New study uncovers successes and gaps in COVID-19 guide for EMS First Responders
New study uncovers successes and gaps in COVID-19 guide for EMS First Responders

New study uncovers successes and gaps in COVID-19 guide for EMS First Responders


PITTSBURGH – The first comprehensive nationwide assessment of Guidance on Emergency Medical Services (EMS) issued in response to the COVID-19 pandemic reveals that although there was great variation in the development and dissemination of protocols for the protection of frontline emergency personnel and their patients, the majority of surveyed states and territories provided some level of direction.

Yet nearly 2 out of every 5 states or territories did not make their guidelines available online, according to a study by a University of Pittsburgh School of Medicine medical scientist and published this week in Journal of the American College of Emergency Physicians Open. It describes successes and gaps in EMS guidance that can be used to help U.S. states and territories EMS offices prepare for future infectious disease emergencies.

In particular, states and territories without specific guidance have provided less comprehensive information to frontline EMS agencies, including a lack of recommendations on how to perform cardiac arrest resuscitation and when to stop, as well as care for special populations, such as children, despite these topics receive significant media attention.

“As a society, we have survived so much. The question is, what do we learn from these things? By figuring out where the best guidance comes from, it can encourage states to work together faster to bridge any gaps and integrate with each other, ”said Sylvia Owusu-Ansah, MD, assistant professor in the departments of Acute medicine and Pediatrics at Pitt and EMS Medical Director at UPMC Pittsburgh Children’s Hospital.Owusu-Ansah led a team of researchers from Florida to Minnesota in collecting data to learn which COVID-19 protocols and guidelines were available to EMS agencies and what resources were used during the first wave of the pandemic. “EMS, like any healthcare institution, did the best they could to stay on top of the COVID-19 pandemic by changing the guidelines well in advance,” she said.

In the first phase of their study, the team examined publicly available documents in 50 states, the District of Columbia, and five territories to learn about the evolution of COVID-19 guidance and protocols for EMS clinical management and operations. They found that while the majority had readily available EMS protocols published online, a significant minority – 37% – did not.

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In the second phase, the investigation team interviewed government officials using a standardized investigation tool. They were asked to verify whether their state had mandatory EMS protocols or recommended guidance, and whether the pandemic prompted their state or territory to issue COVID-19 specific guidance or make changes to clinical or operational protocols. Among the officials interviewed, 64% said their state or territory issued either formal protocol changes or specific guidance for the pandemic.

Interestingly, the research team points out that the presence of existing EMS protocols or recommended guidelines was not associated with an increased likelihood of states issuing COVID-19-specific guidance. To plan future waves of COVID-19 and other pandemics, the research team says further work should correlate state- and territory-level guidance with COVID-19 clinical and operational outcomes. This would inform whether guidance was effective in influencing EMS response and community service in public health emergencies.

“It’s all about doing what’s best for our patients,” Owusu-Ansah said. “The clock starts ticking in the healthcare system as soon as the patient becomes ill. If a 911 call results, teamwork begins immediately with EMS, and there are many life-saving efforts before the patient ever arrives at the hospital. ”

Additional authors of this study are Matthew Harris, MD, of Hofstra University; Jennifer Fisher, MD, and Phyllis Hendry, MD, both University of Florida; Kathleen Adelgais, MD, fra University of Colorado; Ashish Panchal, MD, af Ohio State University; John Lyng, MD, af University of Minnesota; Kerry McCans, MD, af Temple University; Rachel Alter, BA, from National Association of State EMS Officials; Amanda Perry, M.Ed., from Louisiana Department of Health; Angelica Cercone, MD, af Pitt; and Mark X. Cicero, MD, of Yale University.

About the University of Pittsburgh School of Medicine

As one of the country’s leading academic centers for biomedical research University of Pittsburgh School of Medicine integrates advanced technology with basic science across a wide range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Mainly run by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently published by the National Science Foundation, Pitt ranked number five among all U.S. universities in the overall federal scientific and technical research and development support.

Similarly, the School of Medicine is equally committed to promoting the quality and strength of its medical and graduate programs, for which it is recognized as an innovative leader, and to educating highly trained, compassionate clinicians and well-equipped creative scientists to engage in world-class research. The School of Medicine is the academic partner for UPMC, which has partnered with the University to raise the standard of medical expertise in Pittsburgh and to place health care as a driving force behind the region’s economy. For more information on the School of Medicine, see

PHOTO INFO: (Click on the image for high resolution version)


Caption: Sylvia Owusu-Ansah, MD, Assistant Professor in the Departments of Emergency Medicine and Pediatrics at Pitt and EMS Medical Director at UPMC Children’s Hospital in Pittsburgh.

Credit: UPMC


Caption: States and Territories with Publicly Available EMS COVID-19 Protocols or Guidance

Credit: UPMC

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