The role of emergency medical services in containing COVID-19.

To the editor:

The number of worldwide cases of COVID-19 has exceeded one million. The approach of the World Health Organization has emphasized the role of containment of the virus [1] in the context of countrywide operational planning [2]. Emergency medical services (EMS) can play a significant role in designing and implementing an effective approach.

Magen David Adom (MDA) is the Israeli national EMS organization (8.9 million residents). Dispatch is overseen by the National Medical Emergency Dispatch Center (NMEDC). Routinely MDA is responsible for operating over 1000 ambulances, 2500 salaried workers and 24,000 volunteers. By the end of January 2020, the Israeli Ministry of Health instructed MDA to act to prevent and contain the spread of COVID-19 and to prepare to respond to potential cases of infection. MDA then expanded the NMEDC and opened a dedicated COVID-19 call center. The goal is to contain viral exposure by keeping suspected patients in quarantine at home and away from the public. Upon excluding medical emergency, if the call is concerning COVID-19 and fulfills either the clinical or epidemiological criteria, it is transferred to the COVID-19 call center.

The center is manned by EMS dispatchers along with representatives from the Ministry of Health (MOH). Over 200 MDA volunteers and 50 management staff the center around the clock. Information technology staff provide around the clock support. Routinely, an average of 6000 calls are received a day by the NMEDC. As the pandemic progressed the number of calls increased to 120,000/day.

A flow-chart was developed and programmed into the command and control system together with the infected patient routes. Patients clearly not exposed to an index case, can return to their normal routine. If exposure is confirmed, they are instructed to stay in home quarantine (for 14 days) and a paramedic contacts them to inquire about symptoms. If the case is suspicious of COVID-19, a physician then decides whether to send a paramedic with personal protective equipment to the home to collect samples for testing. Over 25,000 samples have been collected. Cases, where COVID-19 are confirmed, are transported by paramedics on a dedicated negative-pressure hooded bed in an ambulance to the hospital (Fig. 1 ).

Fig. 1

COVID-19 call center flowchart.

As the number of calls and COVID positive patients increased, the system became overwhelmed. MDA then opened four stationary and 8 mobile drive-in testing centers that allow prescreened patients to stay in the car. QR code technology is used for patient identification and flow. Over 23,400 samples have been collected this way.

Maximizing EMS during a pandemic by carrying out phone triage, home testing, and drive-in testing significantly decreases visits to physicians' offices and hospitals and allows early identification of those with COVID-19. These activities contribute to the effort to contain the spread of disease.