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COVID-19: Managing prehospital patient and family distress

This page provides strategies that emergency medical services (EMS) providers may find helpful to reduce patient and family stress in the prehospital environment.

This guidance applies to all EMS delivery models including but not limited to: free standing, municipal third-service; fire-based; hospital-based; private; independent; volunteer and related EMS providers.

Day to day operations for EMS in the prehospital care setting can cause stress and anxiety under normal conditions. During an emerging infectious disease outbreak, such as COVID-19, the number of individuals experiencing distress — and the intensity of that stress and anxiety — may be significantly amplified. This stress and anxiety can contribute to unwanted patient behaviors, increased calls from those who are anxious but not in need of emergency care, and a reluctance to follow guidance from EMS or other healthcare clinicians, which may ultimately contribute to an increase in mortality and morbidity. This document contains strategies that may be helpful in reducing patient and family stress.

The expected surge of healthcare utilization brought on by an infectious disease outbreak may make it necessary for EMS to modify their usual care practices. These modifications may be in direct contrast with the expectations that patients and families have about prehospital care and other health care, and therefore make their experience even more distressing. Listed below are steps that EMS clinicians and their medical directors can take to help patients and their families manage this distress more effectively, EMS clinicians are encouraged to adapt recommended actions based on their agencies' individual needs and practical considerations (e.g. limited resources and staff) as approved by the medical director.

Communication: take time to hear patient concerns and worries

Patients may be scared for themselves or others, may feel guilty, stigmatized, or may be worried about not only practical issues (e.g., who will take care of dependents or pets, how will bills get paid, will they lose their job), but also if they may die from the COVID-19.

Social support: help patients stay connected with their social support system

While in-person visits may not be possible, consider ways that patients can stay in contact with their social support system (e.g., family, friends, spiritual support). Consider strategies to promote social support for these populations:

If transporting alone to healthcare facility

If patient assessed and determined not to need transport

Resources for patients

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, nhtsa.ems@dot.gov, 202-366-5440