Interactions between first responders and patients have changed over the past two years.
Before COVID-19, they aimed to comfort, assuring people in an emergency situation and their families that they were in good hands.
Now, those conversations often take on a darker tone.
“When they’re super sick, it’s important to say [to family], ‘Kiss your wife goodbye because you can’t go to the hospital, and if she gets intubated, she may not get extubated,’ ” recalled Bradley Riley, a firefighter and paramedic with the Keene Fire Department. “... We do a lot more of the conversations where this may legitimately be the last time you talk to your wife, your son, your daughter.”
These mental hurdles have only been exacerbated by the latest surge of the viral disease (from late November to February), which resulted in a spike in COVID-related emergency calls and sicker people needing help.
This extra psychological weight can affect first responders’ mental health, adding even more risk to an already dangerous profession.
“This is very different. It looks different ...,” said Keene Deputy Fire Chief Don Farquhar. “It is this persistent strain on emergency services, as a system and as emergency service providers.”
Challenging, and changing, protocols
It’s difficult for individual fire departments to track every COVID-related call, according to multiple local fire officials, but all of those interviewed by The Sentinel agreed there have been significantly more of them in recent months.
Across Cheshire County, there were nearly 11,500 emergency medical calls in 2021, and about 1 percent of those had a patient with a confirmed COVID-19 diagnosis, according to data provided by the N.H. Department of Safety’s Division of Fire Standards, Training and EMS. Another 5 percent of those calls involved someone with respiratory symptoms or with suspected COVID-19.
However, there are likely more COVID-19 calls than data show, according to Director Justin Cutting.
“That ... depends on the provider’s assessment and then the manner in which they complete the patient care report. So COVID-19 is an option [to classify the call as], but if they haven’t confirmed it, they may categorize it as something else,” he said.
Riley, along with other area firefighters and EMTs, stressed that COVID-19 calls are in addition to all the other types of 9-1-1 calls they receive.
He explained that at the start of the pandemic in 2020, most people were hunkered down and often didn’t need first responders’ help unless they were sick from the virus.
Many avoided hospitals altogether, Riley recalled, out of fear of contracting COVID-19.
“Now, fast forward a year and a half later, and people are living normal lives, so normal injuries and illnesses are happening [again], and COVID is still happening ...,” he said. “It’s added another comorbidity, if you will.”
The ever-changing nature of the virus and its variants presents further complications for first responders, including frequent protocol changes.
These protocols are set by the state, Cutting explained, so each fire department and emergency response service in New Hampshire adheres to the same ones.
The biggest change amid COVID-19 has been talking with patients about whether they need to be taken to the hospital — a conversation that wasn’t allowed pre-pandemic.
This “can be used as an effort to reduce the number of patients in hospitals that could be managed with at-home care ... to reduce the spread of COVID and the surge at medical facilities,” Cutting said.
For example, if a person calls 9-1-1 with mild COVID-19 symptoms and first responders determine their vitals are fine, the paramedic will explain that there isn’t much the hospital can do to help them, so it’d be best for them to stay home.
The only exception — regardless of symptom severity — is for those who have underlying medical conditions, which increases their risk of developing serious COVID-19 complications, according to Cutting.
If someone with mild or moderate disease still insists on going to the hospital after talking with first responders, the crew cannot refuse, and the ambulance will still take them.
Often, these discussions are complicated.
Peterborough Deputy Fire Chief Matthew Robblee said it’s “challenging” to question whether someone needs to go to the hospital.
“I read someplace that the average person calls for an ambulance just a couple times in their life,” he explained. “So when they call ... to them, it’s a big deal. If they dial 9-1-1, that is a big event in their lives. And now, here I am, as a health care provider, telling them they don’t need me.”
Sometimes, however, a patient’s diagnosis is more severe than they realize, and hospitalization is required.
As Riley of the Keene Fire Department said, the first responders have to explain to that person’s loved ones there is a chance they won’t see them again.
He — along with Keene Fire Lt. Greg Seymour and Keene Firefighter and Paramedic Bradford Keay — described the heavy toll these interactions take.
“There’s a massive amount of weight that goes with it. It’s hard to compare. You feel that weight when you’re talking to the loved ones [who are] panicking,” Keay said.
“And we have to be blatantly honest ...,” Seymour added. “We have to make sure they understand.”
Other aspects of the revised protocol add another layer of difficulty — they’re time-consuming.
Decontaminating a truck, for instance, now takes four times as long as it did before the pandemic, even with the help of advanced equipment like sanitization power sprayers.
“It [used to be] a 15-minute thing that happens ... but with COVID-positive patients, that can take up to an hour,” said Robert DiLuzio Jr., co-owner of DiLuzio Ambulance Services in Keene.
DiLuzio added that the service has had to give calls away to other agencies because it was backed up cleaning its trucks. The same goes for the Keene Fire Department, according to Lt. Jeremy LaPlante.
Peterborough hasn’t had that issue.
“We have been fortunate with having the four (4) in-service ambulances that we have ... We can just take a different truck,” Fire Chief Ed Walker said in an email.
