SHAL­IZA HAS­SANALI

Sig­nif­i­cant stress, strain and pres­sure is now be­ing placed on para­medics and emer­gency med­ical tech­ni­cians from the Glob­al Med­ical Re­sponse of T&T (GM­RTT), as they at­tempt to keep up with the de­mand for their ser­vice which the re­cent spike in COVID-19 cas­es has cre­at­ed in re­cent weeks.

Stretch­ing in­to its 14th month, GM­RTT CEO Paul An­der­son told Guardian Me­dia that the emer­gency care sys­tem in this coun­try has been test­ed at an un­prece­dent­ed lev­el nev­er be­fore seen, with the virus pos­ing mount­ing chal­lenges.

The uptick in pos­i­tive COVID-19 cas­es in the last few weeks, An­der­son said, has re­sult­ed in GM­RTT’s 811 hot­lines be­ing bom­bard­ed with emer­gency calls, its 330 staff mem­bers fac­ing burnout syn­drome and the in­take of pa­tients at the par­al­lel health care sys­tem now at near ca­pac­i­ty.

“Cer­tain­ly, it has been a chal­lenge. To this point, we have been able to man­age, al­though it has cer­tain­ly stressed the or­gan­i­sa­tion,” An­der­son ad­mit­ted.

“Our COVID case­load now, in this surge, is about two times what it was when it (virus) peaked in 2020. What we are ex­pe­ri­enc­ing over, say, the last four weeks... our COVID case­load is ap­prox­i­mate­ly dou­bled. The prob­lem that we have run in­to now is that we are hav­ing to do that on a dai­ly ba­sis and that ob­vi­ous­ly stress­es the per­son­nel, re­sources and the ve­hi­cles.”

GM­RTT is the ex­clu­sive provider of emer­gency am­bu­lance ser­vice for the Min­istry of Health.

The com­pa­ny has a fleet of 48 am­bu­lances that serves the pub­lic.

The num­ber of emer­gency calls GM­RTT re­ceives on its hot­lines may vary on any giv­en day, An­der­son said.

Of the 160 to 200 calls reg­is­tered dai­ly, An­der­son said the bulk is COVID-19-re­lat­ed.

“One day it may be 40 the next day it may be 55. This virus has hit every cor­ner of the coun­try. It is af­fect­ing peo­ple in every com­mu­ni­ty. Name a com­mu­ni­ty, we have had a case there. Nat­u­ral­ly, you would see more sat­u­ra­tion in dense­ly pop­u­lat­ed ar­eas, but as far as the dis­per­sion... it is across the is­land.”

The coun­try had record­ed 19,444 to­tal COVID pos­i­tive cas­es as of yes­ter­day’s Min­istry of Health up­date.

There were 7,765 ac­tive pos­i­tive cas­es and 365 re­port­ed deaths.

Since the im­po­si­tion of the State of Emer­gency and 9 pm to 5 am cur­few last Mon­day, An­der­son said more COVID-in­fect­ed in­di­vid­u­als have been ac­cess­ing their free ser­vice.

“In­ter­est­ing­ly, to a small ex­tent, the non-COVID re­lat­ed 811 calls that we re­ceive are down a lit­tle bit. That’s be­cause of the lock­down, shut­down and cur­few. Now, COVID over­fills the void that is cre­at­ed from that flight we have left from the vol­ume. What we are see­ing pre­dom­i­nant­ly is peo­ple with very low oxy­gen sat­u­ra­tion and what we are see­ing now is even more pro­found in what we call de­sat­u­ra­tion or de­com­pen­sa­tion.”

While in tran­sit, pa­tients with laboured breath­ing are mon­i­tored and pro­vid­ed oxy­gen by para­medics un­til they reach a med­ical fa­cil­i­ty, he said.

“That is what is dri­ving the oc­cu­pan­cy rates...it’s the peo­ple who re­quire oxy­gen,” An­der­son said.

Af­ter drop­ping off a COVID pa­tient for med­ical at­ten­tion, the am­bu­lance must be prop­er­ly sani­tised be­fore re­spond­ing to an­oth­er dis­tress call.

It can take be­tween 30 min­utes to over an hour for GM­RTT to de­con­t­a­m­i­nate one am­bu­lance, An­der­son said.

“It all de­pends on the lev­el of con­t­a­m­i­na­tion of the pa­tients, who can ex­hib­it mild to se­vere symp­toms. It is a process where an aerosol plug is used to make sure that any bio el­e­ments are on any flat sur­faces are killed. Then there is a process of air­ing out that needs to oc­cur. All of that adds to what we call tax time,” An­der­son said.

This process can some­times re­sult in a de­lay in their re­sponse time.

How­ev­er, he said they can­not af­ford to cheat on this process, as sani­tis­ing must take place to pro­tect the staff and the next per­son util­is­ing their ser­vice.

Pressed on if pa­tients would some­times have to wait in­side an am­bu­lance un­til health care providers find an avail­able bed space, An­der­son said, “There are times but it is not rou­tine. There are times where there is some co­or­di­na­tion that needs to be done. It’s lim­it­ed but it does hap­pen on oc­ca­sions just be­cause the sys­tem is un­der such stress.”

