Patient honesty a crucial factor in keeping Peel Paramedics safe

Peel Paramedics saw its first diagnosis of COVID-19 last week. But the daily threat of exposure was present well before – and some residents of Peel had a lot to do with the reasons for increased risk faced by first responders.

On March 25, Dave Wakely, a paramedic and president of the Peel Paramedic Union, representing more than 650 workers, tweeted a statement on its Twitter account. The message was clear: patients, don’t lie to paramedics about symptoms you’re experiencing. This can have dire circumstances. It has already played a role in the exposure of COVID-19 for one Peel Paramedic, who tested positive after responding to a vehicle collision in late March when he attended to someone who needed help.

Under previous rules, if the results of a point of care risk assessment (PCRA) determined a patient was negative for the novel coronavirus, paramedics were not required to wear masks. It would only be needed if the person had received a positive test result and indicated this. “That’s what the crew did that was exposed. The person had screened negative and then there were some questions that turned out that they actually ended up testing positive,” Wakely told The Pointer. A PCRA includes questions that help determine if an interaction could result in exposure to the virus.

Now paramedics have to wear personal protective equipment during every call. “We definitely had some people that were less than forthright about their symptoms and then in the back of the ambulance they disclosed that they actually had a fever for the last three days or something,” Wakely said. 

The protocol for this comes under the guidance of the Ministry of Health, which updated its guidelines on March 30. “At a minimum, contact and droplet precautions must be used by healthcare workers for all interactions with suspected, presumed or confirmed COVID-19 patients. Contact and droplet precautions include gloves, face shields or goggles, gowns, and surgical/procedure masks,” the ministry’s website states. 

A fully sealed face mask is worn by Peel paramedics 

It’s not clear why these directions weren’t implemented sooner, given recent statements from Christine Elliott, Ontario’s Minister of Health, who said first responders, including paramedics, need to be protected.

According to an April 6 press release, the provincial government made an emergency order allowing first responders to obtain information on individuals they’re coming in contact with to determine if they’re positive for the novel coronavirus. 

This allows them to protect themselves and members of the public. To protect privacy, the shared information will only include the individual’s name, address, date of birth, and whether or not the person has tested positive for COVID-19. 

“Strict protocols will be enforced to limit access to this information and will only be used to allow first responders to take appropriate safety precautions to protect themselves and the communities they serve,” a joint statement from Elliott and Sylvia Jones, Ontario’s Solicitor General, said.

Until these recent changes, paramedics only had the honesty of the patient being helped to rely on. They were being asked about any possible symptoms of the virus when first approached.

“Whether or not a patient misunderstands or is dishonest is less important now. We still like them to be honest but we’re taking all the precautions and all the calls now,” Wakely said. He believes there are a number of reasons why people choose not to divulge their actual circumstance.

Denial is one of the main reasons, he said, as people don't want to think they’re sick.

Another reason is some people’s inability to determine their level of wellness. For example, people may not be able to differentiate between a persistent cough being the result of a seasonal allergy or a symptom of COVID-19, Wakely said. 

Some people might also be concerned they will not get the care they need if they’re honest. “People come in all shapes and sizes and they’re not necessarily thinking when they answer the question. There's competing interests they are thinking about when they answer the questions.” 

While Wakely doesn’t believe people do this in a malicious way, they seem to forget that paramedics have families and have to look after their own health, as well as the general public. 

The biggest fear among paramedics during this time is bringing the virus home to their loved ones, including young children and older adults living with them, Wakely said. “It's a strange time for everybody and everyone is trying to figure out how to exist in different roles and trying to still be a parent or a child, and also serve their community as a paramedic and that tension can create a lot of stress.” 

Wakely said the recent diagnosis in Peel was bound to happen, but it was still a shock. “When I first heard it my heart sunk because it marks the sort of beginning of the next phase and as this virus ramps up and the curve continues to climb, we’re going to see more of it,” he said.

In Newfoundland, four teams of paramedics were recently forced to self-isolate after members were exposed to the virus from calls, but only found out after, when public health officials traced their contacts to individuals they had helped who already had the virus.

At least one of those patients, according to the paramedics union there, had not been honest about their own risk of exposure from recent travel or for other reasons.

Now, the entire area served by the teams will likely have poorer paramedic coverage, while other first responders might have to fill some of the gaps, putting even more strain on them.

It ultimately boils down to people putting their own concerns ahead of others and the broader public good, paramedics across the country have said.

If the spread of the virus in Peel impacts shifts and coverage, a plan is in place to ensure service continues. Wakely said the organization has been planning for the pandemic since February 2 and has frequent meetings on emergency operations, with a group working seven days a week on the operation. 

The approach being taken in the event of required coverage help involves changing the way paramedics sign up for shifts. “[A]t a certain point the union will help with scheduling [by] using our email server to reach out directly to paramedics, and to build a list of people who are available to come in,” he said.

Peel Paramedic staff prepare supplies ahead of ambulance shifts; they currently have enough protective equipment

If things get worse and a staffing problem occurs due to the pandemic, Wakely said they have the option to lengthen shifts, which typically last an average of 12 hours. However, this is not something that's going to be implemented anytime in the near future. “It would have to be a pretty big dent before we started to routinely expand the lengths of shifts just because it is very impactful and it would have some net negative impacts that would be hard to mitigate.” 

In an increasingly anxious environment for our first responders, other types of help are also needed. While Wakely is always in favour of more mental health support, such help for paramedics will also be needed after this fight is over. “We'll have to develop plans for taking people out of the fight if it starts to be too impactful for them, but the reality is, right now everybody is geared up,” he said.

The length of the public health crisis will also dictate the amount of personal protective equipment paramedics need. At the moment, Peel Paramedics are comfortable with what they have. “Our logistic folks have been doing a great job and we are confident with our current levels of stock able to last for the immediate future.”

But things could be different a few weeks from now, Wakely said, adding to the immense pressure paramedics are already under.

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