But not being able to take calls can also happen due to ongoing staffing shortages, especially when multiple calls tend to come in simultaneously, firefighters say.
“It puts a lot of weight on people’s minds that I need to be in two places at once, and there’s no possibility to do that,” Seymour said. “That’s anger and frustration that people bring home with them as well, and it gets downloaded on our family, either on purpose or on accident.”
The amount of personal protective equipment now required on a scene — face masks, gowns and gloves — and having to don and doff it for every call can also eat up valuable time.
Another challenge comes from the limited amount of hospital beds that were available for patients in the latest surge.
The number of COVID-19 inpatients overwhelmed hospitals in New Hampshire and beyond, leaving many people waiting in the emergency department for a bed to open up.
This meant that not only were local hospitals full, but so were the ones they’d typically transfer patients to when needed.
DiLuzio crews have driven patients as far as Poughkeepsie, N.Y. (just over a three-hour drive from Keene). The Keene Fire Department has driven patients to Boston, and in Peterborough, EMTs have traveled all the way to Burlington, Vt. (both of which take about two hours).
Typically, the maximum ambulance ride for a crew before COVID-19 would have been between one and two hours.
Robblee, of Peterborough, said the extra drive time takes a toll on providers mentally and physically.
“If you can imagine, you’re in the back of this truck for three or four hours without the ability to use the restroom. You don’t get to take a break or a snack. You’re in there in full gear. Most of these patients are acutely ill ...,” he said. “It becomes much more complicated.”
Coping with COVID stress
All of these factors — in addition to worries about contracting the virus themselves — have turned an already demanding job into a nearly impossible one, with limited resources available to help first responders cope.
A national study from August 2021, published in the Journal for Emergency Medical Services, shows that 88 percent of the 122 first responders surveyed reported feeling more stressed amid the pandemic. Seventy percent said their mental health had worsened and 33 percent said they were considering changing careers because of COVID-19.
In the short term, the survey’s authors suggest that emergency service agencies find ways to boost morale and provide mental health help.
Without this help, grappling with these issues can be even more dangerous than the line of duty.
Firefighters are three times more likely to die by suicide than die on the job, according to the National Fallen Firefighters Foundation. They are also at increased risk of suicidal thoughts and behaviors, regardless of if they are active in the field or retired.
Front Line Foundations, a peer-based nonprofit in Bellows Falls for first responders and veterans dealing with trauma, is one way people can seek help.
Clinical Manager Jennifer Sell Knapp said that while she hasn’t seen an increase recently in people coming to the program — which opened its doors to clients in October 2020 and has helped 50 people so far — the conversations are almost all about COVID-19.
The increased call volume and its repercussions is the struggle she said she hears about most often.
“Our first responders were maxed before then, because of not enough staffing and the opioid crisis and all those [other] calls, and COVID is certainly not helping with that. It’s only making it harder,” Sell Knapp, a retired firefighter and paramedic, said.
She added that frontline workers dealing with these issues should talk to one another about them. This can help them stay grounded and be more aware of their emotions, according to Sell Knapp.
The foundation is also available to people in need of further help.
One of its programs — a two- to four-week resiliency program — works with people to talk about their stressors and gives them specific skills to help deal with them, both on and off the job. The foundation also offers individual counseling.
Most health insurances cover the cost of all of its programming, but Sell Knapp said anyone under- or uninsured won’t be turned away.
She added that the foundation helps not only the person who comes in, but also those around them.
“We view what we do as giving all of our clients the tools, the solid foundations, they need to help save themselves ...,” Sell Knapp said in an email. “We also view it as a sort of ripple effect ... Their well-being and good mental health directly impacts each of the lives they touch every day in their work on the ambulance, in the police cruiser, and on the fire truck.”
Keay, of the Keene Fire Department, said he utilized the foundation during a dark period.
“It’s been a huge, huge thing for me. I like to say it kind of saved my life. I was going down a path that was a struggle, and it was a game changer,” he said.
Other times, he’s turned to his fellow firefighters to blow off steam.
“The best thing for us is just the kitchen right here in the fire department. Just the back and forth, how we handle it, joking around with our struggles,” he said.
While this helps, these stressors will likely continue, with no near end in sight to the pandemic.
First responders will, too, despite them.
That doesn’t mean it’ll be easy.
“That’s what they are called to do, is to help people, so of course they will over-extend to help cover shifts and to take care of everybody,” Sell Knapp said. “But it’s at a cost to them and their wellbeing.”
To make an appointment with the Front Line Foundations, call 802-732-2518 or email flf@frontlinefoundation.org.
For immediate mental health assistance, Monadnock Family Services offers 24/7 care to Monadnock Region residents at 357-4400. New Hampshire also offers a similar service at 833-710-6477 or through its hotline at 9-8-8.
If you are experiencing thoughts of suicide or know anyone who is, contact the National Suicide Prevention Lifeline at 1-800-273-8255.
Funding of the Monadnock Region Health Reporting Lab comes from several sources, including The Sentinel and several local businesses and private donors. We thank these donors, most of whom wish to remain anonymous, for their backing, and we continue to seek additional support. The newsroom maintains full editorial control over all content produced by the lab.