#2 Covid March 2020 Update: with Dr. Chelsea White
Good morning everybody, or good afternoon, depending on where you’re seeing this from. My name is Vince Trujillo and I own a marketing agency here in Albuquerque, New Mexico. And I’m excited to have a podcast in collaboration with the Firefighter Kingdom, which is affiliated with the New Mexico Professional Firefighters Association, located here in New Mexico. First off, I would like to go ahead and introduce the host, who is in charge of this podcast. His name is Mr. Robert Sanchez.
Vince Trujillo: Robert, good morning. How are you doing this morning?
Robert Sanchez: Good. It’s nice to talk to our audience out there in the FireFighter Kingdom. We have a lot in store for us today. I’m excited.
Vince Trujillo: Good. Good, so just a little bit about you, Robert. I know you don’t like to brag about yourself, so I’ll go ahead and do it if you don’t mind. Robert has been a proud member of the IAFF for over 19 years and was the longest serving executive officer at the board at over 16 years. Robert has concurrently served as the president of the New Mexico Professional Firefighter Association since 2019. Robert, do you want to talk a little bit about that?
Robert Sanchez: Sure. I’m proud of our organization, the men and women, firefighters and paramedics in the state of New Mexico. I try to always be an advocate for firefighters, especially in the legislature level to try to get several acts passed for us, to better assist us in our jobs and again, proud to be here.
Vince Trujillo: Wonderful. Also joining us today, we have our special guest in the healthcare field. With everything going on with COVID-19. We are very fortunate to have Dr. Chelsea White. Dr. White is an emergency medicine physician in Albuquerque, New Mexico. He’s affiliated with multiple hospitals in the area, including the University of New Mexico and the UNM Sandoval Regional Medical Center. Dr. White received his medical degree from the University of Michigan Medical School and has been in practice for the last 10 years. Doctor, Thank you so much for taking the time out of your busy schedule and joining us today, to help us cover some of whats going on right now with COVID19.
Dr. Chelsea White: Thank you very much. I appreciate the opportunity to be here and help everyone who is actively helping others right now. Thank you.
Vince Trujillo: You’re welcome. It is our pleasure. Robert, go ahead and give us a little background on how you came to know Dr. White and I’ll let you start the interview.
Robert Sanchez: Sure. Well, I just have to add real quick. I’ve had the privilege and honor of working with Dr. White throughout the years and the consortium of program that he assisted in and he’s also did great work to assist firefighters and paramedics in the state of New Mexico. So, what better time is there right now to talk about the coronavirus, Doctor. Perfect person to talk about. I know you’ve been dealing with it for over the last two or three weeks and it’s been going on. So, I guess first I think what the audience likes… What we would want to know about the coronavirus, the effects of the coronavirus and kind of the exposures to firefighters and if there was a firefighter exposed in New Mexico. Is there a type of plan that the hospitals are using to assist in those exposures and make us do our job without tasking the system.
Dr. Chelsea White: Absolutely. Robert, thank you for those questions. First of all, I want to stress what is being mentioned everywhere right now, but there is a lot that we just don’t know about COVID-19 right now. A lot of this is still developing from information that we’re gleaning from what other countries are going through. It is called the novel Coronavirus because it is novel and it is new and that’s why every day it seems like information is changing. This makes it difficult for us because what you heard yesterday might not be true today, and what I’m telling you right now, unfortunately might be different tomorrow. So, I’m going to try to answer everything I can with as up-to-date information as possible, but I urge you to please make sure that you’re following the Center for Disease Control website and as well as New Mexico Department of Health just to make sure that things aren’t changing out from underneath us as we speak.
Vince Trujillo: What type of exposure does the medical field have right now? What are the concerns in regards to firefighters and first responder or even those who are going into the ER for the first time? What type of exposure do they have as far as being susceptible to contracting it?
Dr. Chelsea White: Well, as you know, those of us who are out in the field and EMS and those of us in the emergency departments especially share a common exposure to all illnesses. We’re all equally faced with patients that have unknown illnesses every day. So, this is certainly not unique to COVID. And in fact, I think the COVID situation, I hope will encourage us to be much more careful with all illnesses once the COVID situation passes. But we are exposed and especially to respiratory illnesses like this one. As we have learned, COVID is being spread through respiratory droplets, which means anytime any amount of saliva or other respiratory secretion is aerosolized. It gets in the air and that is potentially infectious to us.
So, anytime anybody coughs, anytime anybody sneezes, anytime anybody spits when they’re talking, we all do that, we know that. That exposes anybody around. And we in EMS and in the emergency departments are often the first point of contact and are often the first ones to note the concerning symptoms that a patient may have. And so we may be exposed before we are able to protect ourselves and before we are able to protect the patient. And in both situations with appropriate PPE for us in the field and in the emergency departments as well as a mask on the patient to try to capture those droplets before they get spread into the air.
