Though first responders are out on the front lines exposing themselves to potentially infected residents every day, the place that one Brooklyn-based firefighter is most concerned about catching the virus is right in his own station.
"There are firehouses that went from not one infection to 7-10 infections in a week," said the FDNY firefighter, who spoke with 鶹ý on condition of anonymity.
Teams are cautious on medical calls, he said, but he's one of the only members of his station who takes the precaution of wearing a surgical mask off-duty, and who practices social distancing when cooking or spending time in common spaces: "I'm concerned about it," he said.
"People are going to get serious, people are going to wear masks in the firehouse," he said. "But it hasn't hit them personally."
New York City's first responders -- paramedics, EMTs, firefighters, and police officers -- continue to man the front lines of the COVID-19 epidemic, despite dwindling amounts of protective equipment and an increasing proportion of their workforce out sick. They are struggling to avoid getting sick, while working increasingly demanding shifts and managing call volume surges.
Vincent Variale, president of the Uniformed EMS Union Local 3261 in New York, said that normal medical call volume is about 4,000 calls a day. Now, EMS providers are responding to more than 6,500 calls daily.
They're also managing longer work days, rationing protective gear, and following guidelines that continue to change as hospitals overcrowd with patients.
Last week, for instance, New York City enacted . If paramedics and EMTs cannot save a patient who is in cardiac arrest in the field, they are being instructed not to take them to the hospital.
"We're used to dealing with horrific situations and we're used to dealing with death," Variale said in an interview with 鶹ý. "But now it's coming at an accelerated rate."
A Diminishing Workforce
"We had a staffing problem before the crisis," Variale said, but the virus has made it far worse.
Thanks to COVID-19, about one in four of the 4,000 total paramedics and EMTs in New York City are now on medical leave. Variale said that EMS providers are working 16- to 17-hour days during the pandemic, some sleeping in their cars at night to avoid the possibility of infecting their families at home.
But EMS is not the only line of response with an increase in members on sick leave. The FDNY has lost nearly 18% of its workforce to medical leave as of Monday, said Deputy Commissioner Frank Dwyer in a statement to 鶹ý. Officials from the NYPD have said that Monday -- 19% of the total workforce.
Reed Smith, MD, operational medical director for fire and police services in Arlington County, Virginia, told 鶹ý that his department is preparing for staffing shortages as they see more COVID-19 cases.
"We need 80 people a day to show up, roughly," Smith said of his fire department, which is adjacent to Washington, D.C. "How do we function if only 50 show up?"
"We are planning on having wide, wide losses in our personnel," Smith said. "And so we're looking at what we call alternative dispatch, dropping units, and all kinds of different ideas on how we function with a reduced workforce in a higher volume of calls."
In addition to preparing for short staffing, Smith said his fire department is also limiting unnecessary exposure of personnel to prevent more members from getting sick.
"When we do attend a call, we will only send in an assessment team," Smith said. On normal medical calls, the fire department sends a team of six firefighters to respond to the scene. But as any patient puts first responders at risk of exposure to the virus, Smith has limited initial response teams to just two firefighters. The assessment team, consisting of two firefighters in full protective equipment, will leave the remaining responders outside.
In some cases, the team of two may treat the patient in the field. But if the patient requires further care, they'll call in additional responders. "As opposed to six people being exposed on a call, we're seeing maybe four at the most, if they need help lifting and moving the patient," Smith said. In many cases, the two-person assessment team can handle a call by themselves, Smith said.
This not only limits exposure of personnel, but also saves protective equipment.
Protective Gear Shortages
In addition to more of the workforce calling out sick, first responders are struggling with a challenge that is impacting healthcare workers across the country: an inadequate supply of protective equipment.
Phil Petit, the national director of the International Association of EMTs and Paramedics, said that EMS workers across the country have been struggling to obtain masks. "We represent about 80 different shops across the country and in around 30 states, and their number one concern has been PPE, primarily masks," Petit said in an interview with 鶹ý.
In New York, this shortage of masks has prompted instructions to firefighters that they , including intubation, asthma treatment, and cardiac arrest care.
Variale, the EMT/paramedic union president, objected to that FDNY guidance on masks. "They're basically downplaying the importance of wearing an N95 mask all the time, and it's endangering our health and safety," he said.
The FDNY's Dwyer said his department has updated its policy, requiring responders to wear a surgical mask during all medical calls. "CDC now recommends the use of face coverings when in public places," he said. "FDNY goes one step further, mandating surgical mask use for all medical responses, other than aerosol generating procedures (which require an N95), and during all close proximity work."
But masks aren't required in the firehouse: "Surgical mask use will be optional during all other work hours," Dwyer said.
Dwyer added that "FDNY is working tirelessly to obtain adequate supplies, but all healthcare workers are in need."
Robert Duval, northeast regional director of the National Fire Protection Association, said that he cannot imagine the struggle of first responders in major cities to get necessary amounts of protective gear. As a volunteer firefighter at a small, rural station in Connecticut, he added that a surge in cases may only leave his department with enough protective equipment to get through the end of the month.
"We're going to look at our stockpiles a lot differently," Duval said in an interview. "I don't think anyone's going to let the strategic stockpile go down anymore, or get as old as it was. That complacency, I guess, is going to have to go away."
After the Crisis
The stress of constant call surges and changing procedures leaves first responders under an immense amount of stress, Smith said. "We're changing on a daily basis, and it's creating a sense of discomfort and anxiety among everybody." He added that healthcare workers and first responders alike will need increased mental health resources after the crisis dies down.
"It's a hard enough job" in normal times, he said. "I think the psychological effect of this on the first responder is going to be a little more intense and unique."