importance, such preventive measures as the administration of vaccines and ensuring that prompt and effective medical care is available should the risks so often involved in emergency responses overtake a responder.
In any disease-based event, force protection always will include the establishment and use of physical barriers such as masks and gloves – but it also will encompass vaccinations and the administration of pharmaceuticals such as antibiotics and antivirals. The administration of vaccine is well within the skills of a paramedic and of most intermediate emergency medical technicians (EMTs), who provide injections using the same techniques on a routine basis.
A Very Special Delivery Advocated
Some emergency planners have called for the use of mail carriers to bring Cipro or other pharmaceuticals to every house and apartment in an area threatened by a massive outbreak of disease or a bioterrorism attack. Simple logic suggests that, if the lay public – with no training and no pre-screening process – can be counted on to follow the directions shipped with the medications, trained medical personnel such as EMTs and paramedics certainly can be trusted to do the same thing. Regardless of the medication or the method of delivery, EMS professionals have both the skills and the equipment needed to deal with the most severe negative outcome possible: the overwhelming allergic reaction called anaphylaxis.
Many emergency-response agencies have instituted programs in which staff personnel are vaccinated at their work locations, usually by nurses. These programs typically include shots for hepatitis and annual influenza vaccines. Similar programs could be enacted during an outbreak to ensure that vaccines could be shipped to stations where paramedics work, and they in turn could vaccinate the other members of the staff.
Implementation of such a plan would of course require the drafting of protocols that outline a patient profile of who should not be vaccinated and/or provided medications. The same documents should spell out not only what vaccines should be administered but also under what conditions, what the anticipated adverse effect(s) might be, and, of the greatest importance, those persons who should not receive the vaccine.
Approval of such plans from the state agencies that oversee the boundaries of medical practice and those that oversees EMS regulations would have to be obtained in advance, of course. In order for paramedics and EMTs to immunize their co-workers – or anyone else, for that matter – the scope of practice must be adjusted to allow such immunization. Because any such change might require an act of the legislature – or, at the very least, approval on the part of the state oversight agency – this needs to be done in advance.
During a biological disaster, maintaining the human resources available in operational readiness translates directly into the saving of lives – and, more importantly, is the least that the public can offer those people who agree to go into Harm’s Way to save the lives of their fellow citizens.
Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.