Honolulu EMS paramedics and EMTs adapt to COVID-19 changes

During the last two months, Honolulu’s paramedics and emergency medical technicians have had to adapt to the changes COVID-19 has brought to the rest of the city — something they continue to do even now.

Brent Shimabukuro, 30, who has been a paramedic with Honolulu’s Emergency Medical Services for four years, said he would respond to 10-15 calls per 12-hour shift before COVID-19 hit Hawaii.

During the outbreak it’s been closer to half that.

“Once … the order came through to stay home, we were maybe averaging six to eight calls a night,” he said.

On March 25, Gov. David Ige ordered residents to stay home and “nonessential” businesses to close. EMS provided data to the Honolulu Star-Advertiser showing that EMS dispatchers normally received 250-300 911 calls per day for most of March.

Photo Gallery: Paramedics, emergency medical technicians adapt to changes brought on by coronavirus

Since the height of the outbreak in late March, it has received around 200 calls daily, and often fewer than that.

But Shimabukuro, who works in urban Honolulu, said his physical workload has stayed about the same.

“The physical toll on your body, I feel, is about the same, even if the call volume is less,” he said. “Taking those extra precautions and sanitizing everything every day, I feel just as tired going home as a 12-call shift.”

EMS essentially treats all callers as if they have COVID-19. Paramedics and EMTs respond to nearly every call by donning personal protective equipment: gloves, N95 masks and face shields or goggles. Sometimes they use uncomfortable gowns if a patient is suspected to have the new coronavirus.

And if a patient is transported in an ambulance, EMS will spend about 10 minutes wiping or spraying down the surfaces inside.

The constant use of PPE, cleaning and monitoring, according to Shimabukuro, is something paramedics and EMTs are getting used to.

But when the first cases of COVID-19 in Hawaii were reported, the EMS staff was shaken.

Sonya Austin, a paramedic in Nanakuli with 21 years of experience, said a fear from uncertainty was common within EMS in March, and employees did not want to come to work.

“In the beginning we didn’t really know what to do as far as protecting ourselves, so a lot of my crew at Nanakuli were very scared to go to calls,” she said. “Every day the rules were changing. Every day — every single shift.”

Austin said she had to distance herself from her family to avoid potentially spreading the virus to them. Her daughter, who is also a paramedic, had to do the same thing.

She described many others also being worried about potentially getting family sick, and said even today some are keeping their distance.

“For people with young children and people with families, they just didn’t want to come to work, and we couldn’t blame them. … They didn’t want to get their family members sick,” Austin said.

More is known now about COVID-19 and how to deal with it, so some of those initial concerns are no longer as frightening, but EMS still has its concerns.

While not dire yet, Christopher Sloman, EMS’ acting chief, said PPE shortages continue to be a problem. He projected that EMS currently has about six weeks’ worth of N95 masks if the masks are disposed of after every call.

EMS paramedics and EMTs do not need to reuse their mask — an emergency measure used by health care workers in parts of the country with extreme PPE shortages — but if the masks are believed to be clean enough, they can be sanitized up to three times using an ultraviolet light treatment.

Dan Ross, president of the Hawaii Nurses Association, said the consensus is that reusing a sanitized mask is better than using a surgical or other loose-fitting mask. But he prefers, during the pandemic, that N95 masks be used once before being sanitized and saved for emergency use only.

More masks have been ordered for EMS, but Sloman said it’s not clear when they’ll arrive.

He also acknowledged that it could be difficult becoming comfortable with some of the procedural changes EMS has made. N95 masks are known for being difficult to breathe in, and face shields and goggles are prone to fogging, but paramedics and EMTs often have to wear those throughout the day.

“We had (someone) who was in the process of intubating a person, and her stuff fogged up and she couldn’t see,” Sloman said. “Her instinct was to take it (PPE) off to do that. We scolded her a little for that, but that’s the kind of stuff that we’re going to continue to find ways to overcome.”

But with no confirmed COVID-19 cases within EMS so far, it appears its preventive measures are working.

EMS is bracing itself as the city begins opening back up. On Saturday, one day after nonessential retail stores were allowed to open, Mayor Kirk Caldwell opened Honolulu’s beaches.

Shayne Enright, spokeswoman for EMS, reported that Ocean Safety was busy Saturday and made over 250 ocean rescues. EMS had to assist with some of those rescues.

Paramedics and EMTs likely will be responding to more noncoronavirus emergencies as Hawaii continues to flatten its COVID-19 curve and people venture back outside.

The state Department of Health has reported 640 total cases in Hawaii, but in May it has recorded no more than five new cases in a single day, including zero on Monday.

Gov. David Ige in a press briefing Monday revealed a four-phase plan to reopen the state’s economy, and anticipates the health care system can keep the virus under control.

Still, Sloman said EMS likely will experience a “new normal” that could last years — or until a vaccine for COVID-19 makes itself widely available — because the virus will continue to circulate throughout the community.

“Until we get to the point where the majority of the population has immunity, then it will be a constant process, so I’m anticipating EMS will be doing things like wearing masks, having to (decontaminate) masks after every call … for the foreseeable future,” he said.

Sunday marked the beginning of National EMS Week, and Sloman said it’s special this year because of the work of paramedics and EMTs during the pandemic. He said health care workers are on the front line of the pandemic, and called EMS the “tip of the spear.”

Austin said there has been an outpouring of support from the community, and she has seen donations of PPE and even food to EMS. But for her, being a paramedic is a responsibility to care for others.

“People who cannot get to the hospital … we have to go and take care of them,” she said. “So we feel like a sense of duty, but more so, we have to take care of people.”

It’s the same for Shimabukuro.

“It’s EMS’ moment, the hospital’s moment, the rest of the first responders’,” he said. “We’ve got no choice — it’s our job. It’s our contribution to the community.”