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Emergency medical services systems and providers are on the front lines of the health response to large-scale disasters, including COVID. EMS professionals in the United States have provided medical care and transportation during pandemic influenzas, importations of Ebola, and other high-consequence pathogens, but none have had the widespread systemic effects of COVID. Because of the unpredictable and, at times, chaotic nature of EMS practice, EMS providers face different occupational health risks compared with hospital-based clinicians. Infection control and prevention practices in EMS rely primarily on the provision and proper use of PPE and on universal precautions, such as hand hygiene. However, like other healthcare workers, EMS providers have been facing serious shortages of PPE. EMS agencies chronically struggle with inadequate funding, which limits their ability to stockpile appropriate PPE.51 As such, COVID is taking a dramatic toll on the EMS workforce in the hardest-hit areas. Amid record-high call volumes, it was reported that 1 in every 4 New York fire department EMS providers had called in sick and that roughly 10% of the workforce had tested positive for COVID.52 A similar but perhaps less dramatic strain on EMS is expected in other states with increasing COVID transmission. It is not clear what role infected EMS personnel may play in the spread of COVID.

The highly fragmented nature of EMS practice in the United States makes achieving systemic reforms challenging. However, recent years have seen some qualified successes. HHS’s Hospital Preparedness Program (HPP) provides a grant mechanism to enable hospitals, public health departments, EMS agencies, and other stakeholders in a given locality to conduct joint planning for large-scale emergencies, an investment that we believe has paid dividends. However, additional resources and creative thinking will be needed to more fully integrate EMS systems and providers into the larger healthcare response to high-consequence epidemic and pandemic diseases. To that end, we recommend the following:

Recommendations

• Federal, state, and local governments should prioritize and fund EMS systems and providers to receive PPE, particularly N95 respirators, on par with hospitals.
• States should integrate EMS data into COVID surveillance systems to better understand disease transmission, especially in large cities.
• In the longer term, CMS should reconsider the reimbursement process for EMS, and state and local governments should reassess the baseline funding needs of EMS.”