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How Treasure Valley first responders are adapting what they do in response to COVID-19

"There isn’t clear guidance yet in terms of who needs testing (for infection by the coronavirus) and who doesn’t need testing."

BOISE, Idaho — Editor's note: The above video of Gov. Brad Little discusses the precautionary measures that the State of Idaho is taking to prevent the spread of COVID-19.

The presence of the novel coronavirus in Ada County hasn’t yet drastically changed how emergency response is handled. But Ada County Paramedics Chief Steve Boyenger said first responders are ready to change their approach if necessary.

“And we’re kind of in the same boat as the hospitals," he said Wednesday. "There isn’t clear guidance yet in terms of who needs testing (for infection by the coronavirus) and who doesn’t need testing."

He said he anticipates there will be more guidance once there is more availability for testing to see if a person has been infected by the new coronavirus. The county, as of Friday evening, has eight confirmed cases of COVID-19, which is the disease caused by the novel coronavirus.

Dispatchers currently ask everyone who calls 911 a list of screening questions before paramedics are dispatched. Those questions center on a person’s recent travel history, and whether they’re experiencing a fever or a cough, Boyenger said. Dispatchers ask these questions of every person who calls 911, regardless of their symptoms.

Additionally, he said, paramedics are using personal protection equipment — or PPE, such as gowns and masks — whenever they interact with a patient who is presenting with possible symptoms of COVID-19. Those symptoms include a fever, a dry cough, and shortness of breath.

Citing call data, Boyenger said that between March 14 and 18, paramedics have used masks in working with roughly 20-25% of patients; they’ve used gowns when interacting with about 10-15% of patients during the same time period.

Just because paramedics are wearing the personal protection equipment doesn’t mean they are working with a patient with a confirmed case of COVID-19 — it simply means they are working with someone who is displaying possible symptoms of the disease, or paramedics have reason to believe they might be at risk of exposure.

The Ada County Coroner’s Office on Wednesday also announced some of its investigators may be using protective gear as a precaution.

“This gear does not mean they are responding to a COVID-19 death,” the coroner's release states. “All cases are being treated with the utmost mindfulness of the possible hazards relating to a novel coronavirus death.”

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The concern — repeated by governments across the country and by Gov. Brad Little — is the possibility of a sharp, sudden spike in cases that could overwhelm the state’s health care system.

While that has not happened in Ada County, Boyenger said the Ada County Paramedics, along with other agencies in the Treasure Valley, have formed a work group to plan for that possibility. It means the responses of all agencies working together would be uniform — for example, each agency would have the same criteria for using personal protection equipment, said Char Jackson, spokeswoman for the Boise Fire Department.

“As of right now people will still get the same exact response they have come to expect in 911,” Boyenger said.

Still, he said, the agencies have discussed alternate response plans in case call volume spikes or a significant portion of first responders get sick.

One such possibility is based on a model first responders are using in Seattle. It involves sending one firefighter and one paramedic to calls involving a person who doesn’t appear to need immediate transport to a hospital. The two-person team wouldn’t take a vehicle used for transporting patients — thus keeping those vehicles, such as ambulances, available for when a person needs to be taken to a hospital. If the two-person team determines the patient needs an ambulance, they could call for one.

Paramedics would call ahead to alert the hospital's staff to a possible case of COVID-19. Between Monday and Friday, the Ada County Paramedics have called ahead to a hospital with 20 possible COVID-19 cases, according to Boyenger — about 5% of the agency's calls.

Everything’s sort of on the table depending on call volume and staff availability,” Boyenger said. “We haven’t done anything in terms of alternating our response goals.”

There’s currently no need for paramedics to take precautions when they go inside a hospital, Boyenger said. That’s because hospitals still have enough space to isolate every person who has COVID-19.

As of Friday, first responders in the Treasure Valley have enough personal protection equipment, according to Meridian Fire Chief Mark Niemeyer, who serves as the emergency operations commander for the group of agencies. But Niemeyer said first responders in the Treasure Valley are "very concerned about our supply."

"We're desperately working to try to find a supplier," Niemeyer said, adding that the group has about four or five people working on finding a source of the equipment.

Because there are reports of COVID-19 from across the globe, shipping from certain countries — such as China, Taiwan, and India — has decreased, even as demand for some product and materials has increased, according to the Centers for Disease Control and Prevention. That slow in trade means manufacturers have struggled to meet the new demand on certain types of personal protection equipment, such as face masks.

“Plans for surge manufacturing globally are underway,” according to the CDC’s website.

The need for access to such supplies is part of the reason Little declared a state of emergency in Idaho, he said at a press conference last week. Doing so allows him to expedite contracts and the purchase of supplies; it also lets Idaho tap into some supplies available through the federal government.

Boyenger said first responders are keeping abreast of what happens in other cities and how other agencies are handling their response of to the presence of the coronavirus.

“For now we’re asking more screening questions, we’re gowning up and masking up, we’re working closely with the hospitals,” he said. 

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