Laughter is heard coming from BC Emergency Health Services (BCEHS) Station 341 in Kelowna. It’s a quiet, rainy afternoon on Nov. 30, and inside, over a dozen paramedics sit on couches, chairs, warming up with beverages. It’s a rare sight at an often deserted station.
It’s been a long time since they’ve been able to sit, chat and laugh together. One smiled behind his mask, calling it “a rare treat.”
“These times right now, this is actually really valuable, when everyone’s together. Right now it’s a big deal for people to laugh about a few things,” said Kelowna paramedic Kevin Brown.
Both Brown and fellow paramedic, Jason Manuel, have combined on-the-job experience of nearly 60 years. But even for them, the last nine months have been challenging.
They say the second COVID surge of infections, at least in the Interior Health region, has proved far more difficult than the first.
Second wave, twice the anxiety
Looking back now, crews view the first wave as a build-up of anticipation. The second surge is a different story.
Although often unseen, patient transport services, or paramedics, have been playing a key role in moving COVID-19 patients to higher levels of care from rural and remote communities.
“Things are a lot more real, the numbers are quite huge, compared to what we had in the first wave,” said Manuel. Two days ago, he transported two people he’s certain were positive for COVID-19.
At the beginning of the pandemic, BCEHS crews saw an increased volume of emergency calls from those concerned about potential COVID-19 symptoms, and whether they should be transported to hospital. Now, the winter surge in COVID-19 cases has meant higher daily call volumes in some areas including Kelowna.
“It’s more real to me today than it was because we’re seeing more sick people now come in. And even though the rates of people who have become serious(ly ill) are very low, it’s still very real. I don’t know who that (next) person is going to be, I don’t want it to be me or my family.
“I’ve transported several people with serious medical symptoms of COVID … we’re being careful. These guys are sick,” said Brown.
To combat the increase in call volumes, BCEHS recently added 55 ambulances to B.C. streets and three more aircraft.
Due to patient confidentiality, paramedics don’t find out what happens to the people they transport.
“Anxiety – even before getting to work, you’re thinking about it. How many of these people am I going to see a day? Oh my god, am I going to get this? I do not want to get it. It’s worrisome,” Manuel said.
Brown is a minimizer by nature. He’s usually able to keep his worries at a distance. Lately, that’s not been the case.
“Recently (I encountered) several patients who absolutely had some symptoms that were affecting them medically to the degree that they needed our help, all of a sudden my brain kicked in to ‘I don’t want this.’ “
When COVID first hit, patients with influenza-like-illnesses were labelled as just that – an ILI. Now, due to the increase in testing and positive cases, paramedics often know if a person is COVID-19 positive before responding to the call.
As a paramedic on the front lines, Brown says cross-contamination is always on his mind.
“Making sure you’ve got everything on properly, cleaning properly. The level of importance and concern over how you spend your time with your patient, what you do with them, what you touch, because it’s very easy to cross-contaminate. That’s the main fear because I don’t want to take this anywhere,” said Brown.
He knows many people who have contracted the virus who have no idea how it happened, which also has him worried.
Manuel’s health concerns stretch outside of his work bubble. With kids in the school system, he’s also worried about them contracting the virus there.
“It’s definitely spreading, for sure, a lot more.”
Fatigue a lingering presence for first responders
Brown loves his job. He’s in his 31st year with BCEHS. He finds coming to work and helping people daily, very rewarding. But he admits the stress does build.
“I’ve noticed it in myself occasionally where I just don’t have the energy I did. And the attitude might be a little out of line at times. I’m just tired. I can see that even among other members. In the (other) room they may be laughing right now and enjoying the moment, but it has been taking an effect.
“That mental stress is very real, and it does kind of empty the tank over time.”
Methods he would regularly use to deal with this are locked away – socializing with others is restricted; likewise recreational activities. Connecting with others, even on the phone, helps him every day.