Robert Sanchez: Great. Thank you. So, Doctor, just being that it’s probably not, it’s if but it’s when first responders and firefighters, even healthcare workers are going to be exposed to this, which I’m sure healthcare workers already have, obviously. What happens when a firefighter or first responders are exposed to it in the field and they got a positive for COVID-19?
Dr. Chelsea White: So, I think I’d actually take a step back from that in that what happens when you are exposed before you get tested? Because that is really the scariest part. And I think that we need to first of all realize that there are steps in place to protect us. The first step for EMS providers is dispatch. So, dispatch in our MPDS call centers as well as our smaller call centers have all been using special questions to screen callers ahead of time. And that includes asking the important questions; does the patient have a fever? Is the patient coughing? Does the patient have trouble breathing? We were initially asking travel questions, but as COVID has become more widespread, we’re no longer asking that because that’s not as much of a risk. So, hopefully if the questions have been asked appropriately and if the caller has given answers appropriately, hopefully we will have a warning ahead of time that we need to put on a full PPE.
And I’m sure that you just as I have been listening to the radio channels back and forth and we have been hearing a lot of dispatch saying, put on appropriate PPE and telling about the risk factor. So, that right there is already our first line of defense. Our second line of defense is us asking those same questions. If we haven’t gotten positive answers to that from dispatch, we need to be asking those same questions and if any of them are positive or if any of them turn positive, because we all know that patients sometimes change their answers or may suddenly start coughing even though they said they weren’t. We need to put a mask on them and we need to retreat and put our PPE. What happens if you do get coughed on? What happens if you do get sneezed on?
If you’re in full PPE according to CDC guidelines and that includes a face shield, eye protection/face shield, that includes N95 respirator mask, that includes impervious gown and of course our gloves. If you’re exposed to a patient who ultimately test positive for COVID and you’ve worn all of those things you are safe. You don’t need to be quarantined, you don’t need to be tested. Now, what if however, what if you’re not in full PPE and you get coughed on? Well, that is a different situation. At that point, you need to start monitoring your symptoms. As soon as you have any of the symptoms of COVID yourself, that’s when you need to be in isolation and you need to determine whether you need to get a test or not. I’ll get to that in a second.
Now, if you end up with a patient who is positive, the State Department of Health is tracking these very carefully. They’re tracking it very carefully, who is positive and who has come in contact with those positives so that we can get the information back to our providers on how to check themselves. Now, if you have been exposed, the guidelines for you are the same as the general public. What you need to do is you need to isolate yourself at home, which means not going to work and that means watching your symptoms carefully and you need to be checking yourself for fever, cough and shortness of breath. Should any of those develop, you’re going to need to go get tested as well. Should the shortness of breath develop, you need to get tested. If you just have a fever and a cough right now, we are
recommending that as long as you’re safe to stay home, that you stay home.
A new guideline has just been released by the state about when you can come out of your isolation and I will check on that in just a second. But you need to maintain isolation unless you are truly getting sick. And this is what we are telling the public too. Isolate at home until you’re truly having severe illness symptoms like difficulty breathing and that’s when you need to go in to the hospital to get tested.
Robert Sanchez: Well, great information Doctor. Like you said, information is changing on a consistent basis and it’s our responsibility too as firefighters or first responders to actually check the CDC guidelines and make sure that we’re taking appropriate action on calls. Now, if someone with a confirmed test actually goes into the ER, what do they do actually in the ER to keep them quarantined from the rest of the patients or healthcare workers so they don’t to get exposed. What exactly happens?
Dr. Chelsea White: So, that varies from hospital to hospital. But in general, patients that have either a known positive test who now have severe symptoms or a patient who has symptoms that are concerning for COVID, are supposed to have a mask placed on them and then immediately placed into a negative pressure room. There will be signs posted on the door that explain that anybody who needs to come in, needs to be in full PPE and we will try as much as possible to reduce the possibility of aerosolization. So, the problem of course with COVID is it’s a respiratory illness and so many cases, patients are going to need oxygen. In many cases, patients might even need albuterol. They might need to have an advanced airway or CPAP or BiPAP. All of that stuff creates respiratory droplets in the air and makes things more difficult.
