While still in the grip of a crippling pandemic, we struggle every day to keep up—working to maintain adequate staffing in our dispatch centers, in the field responder workforce, adjusting to a new makeshift policy or procedure almost daily—always hoping our local hospitals can handle the load. Too often we watch our colleagues, friends, and family members fall ill and wonder if we’re next. In times like these, a little reflection can be instructive—and perhaps therapeutic—adding context and even giving us a glimpse of the calm after the storm. In this issue’s “Blast From the Past” we look at an article from this century’s first pandemic: the 2009 H1N1 flu outbreak, sometimes known as the Swine Flu.
According to the Centers for Disease Control (CDC), the H1N1 pandemic (a strain of influenza A) inflicted tremendous damage on the U.S. population between April 2009 and April 2010: 12,469 known deaths, 274,304 hospitalizations, and nearly 61 million total cases. This sounds ominously familiar to us now.
Dr. Jeff Clawson’s article from the July/August 2009 issue brings up a now-familiar topic—the use of Protocol 36 (Pandemic/Epidemic/Outbreak). As Chair of the IAED’s Chemical, Biological, Radiological, and Nuclear (CBRN) Fast Track Committee, I can confirm that some of these same issues are still being discussed and evaluated—but this time for the latest pandemic, COVID-19. Indeed, the same discussion about which symptoms are most relevant for this disease—and therefore should be considered in the use of Protocol 36—is one that occurs regularly among members of our committee, and with certified EMDs and EMD-Qs at large.
If you’ve had a chance to review the latest version of Protocol 36, you’ll notice Rule 1 has been adjusted for COVID-19 to include only three Chief Complaints: Breathing Problems (P6), Sick Person (P26), and Chest Pain (P10). This was done because COVID-19, unlike H1N1, is a true respiratory illness. Headache is a common flu symptom. Another change includes the dropping of several common gastrointestinal (GI) symptoms in the Key Question sequences. While we know that GI symptoms do occur in COVID-19 patients, they are not the true indicators of the most potent, severe form of the disease. As of this writing, doctors and hospital staff are focused on the respiratory component of COVID-19 because of the risk of mortality in patients that present with respiratory symptoms (plus fever). Of course, as we learn more about COVID-19, we must continue to evaluate and critically review the content of Protocol 36. So, let the discussion continue! We welcome your feedback.