March 24, 2020
Emergency Medical Service union officials are speaking out against what they claim is a dangerous loosening of the occupational-safety standards for their members in dealing with the coronavirus pandemic.
They cite a shortage of personal protective equipment (PPE) including surgical masks and N95 respirators, and a change in FDNY policy requiring EMS personnel to continue working after being exposed to COVID-19 patients as long as they are not showing symptoms of the disease.
Same for Firefighters
That policy also applies to firefighters, whom the department previously instructed not to respond to certain calls that could indicate the patient had coronavirus for fear they could wind up contracting the disease and then infecting colleagues with whom they share quarters.
"They're no longer quarantining unless you're showing symptoms," Uniformed Firefighters Association President Gerard Fitzgerald told this newspaper March 19.
The previous day, EMS Chief Lillian Bonsignore explained the change by saying that "quarantining persons to prevent exposure...is of little value because the likelihood is that you and everyone have already been exposed."
FDNY Deputy Commissioner for Public Information Frank Dwyer said March 23, "The department continues to monitor usage rate for all PPE. It is a growing concern throughout the entire health-care world right now—doctors, nurses, hospitals, testing centers and first-responders."
He said the department was receiving about 4,500 medical calls daily—roughly a 5-percent increase from its normal average.
EMS Unions' Fears
The EMS unions say they are concerned that equipment shortages and continuing to deploy ambulance crews that, while not showing symptoms of coronavirus may have become infected could repeat problems encountered in Italy, which last week surpassed China in the number of virus-related fatalities amid thousands of health-care workers becoming sick, which further hampered that nation's efforts to combat the outbreak.
Initially, EMS personnel were told to self-quarantine for two weeks if they thought they had been exposed to the virus, which has already killed 100 New Yorkers and 15,000 people globally.
The FDNY reported March 23 that 46 of its employees have tested positive and two have been hospitalized.
"The watering-down of safety precautions due to lack of supplies has placed our members and their families in grave danger," said Oren Barzilay, president of District Council 37 Local 2507, which represents EMTs, Paramedics and Fire Inspectors. "We are ordinary people, with extraordinary passion to help others. However, we're not immune to COVID-19."
He continued, "Many of our members have now tested positive and countless others are sick. Furthermore, the department is refusing to send our non-essential personal such as pregnant and injured members home."
'No Regard' for Health
"Our EMS and fire inspectors are tasked to perform their duties with no regard to their well-being," he added. "Our members are frustrated and furious for the lack of preparation and no testing available to them by the FDNY."
In response to Mr. Barzilay's remarks, the department said in a statement that it was "following guidelines set forth" by Federal, state and local health officials. "What our doctors and leadership have told our members is that if you are healthy, with no symptoms, [you] need to work."
Vincent Variale, president of DC 37's Local 3621, which represents EMS Officers, said in a phone interview that he was "troubled" by what he saw as parallels between the government's COVID-19 response and how the Environmental Protection Agency during the Bush Administration less than a week after 9/11 gave the public what turned out to be an erroneous assessment that the air quality around the World Trade Center site was safe to breathe.
In a March 21 letter to their members, Locals 2507 and 3621 and the Superior EMS Officers Association wrote they had "been informed that the Department is experiencing difficulty in obtaining additional personal protective equipment. As a result of a worldwide shortage of personal protective equipment, the [Centers for Disease Control and Prevention, the World Health Organization and the state Department of Health] have altered recommendations for N95 mask usage."
The letter continued, "Accordingly, the Department has mandated that N95 masks will only be utilized during high-risk procedures. Those high-risk procedures are limited to nebulized medication administration, CPAP therapy, intubation and cardiopulmonary resuscitation. Surgical masks will now be utilized for those patients with FC call types, those that come from countries in the CDC travel advisory areas, COVID-19 positive patients and those patients who have come in close contact a COVID-19 positive person."
'Limit Members' Exposure'
The unions said that they understood it was the scarcity of the equipment that spurred the protocol changes but wanted the FDNY to consider union "recommendations to limit exposure to our members by discontinuing programs and eliminating calls that may not require our response."
In a March 18 department-wide advisory, Chief of EMS Lillian Bonsignore stated that "the bug was out of the box" and that community transmission of COVID-19 was so widespread that all New Yorkers "should consider themselves exposed to COVID-19 and should therefore self-monitor for symptoms at least twice a day."
She continued, "With sustained community exposures already occurring, quarantining asymptomatic persons to prevent exposure to others (what we call containment) is of little value because the likelihood is that you and everyone have already been exposed during everyday activities."
Ms. Bonsignore explained that the new policies, which are based on the guidance from state and Federal health officials, meant that "instead of quarantining to limit exposures between asymptomatic persons who are likely to already have been exposed, we need to isolate symptomatic people who are the most likely to spread the disease."
Includes Risky Responses
The new guidance calls for health-care workers not showing symptoms to remain on the job and applies even "to high-risk exposures defined as no PPE or PPE breach when in close contact to a [COVID-19] positive patient during an aerosol-generating procedure" like CPR, intubation or nebulization.
The FDNY bars members of the service who become symptomatic from reporting to work, and if already there, to "immediately self-isolate."
According to the FDNY policy, medical-leave documentation is not required for members to self-quarantine, and a positive COVID-19 test is not required because "false negatives may occur."
The symptoms to be wary of include: a temperature of at least 100 degrees Fahrenheit, a cough, shortness of breath, sore throat, and flu-like symptoms.
"We are going to see a curve much like Italy because we did not respond to this in a more-aggressive way in the early stages," said Don Faeth, a retired EMS Paramedic and former Local 2507 vice president who now is now an EMS instructor at LaGuardia Community College. "One of the problems with this virus is it is so communicable" and can spread without the infected person knowing it.
'System Going to Collapse'
Mr. Faeth said he has been told by active FDNY EMTs that they are getting besieged by with 911 calls to take young adults, without an underlying medical condition complaining of just fever and cough, to the hospital.
"With these call volumes and EMS members now going out sick, the system is going to collapse in the very near future," he said. "The city needs to make public announcement to save 911 for true emergencies. And not giving EMS the proper respiratory and body-surface isolation protection at this time is like not giving a surgeon a scalpel, a police officer a gun or a firefighter a hose-line."
The FDNY said it has been instructing anyone looking for COVID-19 information to call 311, and that such calls that come into the 911 system are transferred to the non-emergency information line.
The shortage of basic PPE equipment for health-care providers is a national issue, according to Dr. Patrice Harris, president of the American Medical Association.
"I am hearing stories every day where physicians are reusing masks and being asked to re-sterilize masks and the community is coming together and making masks, but this is unacceptable, this ad-hoc way of getting physicians and other health-care professionals the supplies we need," Dr. Harris told MSNBC. Mr. Dwyer said call volume was running about 4,500 medical call a day, roughly a five-percent increase.
BY BOB HENNELLY
We depend on the support of readers like you to help keep our publication strong and independent. Join us.