Work­ers ex­haust­ed

An­der­son said when some­thing reach­es its peak, chal­lenges can oc­cur and things can get com­pli­cat­ed. He said he knows his work­ers are ex­haust­ed from the cur­rent high work de­mands.

“There is a toll that comes with that. This is a glob­al pan­dem­ic and it has had that kind of pres­sure. How this dif­fers from any­thing that I have dealt with in my 30 years in this busi­ness, is that this has been a slow burn cri­sis for the last 14 to 15 months. That is a dif­fer­ent stress than a trau­mat­ic event that some­one suf­fers.”

As T&T bat­tles the pan­dem­ic’s third wave, An­der­son said his staff has to be con­stant­ly re­mind­ed to pro­tect and safe­guard not on­ly them­selves but their fam­i­lies, peers, friends and the pub­lic.

There is no room for slip-ups or short­cuts.

An­der­son said han­dling COVID-19 cas­es is far more com­plex and time-con­sum­ing.

“These calls take much longer to han­dle. Of­ten­times, the trans­port dis­tance is much longer...be­cause we’re not nec­es­sar­i­ly tak­ing some­one to a fa­cil­i­ty near to where they live. We may have to go near­ly across the coun­try in some cas­es. They take a lot more time for us to man­age. There is more in­volve­ment with the crew.”

He said, how­ev­er, that his crew, which has had to be sep­a­rat­ed in­to those who deal with COVID-re­lat­ed cas­es and those who deal with oth­er med­ical-re­lat­ed cas­es, has been go­ing be­yond the call and step­ping up and han­dling the task at hand.

“Every­one ac­knowl­edges the work­load that we are faced with. It has been un­re­lent­ing. When you add all of these things to­geth­er, it very much stress­es the sys­tem.”

Sim­i­lar sen­ti­ments have been echoed by the Min­istry of Health se­nior med­ical team dur­ing the week­ly COVID-19 up­dates. They have not­ed that the med­ical pro­fes­sion­als are fac­ing tremen­dous strain as they deal with the crush of COVID cas­es now com­ing be­fore them.

The stress­es on their job, An­der­son ad­mit­ted, have pushed some work­ers to seek Em­ploy­ee As­sis­tance Pro­gramme (EAP) ser­vices.

This gives an in­di­ca­tion, An­der­son said, “that peo­ple are recog­nis­ing the psy­cho­log­i­cal and emo­tion­al toll it is tak­ing and they are do­ing things to pro­tect and look af­ter them­selves.”

Asked if any of his em­ploy­ees had ten­dered their res­ig­na­tions as a re­sult of mount­ing stress, be­ing un­able to cope with the case­loads, or were gen­er­al­ly fear­ful of han­dling COVID pa­tients, An­der­son said he was not sure.

“I don’t think if some­one did they would nec­es­sar­i­ly dis­close that.”

Staff con­straints in­crease

The biggest chal­lenge for GM­RTT, An­der­son said, was deal­ing with staff con­straints, which have in­creased now with some of the pro­to­cols that peo­ple are be­ing forced to ad­here to as the lev­el of COVID con­t­a­m­i­na­tion spreads coun­try­wide.

He said when­ev­er a close fam­i­ly mem­ber of a GM­RTT em­ploy­ee is quar­an­tined now, that work­er al­so has to self iso­late.

“And so we lose staff to that. Present­ly, we have some­where be­tween 15 to 20 peo­ple un­der a quar­an­tine or­der. There are new chal­lenges in peo­ple be­ing able to re­port to work. There are new chal­lenges while they are at work and new chal­lenges just as­so­ci­at­ed with the vol­ume (of COVID-19 cas­es) that we are deal­ing with.

“Put that all to­geth­er...and that sus­tained over a long pe­ri­od of time, that puts peo­ple and that puts an or­gan­i­sa­tion un­der a lot of pres­sure,” he said.

Ear­li­er this month, rel­a­tives of a fa­ther and son Prem­nath Ramkalwan, 66 and Nigel Ramkalwan, 36, who died from the COVID-19 virus, claimed para­medics failed to re­spond in time to take them for In­ten­sive Care Unit treat­ment.

Asked to re­spond to the is­sue, An­der­son ex­pressed con­do­lences to the fam­i­lies who lost their loved ones.

“Do­ing this kind of work and lead­ing this or­gan­i­sa­tion, you have to de­vel­op a very thick skin be­cause, of course, some­one who suf­fers that kind of loss, they are go­ing to grieve and their in­ter­pre­ta­tions are go­ing to be dis­tort­ed. And whether it is a COVID-19 case or a reg­u­lar or­di­nary emer­gency, min­utes turn in­to hours while you are wait­ing for an am­bu­lance to come for your fam­i­ly mem­ber,” he said.

“And so, I ab­solute­ly em­pathise with that. But I am not go­ing to get in­to any kind of tit-for-tat...or no, to say this is the ac­tu­al facts.”

An­der­son al­so plead­ed with the pub­lic not to chas­tise his staff if their re­sponse time ex­ceeds their ex­pec­ta­tion.

“You should not take it out on them be­cause you are talk­ing about peo­ple who have been work­ing the hard­est days in their lives for a year and a half.”