12/09/2020
Washington County COVID-19
Continuation of Emergency Medical Services Plan
I. Purpose:
This document is intended to be a guide to provide a continuation of emergency medical services to the citizens in Washington County, Maryland during the COVID-19 Pandemic. These adjustments may be necessary due to a myriad of reasons, such as reduction of available responders due to illness, exposure restrictions or increased response demands.
II. Scope:
The Washington County Continuity of EMS Operations Plan establishes tiered guidelines for the daily operations and long term mitigation of the COVID-19 pandemic in the community.
III. Goals of Plan:
To adopt a system-wide COVID-19 pandemic response plan within Washington County that specifically addresses these three goals.
1. Protecting those we serve
2. Protecting our personnel and
3. An EMS delivery system that is sustainable
IV. Expectation Statement:
1. It is the expectation that during these challenging times of the COVID-19 pandemic, the eight independent EMS service delivery organizations will take all necessary actions to maintain the required minimum staffing levels of the essential services you are charged to provide.
2. The RSF 4 deliverables to the stakeholder from within the expectation statement are to provide a single point of contact with the development scheduler position, creation of a dashboard that will identify any COVID-19 position vacancies, and craft an alternative EMS deployment plan.
V. Operations Section Leaders Intent:
1. The response to the COVID-19 pandemic should be flexible, scalable, dynamic, and timely with the ability to change rapidly based on addressing the critical needs on the system. Emergency Medical Dispatch protocols have been modified reducing call types Charlie to Bravo level determinants. Alternative response staffing matrices are developed to meet our minimum essential services.
VI. Recommended Staffing Processes:
1. To maintain operational readiness and response capabilities during exigent circumstances of the Covid-19 pandemic, a creative out of the box process is needed to meet daily staffing minimums. All eight independent EMS service delivery organizations operating policies vary in how essential personnel are deployed to meet the mission. It is recommended to fulfill the vision and mission (i.e. mission essential functions) of the Washington County EMS Operations program to collectively manage ourselves as an adhoc single system. These guidelines will provide direction to increase or decrease staffing in response to pending or emerging exigent needs for each EMS station. It recommended that during this pandemic response the following actions be implemented.
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2. When deemed necessary
a. Participate in a shared Staffing model with other companies from within the EMS operations program
b. Temporarily revoke any PTO use and allow for carryover of PTO hours into next calendar year
c. Temporarily suspend Kelly Days
d. Modify work schedules
e. Temporarily implement an interim policy for mandatory holdover to the minimum level required
3. Prior to having to implement any of the above recommendations this plan is suggesting the following processes to meet the daily staffing requirements.
a. Fill all essential positions through your established normal process.
i. Part-time Staff
ii. Voluntary Overtime to Full Time Staff
b. The company point of contact notifies the EMS scheduler 72 hrs. in advance when possible of vacancies. This will serve as an awareness notification. The EMS
scheduler has developed a comprehensive essential position dashboard to display gaps in the schedule.
c. The EMS scheduler will send out a Mass Message to all the designated company point of contacts requesting personnel to be shared to fill an essential position. The
priorities will be first to fill designated ALS slots first, with BLS being secondary.
d. The scheduler will then communicate outcomes of his solicitation with requested companies.
e. No response of solicited personnel will lead to the notification of the need for DES staff to Deputy Director Chisholm.
f. If all efforts have failed. The company is expected to implement a mandatory hold over, to prevent any lapse in minimum service deployments.
VII. Response Tiers:
1. Tier 1 Operations:
a. In cooperation of the eight independent volunteer EMS service delivery organizations, Washington County Division of Emergency Services and the Washington County
Emergency Operations Center will modify daily EMS delivery operations to a Tier 1 Operations based upon the following trigger points:
i. The confirmation of a COVID-19 patient in Washington County and EMS
units begin actively responding to incidents with COVID-19 symptomatic
patients.
ii. The confirmation of COVID-19 EMS providers in more than two companies.
2. Tier 1 response operations move three ALS staffed transport units to three BLS transport units. The ALS providers are placed into chase cars that will be deployed based on call determinants or upon request by the BLS unit.
3. To reduce the potential stress on the current responders and to meet the plan requirements, an alternative staffing plan has been developed. An evaluation was completed of potential cross trained county employees that arenât currently assigned to the Division of Emergency Services. Also, cross-trained staff assigned to the Division of Emergency Services – Emergency Communications Center were evaluated for reassignment. These cross trained county employees will backfill the necessary BLS positions outlined in the table below.
