Mitigate COVID-19 Absenteeism: Protect EMS Workers
The resilience of our nation's emergency response system depends on our healthcare workforce's ability to report for duty. Critical supplies, equipment and surge capacity rely on dedicated, trained health professionals and support staff to enable care. This page contains general concepts you can use to prepare and take action in order to help your EMS/911 agency protect your workers' psychological health and well-being.
Prepare your workforce for what is to come before the surge takes place
- Organize peer support—staff-to-staff and family-to-family—to provide assistance with tangible needs like childcare, dependent care, pet care, and food and medication delivery.
- Assist staff to locate resources to establish emergency plans for childcare, dependent care, pet care and family communication to mitigate absenteeism due to urgent needs at home.
- Encourage staff to pre-arrange their home to accommodate quarantine or isolation should the staff member require quarantine or become ill (as not to spread infection to other household members).
- Develop a plan to provide boarding on or near the work site for staff who are unable to commute, have a long commute or are concerned about infecting family and friends.
- Establish workforce housing by setting up dormitories, acquiring hotel space, or converting unused areas of the facility.
- Ensure plans account for non-medical staff (e.g., administration, billing, medical supplies, fleet maintenance, etc.).
- Consider setting up shuttle service for employees, or designate drivers for staff working unusual shifts or prolonged hours.
- Check with your local and state emergency operations centers to identify available resources and plans that may help with this need.
- Encourage staff to develop a personal stress management plan to address exercise, nutrition, sleep, mindfulness and relaxation.
- Provide staff with guidance and resources to support personal stress management. Additional information is available from the Centers for Disease Control and Prevention (CDC): see Taking Care of Your Emotional Health and Stress and Coping.
- The Substance Abuse and Mental Health Services Administration (SAMHSA) has useful behavioral health resources on COVID-19 and coping, including a fact sheet for Tips for Social Distancing, Quarantine and Isolation.
- Pre-identify behavioral health resources in your area such as local behavioral health providers, American Red Cross chapters, Medical Reserve Corps units, telemental health services, as well as grief and loss resources for staff who may lose patients, colleagues, or loved ones.
- Use the SAMHSA Treatment Locator to identify behavioral health providers in your area. Identify behavioral health providers in your area that may have specific experience treating EMS clinicians.
- View the American Psychological Association's Grief: Coping with the Loss of Your Loved One.
Support your workforce effectively during the surge
EMS clinicians may not be able to use the coping mechanisms that they typically rely on to manage stress. Teaching and encouraging the use of simple relaxation techniques may help to decrease their physiological arousal levels and focus on something besides the situation at hand.
- Maximize opportunities for effective sleep.
- Relaxation techniques such as deep breathing, progressive muscle relaxation, and guided imagery can help telecommunicators focus on decreasing the intensity of their distress. (Mindfulness Coach and Breath2Relax apps.)
- Provide opportunities while working for stress reduction activities i.e. comfort dogs, exercise.
- Direct EMS leadership and senior staff to role model good stress management, empathy and psychological support. Organizational policy should support the workforce and a culture and climate of safety. (Free online course through the National Association of County and City Health Officials: Building Workforce Resilience through the Practice of Psychological First Aid-A Course for Supervisors and Leaders.)
- Establish bi-directional communication and a mechanism for staff to make recommendations to leadership through use of dedicated email or a physical suggestion box.
- At each shift change provide briefings on the current status of the work environment, safety procedures and required safety equipment.
- Work with the agency to develop a plan of judicious and strategic days off or leave.
- Establish a behavioral health (or resilience or fatigue management) safety officer who will regularly monitor staff stress, coping and fatigue management and provide guidance, recommendations and corrective action as needed. This important role needs to be empowered by leadership and leadership should be committed to adjusting course based on feedback and ground truth.
- Stress compromises the immune system and affects physical health. Address staff stress and fatigue with organizational strategies.
- Establish and adhere to regular breaks throughout the shift to mitigate fatigue. Limit overtime whenever possible.
- Rotate workers from high-stress to lower-stress functions and monitor and adjust to address fatigue related to diurnal/shift timing issues.
- Monitor and evenly redistribute increased workload resulting from staff illness or accidental exposure.
- Establish communications capabilities so that staff can communicate with loved ones and connect with their social supports through internet, video and telephone.
- Designate a quiet room or area for staff to use to facilitate rest during breaks.
- Develop a strategy to ensure that healthy food, water, refreshments, hygiene and comfort items are readily available without the need to leave the facility.
- If staff are sheltering in place at the facility, ensure access to:
- Exercise equipment.
- Information such as newsletters, social media or television.
- Facilities and supplies needed for hygiene (e.g., showering, teeth brushing, laundry).
- A means to get needed medications and capability to support personal medical equipment (e.g., CPAP).
- Assign experienced staff to mentor and support newer staff and develop just in time onboarding materials to orient staff new to work site, including screening and infection control practices. Ensure newer staff are familiar with CDC's guidelines on COVID-19 infection control.
- Ensure staff know how to access psychological support through available mechanisms such as Employee Assistance Programs, Critical Incident Stress Management (CISM) teams, members trained in stress or psychological first aid, and the Disaster Distress Helpline.
- SAMHSA's Disaster Distress Helpline provides 24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters (1-800-985-5990 or text TalkWithUs to 66746).
- Ensure staff know how to access telehealth/telemedicine resources.
Download this guidance
This guidance was developed by the Federal Healthcare Resilience Task Force (HRTF). The HRTF is leading the development of a comprehensive strategy for the U.S. healthcare system to facilitate resiliency and responsiveness to the threats posed by COVID-19. The Task Force's EMS/Pre-Hospital Team is comprised of public and private-sector EMS and 911 experts from a wide variety of agencies and focuses on responding to the needs of the pre-hospital community. This team is composed of subject matter experts from NHTSA OEMS, CDC, FEMA, USFA, U.S. Army, USCG and non-federal partners representing stakeholder groups and areas of expertise. Through collaboration with experts in related fields, the team develops practical resources for field providers, supervisors, administrators, medical directors and associations to better respond to the COVID-19 pandemic.
Primary Point of Contact: NHTSA Office of EMS, firstname.lastname@example.org, 202-366-5440