## Transcript

 Estimated 14 min reading time.

Welcome to The USFA Podcast, the official podcast of the United States Fire Administration. I’m your host, Teresa Neal. The last 2 years have been tumultuous for our country and our world. We’ve all grappled to learn a new normal and overcome challenges personally and professionally.

This is even more true for our first responders. Not only were they dealing with the same challenges of health and family the rest of us dealt with, but they were face-to-face with the pandemic — and dealing with it head on and dealing with it professionally. The fire and emergency medical services are now looking back to determine the lessons learned over the last 2 years.

We won’t be discussing too much of that today. Instead, we wanted to discuss where the fire and emergency medical services are today. What does the future look like and how do we move into the endemic phase? What are some of the unforeseen consequences of the pandemic?

Our guest on this episode is Dr. James Augustine. Dr. Augustine is a firefighter, physician and a clinical professor. And over the last 2 years he has been the lead physician advisor to the IAFC COVID-19 Task Force. He will provide us with insights and make us aware of some of the challenges we will continue to deal with.

Thank you, Dr. Augustine, for agreeing to be on the podcast today. Could you just tell us a little bit about yourself?

Yes, I’m Jim Augustine. I am an emergency physician and long-time fire EMS medical director. Very pleased to be part of the fire service since my initial training in 1982. So, this is 40 years where I’ve been able to join the other members of the service in serving our communities. I serve as an emergency physician in Ohio, and I work with fire EMS services in both the Dayton, Ohio area and in Naples, Florida, which is my home.

And, Dr. Augustine, during the beginning of the pandemic, I know that you did a lot of work with the task force with HHS, I believe, and also with IAFC COVID Task Force?

I did, and it’s been an honor to serve the last 2 years with the IAFC COVID Task Force, which has been very active alongside the IAFF. And our information has been disseminated in many ways over the last 2 years in an attempt to make the fire service as safe as possible and for our members and their families to be safe.

So, over the last 2 years, I know both the fire and EMS have dealt with numerous issues around COVID, you know, personally, professionally, even with getting supplies and those types of things. But where do you see fire and EMS today?

You know, we’ve been through, certainly, our waves and phases, and the initial problem that we had with the personal protective equipment — the ability to do testing, the ability to have safe operations, the ability to keep our families safe, certainly — has changed. Where we are now is a phase where so many people have been sick; frankly, so many people have died of the illness. And then we’ve had the really rapid development of the COVID vaccines that have allowed our population to be much safer and for our members to be safer, that we now are at a phase where it is very unlikely that we’ll have another pandemic phase of this disease.

That means we’re moving into a phase where we have the disease in the community and on the planet, very certainly. For those people who’ve been exposed and deal with the disease and those people who’ve been vaccinated, they have a high level of protection against a serious form of the disease. But we still have some risk of getting mild cases of the disease. That is a phase that is called the endemic phase. And this week we’ve had a lot of discussion about what endemic means and what the implications are for fire and EMS.

So, at this point, many of our members — vaccinated or vaccinated plus they’ve been ill — many of their family members have been vaccinated. And now we are just waiting. Probably another 6 weeks we will have the Pfizer and the Moderna vaccines approved for young people in the age of 6 months to 5 years of age, so at that age we can begin to protect another segment of the population that hasn’t been affected.

The news of the last 2 weeks also told us that the prevalence of disease has been so high in the community, and it appears about 60% of individuals that the CDC has studied have had the disease, whether they knew it or not. It may be even higher amongst children in our communities, who fortunately in this outbreak of disease, which we called pandemic at the time, but endemic now, that they had the disease, even though they didn’t develop severe illness from it. That’s really good news.

We still have vaccines, and it is likely now that we will have some tweaking of the vaccines to where it will account for new variants of the coronavirus. It may be added to the seasonal vaccine for influenza that we know we get every year. So, at that point, many of our members will say, “Hey, that’s just like we deal with the flu.” Every year we get a vaccine. It protects us against more elements of influenza and particularly elements that they think will be present in the disease in the coming year.
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We still have vaccines, and it is likely now that we will have some tweaking of the vaccines to where it will account for new variants of the coronavirus. It may be added to the seasonal vaccine for influenza that we know we get every year. So, at that point, many of our members will say, “Hey, that’s just like we deal with the flu.”