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Table No. 1 Tier One Alternative Staffing Deployment Plan.
| Unit Utilization | Service Delivery Level | ALS Staffing Needed | BLS Staffing Needed | ALS Support / Chase | ALS Supervisor | Alternative Staff Utilization BLS Staff | Total Daily Personnel Required |
| 19-1 | ALS | 1 | 1 | 2 | |||
| 2-8 | ALS | 1 | 1 | 2 | |||
| 26-8 | ALS | 1 | 1 | 2 | |||
| 26-9 | BLS | 2 | 2 | ||||
| 49-1 | BLS | 1 | 1 | 1 | 3 | ||
| 59-1 | ALS | 1 | 1 | 2 | |||
| 69-1 | ALS | 1 | 1 | 2 | |||
| 75-1 | ALS | 1 | 1 | 2 | |||
| 75-2 | BLS | 1 | 1 | 2 | |||
| 75-4 | ALS | 1 | 1 | 2 | |||
| 75-5 | BLS | – | 2 | 2 | |||
| 75-9 | ALS | 1 | 1 | 2 | |||
| Duty 75 | 1 | 1 | |||||
| ALS 75-10 | 1 | 1 | |||||
| ALS 75-11 | 1 | 1 | |||||
| 79-1 | ALS | 1 | 1 | 2 | |||
| 1811 | 1 | 1 | |||||
| 1812 | 1 | 1 |
Daily Minimum EMS Unit and Staffing Summary:
| Summary of Deployment- Daily Units | Summary Daily Staffing Requirements |
| ALS Transport 9 | ALS Providers 12 |
| BLS Transport 4 | BLS Providers 15 |
| ALS Chase Units 3 | Alternate BLS 2 |
| ALS Sups 3 | ALS Sups 3 |
VIII. Tier 2 Operations:
1. Washington County RSF 4 Operations section will transition daily operations to Tier 2 prior to major deployment challenges that can be forecasted based off the daily monitoring of the ability to sustain ALS and/or BLS coverage will to include; provider availability, shortages of ALS or BLS providers, provider fatigue due to overtime (mandatory and/or volunteer), call volumes and consistency of coverage in areas throughout the County.
2. A decision to modify or collapse any portion of the service delivery model will be made through analysis of the benchmarks above, with emphasis on reducing the impact of necessary changes to the system as a whole.
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Table No. 2 Tier Two Alternative Staffing Deployment Plan.
| Unit Utilization | Service Delivery Level | ALS Staffing Needed | BLS Staffing Needed | ALS Support / Chase | ALS Supervisor | Alternative Staff Utilization BLS Staff | Total Daily Personnel Required |
| 19-1 | BLS | 2 | 2 | ||||
| 2-8 | ALS | 1 | 1 | 2 | |||
| 26-8 | ALS | 1 | 1 | 2 | |||
| 26-9 | OOS | ||||||
| 49-1 | BLS | 1 | 1 | 1 | 3 | ||
| 59-1 | ALS | 1 | 1 | 2 | |||
| 69-1 | BLS | 1 | 1 | 2 | |||
| 75-1 | ALS | 1 | 1 | 2 | |||
| 75-2 | BLS | 1 | 1 | 2 | |||
| 75-4 | ALS | 1 | 1 | 2 | |||
| 75-5 | BLS | 1 | 2 | ||||
| 75-9 | ALS | 2 | |||||
| Duty 75 | 1 | 1 | |||||
| ALS 75-10 | 1 | 1 | |||||
| ALS 75-11 | 1 | 1 | |||||
| ALS Chase ?? | 1 | ||||||
| 79-1 | BLS | 2 | 2 | ||||
| 1811 | 1 | 1 | |||||
| 1812 | 1 | 1 |
Daily Minimum EMS Unit and Staffing Summary Tier Two:
| Summary of Deployment- Daily | Summary Daily Staffing Requirements |
| ALS Transport 6 | ALS Providers 10 |
| BLS Transport 5 | BLS Providers 13 |
| ALS Chase Units 4 | Alternate BLS 2 |
| ALS Sups 3 | ALS Sups 3 |
3. Below is a visual reference only to reflect graphical deployment of the EMS resources. EMS transport station circles are an illustration of a 5-mile radius from their station address. The ALS chase cars are identified with the larger circles illustrating with a coverage area of a 10 milesâ radius from their assigned station address.
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4. Potential Impact of a Pandemic: No area of the United States has been to be spared from some impact of the COVID-19 virus. In terms of its scope the impact of this pandemic may be more comparable to that of a war or a natural disaster. This pandemic has presented significant challenges to the public we serve and how our response organizations may be capable of serving our citizens.
5. In the event the response capabilities of the above tiered response become stressed, and reach critical mass thresholds additional strategically planned operational drawdowns will be essential. When demand for services is greater than the available supply additional physical assets will be requested from Washington County EMS organizations to be staffed by alternative personnel resources previously listed.
6. Daily and weekly statistical evaluation of call volumes, station status reports and Covid-19 exposure and confirmed positivity contact data will be utilized in the decision making process to implement additional drawdown to essential services.
7. As staffing capabilities are at critical mass, the following are some of the actions that may be anticipated:
a. All ALS transport units will be reduced to BLS only. Available ALS providers will be strategically located to provide a county wide ALS chase system.
b. EMS transport units may be âbrowned outâ if the exigent circumstances are based on NON peak hours for services.
c. Prior to complete system collapse an Emergency Management Assistance Compact (EMAC) request will be processed.
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X. Normal Operation Restoration:
1. When progressive Tiers are implemented, this guideline will be regularly evaluated. Given the situation, the Operation Section Chief after consultation with the Unified Incident
Commanders will institute a plan to gradually return operations to pre implementation of this plan.
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