Yet because he’s been working so much, he hasn’t had much time to think about how he combats stress.
“It’s been hard, honestly. I worked 22 (12-hour) days this month. The demands are really big right now.”
Manuel is deeply thankful for his family.
“I try not to let it get to my head too much on days off,” he said.
BCEHS Central Okanagan District manager Mike Boyarski says they are acutely aware of the mental toll the job can take on paramedics, emergency medical dispatchers, call-takers and other front-line and support staff – especially now.
“There’s no doubt the COVID-19 pandemic is putting a strain on all provincial health care staffing and resources.”
Psychologic supports and services have been put in place to help address some of the impacts the work can have on the mental health of paramedics. Staff are now able to call a toll-free workplace health line if they are concerned about exposure to COVID-19.
“I’m very proud of the professionalism and dedication to patient care our frontline staff have shown throughout this crisis,” said Boyarski, adding that they continue to fight the other health crisis – drug overdoses – every day.
Paramedics in B.C. are currently responding to more than 2,300 overdose calls every month. That’s an average of 79 calls a day. In 2019, BCEHS paramedics responded to more than 24,000 calls.
The city of Kelowna generally averages about 75 overdose calls a month. In July, there were 138.
Adjust quickly; pandemic brings with it many changes
Responding to calls is not as simple as it used to be.
One of the hardest factors for paramedics to adjust to has been the increased precautions put in place when responding to a call. Now, instead of jumping into a car and heading out, paramedics must first ensure they’re in the proper personal protective equipment (PPE).
“The precautions, while they’re important, they’re difficult. You can imagine in the summertime when you’re outside and it’s 30 to 35 C, and you’re putting on masks, gowns, gloves … it’s difficult,” said Brown.
Sometimes, in more serious situations, a medical face mask must be worn under an elastomeric half-mask respirator, under a face shield. That makes it hard for paramedics to communicate with patients during an emergency.
Quick turnarounds no longer exist. If a paramedic brings in someone suspected positive for COVID-19, it takes about 45 minutes to decontaminate and get the ambulance back on the road.
Additionally, paramedics have been limited in some of the procedures they can perform, due to the potential to contaminate the area.
Administering aerosolized medications, or procedures that involve aerosolizing such as airway procedures, have been halted. As a result, higher trained Advanced Life Support (ALS) paramedics are restricted in how they can help.
“That’s very frustrating, and it’s actually very stressful because they’re here to help and do the best they can do,” said Brown. “It’s hard to fully understand why some things are put in place, but we have to abide by those rules.”
From the front seat looking out
Brown doesn’t like wearing masks, but he does so in order to protect the people around him, and foster an open society. Although the virus tends to seriously affect just a small percentage of the population, Brown said it’s everyone’s responsibility to safeguard themselves, and each other.
Driving by anti-mask protests while on the job has been hard for paramedics.
“I don’t think it’s a made-up thing. It’s real. We’re seeing it lots,” Manuel said.
“Rather than shut things down, if we can take precautions like masks, awareness, and cleaning stations, that’s a better way to go… a shut down is very difficult for a lot of people, impacting our incomes, our kids at home, the ability for parents to go to work,” Brown added.
Nevertheless, the pandemic has brought with it some unexpected positives.
In normal times, paramedics rarely received recognition for their work, especially not from people on the street. Now, they hear it everywhere. While in a store or restaurant, many people have been thanking them for their work.
“It’s neat to see that appreciation in the community,” Brown said.
The two encouraged everyone to continue to be safe, practise safe social distancing, and wear masks if you can.
They praised the efforts of all frontline workers, especially paramedics and dispatch staff.
Boyarski cautions the public to be safe.
“We need to slow the spread of COVID-19 in B.C. by pausing our social interactions, increasing our layers of protection and staying within our local communities.
“This is a small inconvenience for now, and our holiday festivities will look and feel quite different, but it’s important in our collective effort to bend the curve and reduce COVID cases and deaths across the province.”