And coronavirus, it is not in any way related to influenza virus, but potentially those 2 shots could occur in the same jab, and we would get protected from what we think are the variants of COVID that would come. We still would have a few people that would be very susceptible to severe illness — as we have every year with influenza — but we would be protecting a big part of the population from both COVID and influenza with those seasonal vaccinations.

We also in the past several months have developed treatments for COVID so that individuals who get sick, in particular people at risk for severe disease, can be treated either with an infusion of monoclonal antibodies in their vein, or take a set of pills over typically a 5-day course that will help them get better from the infection and not allow them to progress to more serious forms of infection. That would be a very valuable element for us to have when people do get sick.

And again, that would be very much like the flu, when we have several treatments that are available to prevent flu from becoming more severe. There’s apitional improvements in our ability to test for the disease, and so now we have a variety of tests that people can do, and it’s possible that we will have even simpler forms of testing that can be done either in a health care office or at home to allow people to understand when they do have the disease, and then they can take precautions to not give it to somebody else. All of those things really remind you of how we deal with influenza each year. And where our population is not at high risk to die as we have been over the last 2 years.

So, you mentioned endemic. Can you just explain that a little, what endemic means?

Yeah, so endemic means that there’s a disease that is present on the planet or within the community where we live that is a risk to us or a risk to certain members of the population but does not represent a risk to a large number of people, and in particular not a high risk to a large number of people. So, we have many diseases that are endemic on the planet now, including influenza, including RSV, which is a pediatric respiratory virus that causes very severe illness in some children and a significant inconvenience in others. We have measles and mumps and rubella which are present on the planet.

But many of our children, in particular, and therefore into the rest of our population, they have been immunized to it. Nonetheless, still exists, and is a risk for people who are not vaccinated. And then we have diseases that are a high risk of getting them, and this is things like the cruise ship virus, Norovirus, which is present and can cause outbreaks. But it’s not a very severe risk to people in that it does not cause life-threatening illness, but it’s certainly uncomfortable to have.

Why I mention Norovirus now is because now that we’re in contact with each other again, we have seen some outbreaks of the GI virus that make people feel very miserable for 24 hours, but they’re not a life risk to those people. So those are the type of diseases that are present. Some of them are seasonal, some of them have a tendency to move in certain populations, and we have to be careful of all of them and either prevent or treat widespread dissemination of those diseases. That’s what endemic means.

So, what issues do you see for us or, really, for the fire and EMS as we move toward that endemic phase?

So, there’s 2 things that we think about now. One is resuming what we would call normal operations where there is a new normal. And the second is filling the gaps where we’ve had, over the last 2 years, some problems develop in the system that we’re going to have to find solutions for.

The first, getting back to normal, means that at some point we need to be able to interact with each other and with the community without everybody wearing masks and maintaining social distancing so that we can go back to church, at the concerts and to, you know, fairs and big events that occur in our community. Where we can go into the schools comfortably and teach the kids about fire safety and how to do CPR and how to do first-aid. And where we have the ability to do our usual training and conferences and other things where we learn a lot from each other.

So, the issues now are how to do that safely. Are there situations where people should still be wearing either surgical masks or N95 masks? Those are policies that are being developed now across the fire EMS service that will allow us to, in many situations, be able to interact with our community and with each other as we normally would. But in some situations, continue to use masks, to use distancing programs, and to be a little more safe in terms of protecting ourselves from respiratory illnesses than we used to.

So, many departments are adapting those existing policies to look at a new community where there’s less illness and less risk. I just rewrote our policies. We’re continuing to wear surgical masks for illness interactions. We’re using our N95 still in patients who have respiratory illnesses, and in particular, when they’re coughing or when we’re using aerosol-generating procedures. So that remains an N95 type of interaction.

For other circumstances — like we’re working a fire scene or an extrication scene — masks are not beneficial to us at all, and we can use our usual methods of protecting ourselves from bloodborne pathogens and other things. So that is kind of our current challenge, is being able to go back to our normal interactions with the public and with each other, and then filling in the gaps. You know, we’re at a stage now where some people are afraid to come into our field.