That’s the reason why these patients need to be in the negative pressure rooms. That’s the reason why we need to be in full protective gear. But we also need to do what we can to minimize those droplets creating out of this is that for patients that look like they’re having trouble breathing and heading towards meeting to be intubated, we want to intubate them earlier. CPAP has been a tremendous help in the field of EMS over the last decade or so, because that has helped prevent intubations in the field and in emergency departments. This is the exception to that. We really need to avoid CPAP on patients in the field and in the emergency departments unless we have the appropriate equipment to deal with the respiratory droplets. So, these patients are getting intubated a lot earlier than previous respiratory ailments.
Robert Sanchez: Oh, well great. So, I think our audience out there. So, these are questions that we get asked sometimes even in the field responding to 911 calls. And I appreciate that information. I think it’s a benefit to the public. Another question, Doctor, we get asked quite a bit is, what solutions really work to kill the virus? Is it hand sanitizer? Does it actually work? Does it actually kill the COVID-19 virus? And other than just the plane hand-washing, that seems to be beneficial more to killing the virus than anything. What could you tell us about these hand washing solutions and washing your hands?
Dr. Chelsea White: So what I can tell you is what I know from following the CDC guidelines, I am by no means a cleaning solution expert. What is being recommended right now is washing your hands with soap and water for at least 20 seconds and that makes sense. That’s removing debris including any sort of viral particles with the soap and the water. We know that we don’t have a sink in the front of the ambulance or in the front of the rescue. That makes it difficult when we’re out in the field. I am not aware of the testing results on a commercially available products like your alcohol based hand sanitizers. This is what is being recommended right now. I’m sure that they are doing testing to see if this actually kills the virus, but in absence of a sink with water and soap, using the alcohol based hand sanitizer is the next best thing. So, that is the current recommendation. I wish I was able to speak with more authority on how well it works.
Robert Sanchez: Right. No, great. I thank you for that. I think there’s a lot of questions out there, especially for us watching the news and even talking amongst the first responders. That’s kind of the thing out there is, what really works and what doesn’t work. And I think the thing of just the unknown is tough for first responders and firefighters, paramedics-
Vince Trujillo: You know, Robert, as someone from the general public, this is a question I have. How are the first responders informed? Are they informed just as a general public is? I would imagine that there’s some type of system for informing and cautionary measures, et cetera, et cetera. How does that take place? And even from the ER standpoint, Dr. White? So, I guess that question is for both of you, if you don’t mind, as far as how you receive your information.
Dr. Chelsea White: And when you say for an individual patient or just in general, like how do we prepare for the day?
Vince Trujillo: Well, let’s say for instance I needed to communicate with you guys about an outbreak in a certain area of the city or information just overall. What agencies or news sources do you receive your information and guidance?
Dr. Chelsea White: So I’ll take that question if you don’t mind, Robert.
Robert Sanchez: Sure, absolutely.
Dr. Chelsea White: We on a national scale, we receive information from the CDC website. So, that’s at the same time that the public does. However, on a local level, we receive information from the New Mexico Department of Health. There is a health advisor network that sends out bulletins on an as needed basis to subscribers to that network, which are of course health providers.
Vince Trujillo: Ahh ha great (affirmative).
Dr. Chelsea White: So, that tells specifically about things that are happening in New Mexico. And in certain areas or statewide. So, that is really the way that things happen from that role obviously I’m at, which is where a lot of stuff starts that really relies on the agencies themselves as they discover information. Most of the information though that we get, I think the best answer to your question is through health alert network through the state.
Vince Trujillo: Okay.
Robert Sanchez: Great. So, I know specifically, Doctor, we’ve talked about legislation and laws that I think we can work hand in hand through the state of New Mexico. But one of the things I wanted to ask about that was, in the ER for first responders requiring blood-borne or blood tests when exposed to blood-borne pathogens. What kind of legislature can we assist with or work together hand in hand with the air physicians or physicians in the state of New Mexico and first responders in the next coming legislature?
Dr. Chelsea White: Well, thanks for bringing that up Robert. I am also the president of the New Mexico chapter of the National Association of EMS Physicians and the National Association of EMS Physicians is the professional group for EMS physicians, actually internationally that work hard to advance the field of EMS in many different ways including EMS advocacy. And a special topic that we are very interested in, even before this COVID outbreak was the ability to get source testing for patients that may have accidentally or hopefully not intentionally exposed healthcare providers in the field and in the emergency departments. Right now we don’t have the ability to compel a source patient to provide a blood sample for testing. Other states do have legislation that compels patients to provide blood for source testing and I look forward to working with you to see what kind of legislation we can get in New Mexico that can help EMS providers and help the hospital personnel better understand their exposure risk if they have been exposed by a patient.
