PREPARED FOR THE WORST

By ANDREW MCGINN

a.mcginn@beeherald.com

Paramedics and EMTs didn’t always wear latex gloves.

It’s now just protocol — few patients, if any, would feel as if medics are implying they have HIV.

The same can’t yet be said for respirators.

Michele Madsen, director of Greene County Ambulance, admittedly startles some people these days when she enters their home, her head encased in a powered, air-purifying respirator.

“Some people are like, ‘Jesus, we don’t have Covid,’” Madsen said.

With disarming honesty, Madsen typically informs them, “Nobody’s special in this world. We wear this for everybody.”

With all due respect, it’s entirely possible you are, in fact, spewing SARS-CoV-2 — the virus that causes COVID-19 — every time you open your mouth.

Like other health care professionals, emergency medical services personnel have had to rethink how they provide care amid the ongoing coronavirus pandemic.

“We prep for the worst-case scenario,” Madsen explained recently. “As long as we’re dressed to protect ourselves, we don’t have to worry about exposures.”

But with the need to often start interventions with limited information inside tight and sometimes uncontrolled spaces, theirs was already the most dangerous health care job. These workers aren’t just on the front line — they’re far forward.

“That’s what we sign up for. We know the risk,” Madsen said. “We’re all a little cray-cray around here.”

Since the pandemic began, Greene County Ambulance has responded to each call for service clad in gowns, gloves, masks and face shields, at a minimum.

The county-owned ambulance service has also recently obtained four of its own powered, air-purifying respirators, or PAPRs. Among them are two helmeted CAPRs, costing $1,400 apiece, that are less bulky.

Two limited-use PAPRs — made by the Ford Motor Co. in partnership with 3M to meet a surge in demand during the pandemic — feature the kind of yellow hoods better associated with an outbreak of Ebola in the Congo than chest pain in Cooper.

But there’s good reason for extra precaution as COVID-19 runs roughshod over Iowa. Gov. Kim Reynolds in a live address on Monday said one out of every four hospital patients in Iowa has the virus. Greene County’s COVID-19 positivity rate exceeded 26 percent on Tuesday.

An article in September on the site EMS1 — a news site for the EMS community — asserted that EMS personnel are at a higher risk of dying from COVID-19 than other health care or emergency services professionals. While the actual numbers are unknown, at least 36 EMS clinicians were known to have died from COVID-19 between March and early September.

The pandemic’s relatively slow arrival to rural Iowa provided ample opportunity for local medics to ease up on precautions.

“There came a point when we all wanted to relax,” Madsen confessed. “Everybody wanted to let their guard down.”

She urged staff to stay the course.

“And then it happened,” she said.

Cases locally spiked.

In less than a week, Greene County Schools pulled up stakes and went online, and Greene County Public Health announced the first death of a local resident related to COVID-19.

Madsen said they’ve gone on calls in which Covid wasn’t suspected — only to find out later that Covid was, in fact, present.

“Prepare for the worst and hope for the best is our motto here,” she said. “Any call could become exactly that: a Covid call.”

Unfortunately, Madsen said, she and her medics are just as likely to be exposed by their own children at home than on the job.

Her school-age kids, she said, have already been quarantined twice.

“The grocery store clerks at Hy-Vee are at risk of being equally exposed,” she said. “You just don’t know.”

But just as latex gloves offer protection from blood-borne pathogens, Madsen suspects that masks and respirators to protect against respiratory disease are probably here to stay for EMS.

“Now we’re adapting to the fact that masks are going to be part of it,” she said.

“Change is hard for everybody,” she added, “including EMTs and paramedics.”

Change also comes with a cost.

Madsen in August ordered a new case of blue, three-ply surgical masks. The price: $1,079.60.

“A year ago,” she said, “we could have gotten that box for 300 bucks.”

“I need them,” Madsen reasoned. “They send them. I pay. I have to have it to protect my staff.”

And speaking of that staff: Madsen has a staff of seven full-time employees and 14 part-timers. Early on in the pandemic, she gave the part-time employees the opportunity to remove themselves from the schedule, no questions asked. She said she understood if none wanted the extra risk.

“None of them,” Madsen explained, “wanted pulled from the schedule.”

“That speaks to their character,” she said. “The people here genuinely care about this community. Their concern is not of themselves.”