So, recruiting and retention of our members and displaying a safe work environment for people that they would welcome working in our field is really very important. Another phase is to refill our educational programs and classrooms and educational opportunities for students who want to come and do ride time with us. That program has been interrupted for, you know, 2 years now.

We need to be able to get in the hospitals to be able to do our training in the hospitals, and many of them had no students and no visitors for a couple of years. We are providing kind of a fill-in-the-gap for people who missed our fire education programs, our safety programs, how to use fire extinguisher programs, how to do CPR programs, how to stop the bleed programs. So, all of those things now have gaps that we need to fill. And that’s kind of our current issue, is getting back to normal, fill in the gaps.

What issues do you see when you look at the field that existed — that we weren’t able to fix during those 2 years — that we’re still dealing with right now?

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We have brought with us a lot of lessons. The first is that we have to be very, very careful in maintaining our PPE stocks so that if sudden events occur and we have no ability to refill the supply chain, we have enough to get through our operations.

We have brought with us a lot of lessons. The first is that we have to be very, very careful in maintaining our PPE stocks so that if sudden events occur and we have no ability to refill the supply chain, we have enough to get through our operations. I think that’s item number 1 in many people’s after-action reports, is that we make sure we have enough PPE to cover exposures and make our operations safe.

Number 2, we need to be able to communicate very effectively with our people and give them straightforward messages about what a risk is and how they can reduce that the most for themselves, and for their family members, and for the communities that we serve. Number 3, when we are running up against a problem, how do we test for it safely and effectively and so that it gives us the best information?

And then how do we use those test results to make sure that we are using procedures like quarantine and isolation appropriately? Next is, when we do have solutions to the problem, and one solution to this problem has been vaccinations, how do we get accurate information out to all of our members about the use of that new tool for reducing their risks even further?

And then how do we prevent disinformation from coming out about any tool that we use moving into the future? And then next, you know, we ran into significant shortages of other things, and that is still an issue. And I should have probably brought that up in the issues section before, but we have supply shortages from IVs and IV solutions and medications.

We can’t get computers. We can’t get vehicles — particularly vehicles that need computers. We are short on construction materials. We can’t build a new station. We don’t have chassis, so we can’t re-chassis our old medic units, so there’s a number of supply issues, and again, we didn’t think about these when the pandemic started a couple years ago — that there would be profound and prolonged shortages of a number of things that are really important for us to use, and we didn’t quite change our ways of both allocating and planning for the use of the equipment and supplies that we had.

So, if we knew that there weren’t going to be vehicles available for 2 years, we would have rotated our vehicles in a different way or established other pathways to get vehicles that didn’t have the same needs, etc.

Right.

So those are the things that are really important — and timely issues — and important ones to remember into the future.

Yeah, I don’t think that many people thought about that. Not being able to build parts for vehicles, not able to get a new ambulance, or you know, a backlog of being able to have a fire truck ready. It’s not just those everyday items that we think about, but it’s those bigger ones that we don’t think about until we need them.

Yes, and all of those — even little pieces — think, think about things like a broken refrigerator, and there’s no refrigerators or dishwashers, etc. And then through the things that we really need every day, like 20-gauge catheters and IV tubing and a bag of saline, which are also in very short supply right now.

So, planning for the future, what do you think first responders should plan for?

So, we have a couple concerns now as we move on. Number 1, we still have other diseases, and the one that’s been lurking on the planet recently is Ebola. And we have another outbreak that has occurred in Africa, and we still have to be concerned about that disease because that’s a very deadly disease — very infectious. And if it somehow broke out of Africa, we would be back in the situation we were in 2014: adapting our PPE for a disease that is spread a different way. That’s not a respiratory-spread disease; that’s a liquid hazmat kind of incident.
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Number 1, we still have other diseases, and the one that’s been lurking on the planet recently is Ebola.

And we have another outbreak that has occurred in Africa, and we still have to be concerned about that disease because that’s a very deadly disease — very infectious. And if it somehow broke out of Africa, we would be back in the situation we were in 2014: adapting our PPE for a disease that is spread a different way. That’s not a respiratory-spread disease; that’s a liquid hazmat kind of incident.