Robert Sanchez: Absolutely. Yeah. So, we’ve always worked hand in hand in the field and I could definitely see us working hand in hand in the legislature. And we got a good asset and we’re fortunate or I am fortunate to be involved in New Mexico Professional Firefighters, but what’s also extends to the International Association of Firefighters, all over the United States. So, I know like you mentioned, there’s legislature out there in some other States that we can utilize for us. So, we don’t have to reinvent the wheel all the time. We could just get legislature and kind of adjust it and edit it to what would benefit first responders, firefighters, healthcare workers and physicians throughout the state of New Mexico.
Robert Sanchez: So, I definitely look forward to work with you with that. So, last thing I wanted to ask Doctor, so what can we do next time just to better prepare the hospitals and even fire service first responders throughout the state of New Mexico, so we do have an epidemic or that comes up again as COVID-19? I guess, I don’t know, what did we fail at and what could we do better?
Dr. Chelsea White: Well, I don’t know that I can speak specifically to what we failed at, but I can certainly speak to what we need to make sure that we are ready for next time. And that involves the unknown. So, that makes it hard to prepare of course. But what we do know is that we are as EMS providers and as emergency department providers, we know that we are exposed to all sorts of diseases all the time, some of which are airborne, some of which are respiratory droplets spread like we’re seeing now. So, that means that we need to be prepared for not just the next outbreak, but for the next patient who may have something that is actually that we’re very used to, but we just don’t want to catch. Like the flu, like RSV or like the next novel virus that’s out there.
Dr. Chelsea White: So, we need to be provided with and well stocked with all of the PPE that’s necessary for this current situation. But we also need to be armed with the knowledge and just the general practice that we probably should be using this a whole lot more than we are on just regular old calls. The next time you go on a call with somebody who has a cough, make sure that you’re wearing protective gear. An epidemic or pandemic situation like that at that point. We just need to make sure that we’ve got the protective gear that we think is most likely to protect us for whatever we’re going to face next time.
Robert Sanchez: Absolutely. So, I think we all get complacent sometimes even as first responders and healthcare workers about using our PPE. Let’s face it, sometimes we don’t do it like we should. And definitely if there was an eye opener for us to make us remember to wear our PPE, this is the time that we’ve actually remembered and we’re understanding it more and knowing how important it is. A lot of the times, it just seems like it’s not important, but we all know it’s important for other blood-borne pathogens or exposure to anything else.
Robert Sanchez: So, Doctor, thank you for being on the show. Like I said, it’s an honor working with you. I’ve worked with you in the past and our organization and firefighters across the United States, New Mexico want to work with you and especially passing legislature. I look forward to it. Is there anything else you wanted to add, doctor on this podcast for our audience?
Dr. Chelsea White: Absolutely. Thank you again, Robert for having me on. I want to just stress a couple more things. First of all, the information is changing every day. Please, please don’t use this as your only source of information. Please check the CDC website. Please check the New Mexico Department of Health website. Secondly, please wear your PPE. I know it’s a pain to put on. I know it’s a pain to take off, but please be very careful about this. It is really important that you stay healthy. For your own health, for the health of your family and for the health of your patients. So, that also means isolating yourself right now. I know that we’re talking a lot about social distancing, et cetera. We’re at a higher risk for coming in contact with this disease and we’re at a higher risk for transmitting this to others. Even if it doesn’t affect us that much personally, even if it’s just a bad cold for us, we could be taking it somewhere else.
So, that means that we need to, when we are not at work, we need to be staying at home and trying to avoid the general public as much as possible. That’s the only way that we’re going to… As a society and as a community to slow the spread is to slow just contact with others. And again, because we are seeing sick patients more than the average person is seeing, we really need to make sure that we are trying to stay away from other people when we are off duty as much as possible.
Vince Trujillo: Well thank you Dr. White. Thank you so much. Coming from the public, I can’t thank you and all the healthcare workers and first responders enough for everything that you’re doing for our city and our state. Thank you so much Robert Sanchez for being a first responder, thanks for putting this podcast together. We will definitely be assessing this healthcare crisis as we go and bring some more episodes later in the year from the perspective of other healthcare professionals and first responders. And we’re asking you listeners out there subscribe to the podcast, give us a review or drop us a line and let us know about what you think. Go to FireFighterKingdom.com for more information and on how to be a guest on the show. Dr. White thank you so much for joining and Robert I’m signing off for this episode.
Robert Sanchez: Good signing off, so-
Dr. Chelsea White: Thank you, stay healthy.
Robert Sanchez: Stay healthy and we say bye to the FireFighter Kingdom until our next episode.
Vince Trujillo: Sounds good. Thanks a lot. Everybody. Take care.
Dr. Chelsea White: Be safe.
Originally published at firefighterkingdom.com on May 15, 2020.
