Century Ambulance vs. Pandemic

 

Think how health care partnerships unfolded in pre-pandemic times. Sometimes there was stop and go progress; sometimes partners found themselves at cross purposes; sometimes competition got in the way of forward momentum; sometimes health disciplines worked in silos unaware of impact on others … even with the best intentions.

 

Now during this one-of-a kind experience, Century Ambulance has reenforced its value to the Broward County area, with a business plan utilizing the company’s community and professional knowledge and disaster prep planning mindset.

 

“By identifying changing needs and allocating health care heroes (EMT’s and paramedics skilled in basic and advanced care) and supplies we aim to avoid or at least limit catastrophic crisis situations experienced nationwide due to COVID-19,” Matt Johnson, General Manager said.

 

 Bolstered by their foundation as a forward-thinking transportation and logistics partner in community health care, Century Ambulance is weathering the pandemic amidst significant changes in roles, equipment, staffing and operations.

 

For example, the pandemic turned the patient population drastically askew with slowdowns and cancellations of elective surgery, annual procedural check-ups and postponement of non-emergency health visits resulting in 50% fewer discharges which translated to decreased demand for ambulance transport. Additionally, demand for all event stand-by staffing disappeared as sports competitions, school events, concerts and community fairs were cancelled. Still, the dangerous effects of the coronavirus via infections from exposure to asymptomatic and symptomatic patients created new and heightened concerns for safety and infection control. Specific routines for cleaning facilities and equipment, supplying and utilizing hand sanitizers and social distancing techniques are top of mind for all staffers.

In 2018 when Century Ambulance expanded into the South Florida market, they entered as more than just patient transportation and sought to fill a role as a logistics partner with health care leading institutions providing patient pre-hospital data and tele-care and remote communications to medical professionals during transport. This foundation of knowledge and advanced preparation allowed them the flexibility to meet a changing health care world.

 

However, during the current unique health care environment that mission was challenged by well-intentioned governmental communication efforts regarding the novel virus which led to misinformation, lack of information, misinterpretations of information and changing guidance. Century’s efforts to fill the needs gap and create new services that also supported their business survival during these chaotic times needed to be supple and innovative.

 

Thanks to a committed corporate mindset with no parameters on innovation, flexibility or resourcefulness, Century has supported their employees, community, and their business in several new roles during these chaotic times with exceptional care. For example, as an essential workforce with high potential for exposure to the novel virus Century immediately sourced all major vendors for personal protective gear (PPE). This included non-traditional sources like hardware stores and autobody shops to secure PPEs to keep staff safe and on the job.

 

“As a multi-state provider under the Covalent parent company, I was able to connect with a vendor in the Midwest who had an oversupply due to a client who went out of business. Century budgets for PPE and disinfectant equipment rose from $1,000/month to $100,000 in March,” according to Johnson, “but we do not skimp on safety of our employees or the patients we help.”

 

Our next step was to partner with local Counties and the State Departments of Health in supporting the overall mission of the State in getting as many people tested, especially those in vulnerable populations.

 

“Century trained our crews to safely enter senior living facilities and staff testing sites after learning swab testing techniques,” Johnson said. Additionally, we delivered PPE to facilities provided by the state and counties and helped retrain and remind the facility staff on how to effectively wear the gear and equipment.

 

Due to the distancing issues with the pandemic, the training department had to leverage their skills and technology and do many of the train the trainer education systems via online training. Education was conducted remotely with the Department of Health ‘Train the Trainer’ series and then one-on-one with Century staff.

 

Additionally, Broward County’s demographic prevalence of high-risk special needs patients required a specialized, knowledgeable Century crew, equipped with appropriate protective equipment to make home visits, test for the virus, and transport patients if necessary for further monitoring and treatment.

 

Recognizing the need for additional staff Century has added new staff, reenforced its bench and also moved to provide housing for temporary transfers for staff members volunteering for short term relocation to South Florida from lesser hit areas to support the 24/7 need.

 

Johnson said, “We also anticipated the tripled number of ambulances needed (from 5 ambulances to 15 per day) after initiating new roles so we acquired additional vehicles from our reserve fleet.”

 

“We also have modified our operational procedures. Typically, in our EMS area in North Florida, a team of responders would enter a site together; now, we send one person in first to assess the immediate need and communicate with staff regarding precautionary entry measures. We also have designated administrative oversight in communication with on-site staff to determine and evaluate best next-step scenarios,” Johnson explained.

 

Century, by nature, was also better prepared than many businesses to deal with employees whose home schedules were in sudden turmoil as parents needed to be home for kids since school was cancelled. The county demographics also requires preparation to overcome cultural and language barriers.

 

Johnson explained, “Since we are a 24/7, 365-day operation, we can accommodate change in shifts for parents or guardians and we help with housing for those who volunteer to temporarily re-assign from their home base to areas in Broward County in immediate need. Traditionally, we deliberately staff to better relate to our diverse demographics,” he said.

 

In addition to special preparation training for staff, designated dispatch personnel monitor and keep track of colleagues who conducted home visits or were exposed to the virus and follow-up with them on regular temperature checks or other symptoms. “It was important to us to keep track of these encounters and to identify immediately if someone may have had an exposure. Fortunately, we have not had anyone exposed without PPE gear or test positive for COVID.”

 

And, while Century goes above and beyond State Department of Health and CDC guidelines for safety, they have elevated cleaning and sanitization of ambulances and products during this infectious threat.

 

According to Johnson, they purchased an AeroClave system earlier this year. The system performs a computerized fog-like cleaning of the interior of ambulance. After each transport, all ambulances undergo a full sanitation process which involves 20 minutes of disinfectant fog application that penetrates every nook and cranny to stop the spread of any germs for patient and staff. The ‘fog bomb’ provides additional sanitation precautions to the normal cleaning of each vehicle, inside and out.

 

The initial system was purchased and a second was awarded through a grant through the Broward County Healthcare Coalition.

 

“To date we have had no virus infections and hail our health heroes for going into known danger and protecting our clients and themselves,” Johnson noted.

 

As if this pandemic in and of itself does not impact the ambulance transport and logistics procedures enough, it came upon the scene as the travel and cruise vacations were at a peak and the hurricane season preparation was underway.

 

In both Jacksonville and Fort Lauderdale ports, Century supports the crews who are now quarantined aboard. Providing care for these floating cities often requires attention to language and cultural complications.

 

And, while the disaster preparation team is a year-round endeavor, from June-November tropical storms and hurricanes can present logistical challenges for transportation and shelter. Normally planning includes coordinating with city officials to identify large buildings and stocking them as local shelter support for community residents displaced by storms. During the pandemic, however, social distancing guidelines present new challenges and require planners to think outside the box when evacuations are in order. Century is working with disaster planning officials and stands ready to make ambulances and staff available for transportation to safe areas when evacuation is required.

 

Looking at lessons learned from this serious threat to our nation, Johnson suggests a revitalized effort to support mental health needs of first responders who go toward known danger at every turn. For example, infection control social distancing in the home stations (necessary to avoid spread of COVID-19 germs) can simultaneously negate the benefits of common lounge areas which support a sense of community among first responders.

 

“While EAP support is available, globally we need to apply more resources toward identification, counseling, and support for both staff in the field and on dispatch duty who exhibit symptoms of anxiety, depression, and PTSD,” he explained.

 

Johnson summarized, “Obviously this continues to be a rapidly evolving environment but our highest priority is the health of our patients, workforce, the public and all agencies we support, so we are continuously monitoring national, state and local guidelines to ensure compliance with the most advanced infection control opinions.”