Number 2 and very timely is, there’s a war going on and that war and the threats that have been made by Russia have very significant implications for us, and we need to think through and do our prep for events that include warfare-related events, and even one includes something as horrible as a nuclear event. We haven’t had to think about that for many years and we need to. We are very well prepared now for most types of infectious disease outbreaks. Mother Nature can always throw us curveballs, regardless of the type of disease.

But if you think through the last 40 years, we have developed really good approaches to trauma, to burns, to bombs, to bloodborne pathogens to airborne pathogens, to a pathogen that’s a liquid chemical hazmat, like Ebola is. So, we’ve covered many of the bases in preparedness.

What we still have to make sure of is that we have the supplies available to carry out any of those preparations — that our health care system is prepared for it. And one of our next real challenges in the system — we’ve had a lot of mental health- and substance-abuse problems that have erupted across the community these last 2 years.

Our work in public safety will very much help the health care system in trying to manage individuals who have problems in either of those areas. The hospitals right now are generally understaffed and not able to take care of as many people in the same way as they used to. And, in particular, people with mental health- and substance-abuse programs that we sometimes have in the field and can help the health care system — and provide a very successful second avenue to manage community needs.

The other piece that we continue to think about are day-to-day hazards. What have we been not doing over the last couple of years? You know, hazmat preparation, fire prevention, etc. Some of those things that we just have to go, and as we say, fill in the gaps for things that we haven’t been doing. You know, we still have a lot of those items and risks and the communities that are our day-to-day. But we’re a little more at risk for now because our society has changed over the last 2 years and people have forgotten about those.

Yeah, I’d have to say that the first responder communities are so innovative that even when it came down to the first year, there wasn’t much people could do. We were just trying to catch up. But the second year — the innovation. The ideas that people brought forward to help, you know, keep getting fire safety and health safety information to the right people. It’s pretty inspiring. It kind of makes you feel like, well, whatever gets thrown at us, sooner or later, we’re going to figure it out and overcome and do so much better than we did in the past.

But I can believe that it has been a rough 2 years for everyone. But I cannot imagine what you’re saying with the mental health and just the exhaustion. You know the overload of our first responders dealing with this daily, multiple times a day, and trying to keep them healthy. You know, physically healthy and mentally healthy and being able to have that work-life balance that has really been thrown out of whack over the last 2 years.

It sure has. Very well put. And it’s our opportunity to think about taking good care of ourselves as well as taking care of our communities. And then, and then going back — thanking each other, and thanking ourselves for work that has been very well done for people developing innovative solutions based on the principles that we’ve used for a long time in our service, which is, you know, innovation counts — count on your neighbors. So, we mutual-aid and incident-command a lot of things. And then our basic principles for all-hazard preparedness really, really came to help us during a pandemic that had and continues to have all these new curveballs that it’s throwing at us.

Right. So, do you have anything else you would like to share?

I would like to share a thank you to the members of the service, to outstanding leadership at IAFC and IAFF that have helped our members move forward. For a cooperative attitude amongst fire and EMS providers in many unique situations. Really thanks to everyone for the work that they have done to help us get through this.

And you know, we need to continue to pay attention so that we don’t have anything else come out and surprise us. But take a little time now to say thank you to each other, to be very grateful that we have made it through this. And then our opportunity is to learn from it and help the next generation of fire and EMS providers handle the next one just as well.

Thank you so much for joining us today, Dr. Augustine, and for taking the time to share your wisdom because I know it will be helpful. It’ll give us all something to think about and consider as we start moving forward and making plans — actually making plans for the future.

That’s right. And I love our members, and I love what we do in the community. So, thanks for having this as part of the program.

Thank you.

Thank you for listening to the USFA Podcast, and thank you to our guest, Dr. James Augustine. You can join the conversation about fire safety by emailing your questions and sharing your stories to usfapodcast@fema.dhs.gov. That’s usfapodcast@fema.dhs.gov. We hope you will join us next month. Until then, you can visit us at USFA.FEMA.gov or on social media by searching “US Fire.”

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We share our new episodes every third Thursday of the month. You can visit us at usfa.fema.gov or on social media by searching “usfire.” Until next month, stay safe.