Emergency Medical Technicians (EMTs) and Paramedics practice a largely non-scientific, protocol driven form of medicine, in completely uncontrolled non-sterile field environments with little to no direct supervision.
No matter what valid grievances other sectors had, it was the EMS members in and out of Covid infected households with 1 N95 for a week or 2 issued at most, with no access to 3m Respirator Masks. We all got exposed. 18 of us died in the tri-state area. 6 in the FDNY. Everyone clapped and kept it moving. But some of the therapies we were using of our own initiative were the right ones.
The most widely accepted treatments for Covid-19 are not outside of the practice of a regular EMT or Paramedic. They are part of our regular regime of clinical management before and during Covid-19.
According to the University of Oxford and the British National Health Service a simple set of procedures and medications routinely used by Paramedics on the basis of common sense, protocol and discretionary orders could soon be by the future routine protocol for managing COVID-19.
This combination of common procedures involves a) placing the patients prone to maximize lung surface area, b) providing hyper oxygenation via a nasal cannula set to 6 lpm and a non rebreather set to 15 lpm on two tanks c) Administration Intramuscular or Intravenous of Dexamethasone 12mg an anti inflammatory steroid d) using CPAP with mild sedation to delay or prevent intubation.
A host of expert and lobbyist driven options have all failed. There is no vaccine. Remdesivir used to treat Ebola is very expensive, in short supply and only may only mildly shorten the time it takes to recover from the infection. The FDA just withdrew emergency usages of the anti-Malaria drugs Hydroxychloroquine and Chloroquine as viable treatments for Covid-19. The overwhelming majority of Americans intubated and placed on ventilators have all died.
The Covid 19 virus directly attacks cells lining the patient’s airways and lungs which triggers a rapid oxygen desaturation and an overwhelming immune reaction called Cytokine Storm. Cytokines are part of the body’s normal immune response to infection, but rapid release in large quantities causes multisystem organ failure and death.
Dexamethasone greatly reduces inflammation caused by the immune system, protecting the tissues. In the latest British study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
This week Britain’s National Health Service has begun using the Dexamethasone as the standard treatment for coronavirus patients. The drug costs less than $1 per day of treatment on a single patient. We need these protocols properly established in New York City and the USA.
Paramedics intubate in the field (an anesthesiologists job at the ED), interpret 12 lead ECGs (a cardiologists job at the ED) and administer around 40 medications all of by protocol and clinical judgement. Critical Care Paramedics manage ventilator settings and Rescue Medics carry out field amputations, cricothyrotomies, fasciotomies, escharotomies and other field surgeries. We do all of that for not alot more than minimum wage.
During the Covid-19 Crisis, as many now know, over 17,389 people in New York City alone have perished while much of our medical establishment has remained baffled, terrified and confused. Over 120,000 largely elderly, re-currently sick and largely poor Americans have died so far. The majority of those people died inside the ER.
Push your politicians to invest in EMS. We do not have advanced degrees but we have common sense and our fingertips directly on the pulse of the community.