By Gaby Galvin, Staff Writer              U.S. News                  

AS HOSPITALS AND OTHER health care providers receive priority for protective gear and billions of dollars in federal funding to battle the coronavirus, emergency medical responders worry they'll be left behind.

Like physicians and other health care workers across the U.S., emergency medical responders – including firefighters, paramedics, emergency medical technicians and others – are facing severe shortages of masks, face shields, gowns, gloves and other protective equipment. Some have just a few days' worth of supplies left, organizations representing their agencies say, while others have run out entirely. But unlike America's hospitals, these emergency responders have received relatively little attention and federal funding to help them combat the virus – even though they are often the first point of contact for a patient in crisis.

"We are an extension of the health care system, but we are not being treated by our governmental leaders as essential partners in this war," says Matt Zavadsky, president of the National Association of Emergency Medical Technicians, which represents about 72,000 EMTs and paramedics in the U.S. It's unclear exactly how many medical workers have been infected since the outbreak began in the U.S. But as of Monday, nearly 500 fire and EMS personnel had been diagnosed with COVID-19, while more than 5,900 had been quarantined and thousands of others had been exposed to people who tested positive for the virus, according to a data base maintained by the International Association of Fire Chiefs, which represents the leadership of some 1.2 million firefighters in the U.S. That total does not include New York City, where about 20% of city firefighters are calling in sick every day, says Gary Ludwig, the organization's president.

"We are the ones that are treating, carrying, transporting and being exposed to these patients – not in sterile environments that you might find in hospitals, but in the streets of America," says Ludwig, who is based in Champaign, Illinois. He says he recently spoke with a fire chief who is out of protective gear and has resorted to buying raincoats for first responders to wear. Across the country, the lack of protective gear is forcing first responders to make difficult decisions. In Fort Worth, Texas, where Zavadsky is the chief strategic innovation officer for the area's EMS authority, he says the system is considering deploying one ambulance crew per shift for all potential coronavirus cases – accounting for roughly 20% of the system's call volume – in order to preserve protective gear. That would significantly slow down response times, he says."We're doing all of these ridiculous workarounds because we can't get the materials that we need to effectively manage this crisis," Zavadsky says.

In late March, Congress authorized $100 billion to pay for COVID-19-related health care expenses in what Senate Minority Leader Chuck Schumer had earlier described as a "Marshall Plan for hospitals," with $100 million specifically authorized to buy personal protective equipment and related supplies for firefighters and emergency medical services. But advocates say that isn't enough to ensure EMS organizations can effectively respond to the coronavirus. "All of us share a worry that Congress and the public would understandably believe … that the need of the people who are serving them was taken care of" when it hasn't been, says Aarron Reinert, president of the American Ambulance Association, which represents more than 550 ambulance services across the U.S.

The uncertainty comes as many of these agencies are already bleeding cash. For example, Zavadsky's EMS system typically transports 76% of calls for service to a hospital, he says. But in order to keep hospitals from becoming overwhelmed, they're working with local health systems to identify patients who can be treated on the scene instead, and are now transporting about 60% of calls. The federal Centers for Medicare and Medicaid Services, however, typically only reimburses for ambulance trips if patients are transported – so agencies like Zavadsky's have seen significant drops in revenue recently. Last week, CMS announced rule changes that will allow Medicare to pay for transportation to non-hospital locations such as federally qualified health centers, doctor's offices and urgent care facilities, easing administrative burdens and otherwise adding flexibility for EMS and ambulance services as they respond to the pandemic. But Reinert, Zavadsky and Ludwig say additional steps are needed to protect emergency medical responders in hard-hit areas, including giving them priority for equipment from the Strategic National Stockpile – the reserves of emergency medical supplies that are already nearly depleted. Ludwig additionally wants the federal government to set aside a general fund of $5 billion to $10 billion for firefighters, paramedics and EMTs that would pay for employee overtime, protective equipment and coronavirus testing, and medical treatment for those who fall ill. He also wants the fund to pay for day care expenses for emergency personnel with young children.

The latest round of federal relief allocates about $58 billion to help airlines stay open, Ludwig notes. Ideally, he says, a general fund for emergency medical responders could go toward "anything that we can do to keep our people healthy and safe." And while some state lawmakers are working to address the needs of emergency responders – such as in Minnesota, where lawmakers approved $200 billion in emergency funding for health care providers – advocates say a coordinated federal response is crucial because many practice across jurisdictions. "If emergency medical responders – whether that is police, fire, EMS – don't receive the resources and the tools that they need, and receive them quickly, we either won't have workers, or we won't have the ability to respond," Reinert says.