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On a medic crew in the time of Ebola

Arlington County Fire Department firefighter/paramedic Brad Garmon checks medical equipment at the start of his shift, October 2014.
Arlington County Fire Department firefighter/paramedic Brad Garmon checks medical equipment at the start of his shift, October 2014. McClatchy

The nation’s first responders are scrambling for the Ebola surprise.

Potentially, it can erupt anywhere. Patients with Ebola-like symptoms and exposure profiles already have been identified in Los Angeles County in California; Kansas City, Kan.; and Gaston County, N.C., among other locations.

In each case, subsequent tests cleared the patients. But the onrushing flu season will propel many more feverish, vomiting and anxious patients into the backs of ambulances and medic units whose crews will be the first to respond:

In Arlington County, Va., on a recent day, Medic 102 is rolling.

First came the single tone, the fire station’s alert. Then came the dispatch: Sick person. For a crew of firefighters in northern Virginia, this is no sweat. Brad Garmon and Leanna Berger, the Arlington County Fire Department medics, set their sandwiches aside and saunter to the rig.

It’s 11:40 a.m., a routine weekday.

Right out of the station, and now there are reported complications. Dispatch adds an engine company. A second tone drops. Up come the lights and sirens. Down Wilson Boulevard we go, two medics and an embedded journalist who’s a volunteer emergency medical technician.

Arlington County sounds ready, and it needs to be. It’s danger-close to Dulles International Airport outside Washington, a major transit point for travelers from West Africa. Besides, Arlington’s crews have been training for catastrophes since even before they suppressed the Pentagon fires on 9/11.

“We’ve long been in the hazmat business,” Arlington Fire Chief James Schwartz said in an interview.

Others among the nation’s 30,000 fire departments are less prepared, particularly those in rural areas or small towns. Only 28 percent of California’s fire departments have a hazardous materials team, according to a U.S. Fire Administration census. In Texas, it’s 18 percent; in Washington state, 15 percent. This matters, because a late-stage patient’s violent shedding of the Ebola virus through every conceivable bodily fluid effectively leaves a hazardous material hotspot.

Two-thirds of the nation’s departments are volunteer-run; dedicated, but frequently stretched for reliable manpower. Civilian ambulance companies serve many cities.

With Ebola red hot, personal protective equipment manufacturers are swamped. The cost of the equipment itself can add up. Non-contact thermometers cost about $50 each. Hazmat suits are $400 or more.

“The equipment is like a run on the bank,” Patrick J. Morrison, assistant to the general president of the International Association of Fire Fighters, said in an interview. “They’re trying to get the equipment out, but there’s a backlog.”

National policy guidance, too, has lagged. Initial safety recommendations from the Centers for Disease Control and Prevention seemed unsuitable for paramedics in the field, where conditions can be rugged and unpredictable.

“There has been a disconnect,” Schwartz said. “Most of the CDC guidance was based on a health care worker in a hospital environment.”

Some of the nation’s pre-hospital vulnerabilities already have been exposed, starting in late September when a Dallas Fire-Rescue Department crew routinely transported Thomas Eric Duncan – not knowing he was infected with the Ebola virus.

Some three weeks later, with Duncan having died and two of his nurses having tested positive, a safely encapsulated Fire Department of New York team transported Dr. Craig Spencer to a hospital after he reported worrisome symptoms. Spencer, who had returned to the United States after working with Ebola patients in Guinea, remains under treatment.

The FDNY response, from the hazmat-suited responders to their post-transport decontamination by a mix of bleach and water, showcased how the U.S. first responders’ Ebola textbook is being drafted in real time.

International Association of Fire Fighters representatives met with White House officials to further brainstorm on Oct. 24. In this still-evolving new normal, there’s talk of adding to the CDC’s Strategic National Stockpile of medicines and supplies. Some firefighters think new federal grants could help fire departments prepare. Certainly, protocols are changing.

Depending on reported symptoms, 911 call-takers are getting used to asking about travel to West Africa or possible exposure to infection. Medics will ask the same questions of the patient; if necessary, from five or six feet away.

The killer word “Ebola” itself is scrubbed from the public emergency communication channels. Certain oblique phrases are preferred for the dispatch, discreetly summoning first responders to take special precautions without alarming members of the public who may be listening in.

Arlington has outfitted a utility vehicle, staffed by a medic and hazmat specialist. Officially, it’s called the Hazardous Materials Support Unit. Unofficially, it’s dubbed the Ebola Support Unit, or some dark-humored variation on the theme. Special training is springing up for fire departments, some of it online.

“The main thing that’s important to us is just the education; how the disease is transmitted, and how we protect ourselves,” paramedic Brad Garmon said.

The day’s first call was simple and sad: DOA.

B Shift had started at 0700. Engine and medic equipment were checked. Waiting for the first call, stories were served around the kitchen table like sugared coffee. There was talk of fracking, speculation about the new rookie and a discussion of wealth involving Croesus and Scrooge McDuck.

The television news personalities, turned down low in the background. periodically whispered Ebola, Ebola, Ebola. Soon, no one paid attention.

“It’s a serious threat, no doubt,” said Capt. Randy Higgins, the station commander, “but the way the media is overplaying it, it is scaring the public.”

The DOA call – dead on arrival – sounded when the Medic 102 crew was grabbing lunch. By the time the medic unit arrived on scene, Capt. Anne Marsh, the emergency medical services supervisor, was on the radio and calmly calling the case as obvious.

The medics returned to the station, the deceased’s body being someone else’s responsibility. Ten minutes later, mid-sandwich, the next call came.

Arlington County had one earlier instructive scare, an object lesson for others.

On Oct. 17, a woman complaining of vomiting and diarrhea said she had been traveling in West Africa. A full hazmat response ensued, followed by a brief showdown at Virginia Hospital Center Arlington, where emergency room managers refused to admit the patient.

The patient was driven an additional 8.6 miles to another hospital. For several hours, the Arlington medics were in limbo while officials plotted their post-exposure care, including putting their families up at local hotels while the medics were quarantined at home.

“From a public health perspective, I don’t have a lot of other options here,” Schwartz said, ticking off the few methods available for protecting both medics and their family members.

The woman soon admitted she had not been to Africa, while the Arlington hospital officials subsequently explained they turned her away because their ER’s special “bio-containment” area was still being constructed. It’s now ready, the hospital said in an Oct. 23 press statement.

At some locations nationwide, though, administrators and staff still clash over what “ready” really means. The University of California, for instance, declared on Oct. 24 that the university’s medical centers were ready for Ebola patients, while frontline workers disagreed.

“We are not prepared, not equipped, not staffed for even one Ebola patient,” said Erin Carrera, a registered nurse at U.C. San Francisco Medical Center.

Back at Station 2. The sick person with routine complications has been transported, supplies replaced, the rig cleaned. The half-eaten sandwiches get finished.

In her office, Marsh listens in on an Ebola teleconference. Various measures are underway in the Washington region, including surveys of the number of Ebola-ready transport units. The next day, Marsh will attend a walk-through demonstrating the dicey task of transferring an infected patient from a medic unit to an emergency room.

The embedded journalist leaves. The medics stay. In time, the station tones sound again. The Ebola preparations continue.

“This is so fluid. It keeps changing,” Marsh says, “and we’re going to have to keep responding.”

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