VIENNA — The Maries-Osage Ambulance District (MOAD) is one of the organizations on the front line of the coronavirus COVID-19 spreading throughout the United States and the board members recently had a teleconference with Administrator Brian Opoka to discuss how they will handle several virus-related issues.

The teleconference was held last Tuesday evening. Board member Laura Stratman said she wanted the meeting so they have a plan about how the district will handle COVID-19 infected patients they transport, how they plan to protect district staff while they are on duty, how they will be compensated and more. “I have more questions than answers,” she said.

PPE’s

There are concerns about having enough Personal Protective Equipment (PPE) for MOAD employees who interact with patients, people who potentially could have the virus. Because of the worldwide demand during this pandemic, supplies are not adequate. Opoka said they are not in dire straits at this point although the concerns are legitimate. He said he’s been working on it and he shared with the board members what he knows.

On that day the virus continued to spread. Missouri had 155 cases, which is 31 percent higher than reported 24 hours earlier. In the county where Opoka lives in the metro Kansas City area, there were 36 positive cases of persons infected with the virus. There have been zero cases in Maries County thus far. St. Louis County has even greater numbers.

Opoka said there is a state cache of PPE’s and on March 16 he requested some from this cache for MOAD. He was well ahead of the deadline to make the request. The state has been releasing the PPE’s but it too has a plan. The protective equipment is going to the areas considered a higher priority for viral infection, which is St. Louis and Kansas City, and to the bigger hospitals and the ambulance services in the urban areas, which began receiving them on March 20. Maries County is a lower priority. Opoka said, “We do have PPE’s on the truck we can use. If we had an influx of cases, we don’t have enough today to handle it. But we have a request in. I have full faith in FEMA we will get them.”

Crew Face Shields

There is concern with the crew members regarding face shields, Opoka said, and there is price gouging going on with them. Organizations were told there would be reimbursement from FEMA and the price gouging began. Some of the crews are uncomfortable with MOAD’s equipment that dates back to the ebola scare. Opoka thinks the face shields are adequate but some crew members do not. He thinks he has a manufacturer that he can get new face shields from. Most of the MOAD crew members work full time for another service and they have the new face shields and think MOAD should have them also. But, MOAD is limited by budget but needs to get more face shields which will help the crew members feel better. A big concern is droplets. Opoka is working on this. He mentioned about 40 coming from a donation source.

Exposure

Opoka said the crews have been given updated policies and procedures about social distancing and the medical director has a policy about doing door assessments. This is a type of screening where the crew members stand at the patient’s door, about 10 feet away, and talk to them about their medical problem. The policies also deal with where to take a virus-infected patient and what protocols to use after the crew has transferred patient care.

Opoka said he’s had conference calls with the EMS Bureau and there could be changes about where the patients will be taken. These are rumors within the industry, however, and he didn’t feel he was able to share.

As far as if a crew member is exposed to the virus, Opoka said it can only be handled on a case-by-case basis. If there is an exposure, he will get the details about it. There have been 36 cases in the county where he is and medics and EMTs have had to handle these cases. They attempt to use the proper protocols and the crew members decontaminate at the hospital with a shower and are given hospital scrubs to wear. Then they call the Department of Health and Human Services (DHS) hotline and explain the circumstances. That will determine a true case or not.

“I could get it today and wake up with symptoms the next day,” he said. “What about my family? Nothing is cut and dry.” How they treat the exposure is to be determined by the components of the individual case.

If someone is exposed, they have to isolate themselves for 14 days. “Our employees won’t be able to work, their families will suffer,” he said, adding there will be no favoritism shown, as all will be treated in the same compassionate way.

Board member Victor Stratman asked if the face mask is adequate protection and Opoka said yes. If crew members wear the proper PPE’s, they won’t have to be isolated. Stratman asked if they can be worn in any type of climate. Opoka said the crew members must follow the door assessment policy to ensure the patient is not a COVID-19 patient. For example a fall, the crew would have to access from the door if the patient had virus complaints before they needed to use the PPE’s to protect themselves.

“If they don’t have those complaints, don’t put the PPE’s on for every call. We don’t have the supplies,” Opoka said. “Supplies are low as it is. There’s not enough PPE’s for all of the calls.”

Case by Case Basis

Board member Laura Stratman asked how employees will be dealt with if they are exposed while working for MOAD. Does it fall under worker’s comp? “We need an idea of our actions before it happens,” she said, adding they need to talk about this in order to have some idea of what the district will do. “Our people can’t work from home,” she said.

Again, Opoka said it will have to be determined on a case-by-case basis. If a crew member has to be isolated and MOAD is responsible, what will the district do for the crew members? The board needs to decide what the district will do if an employee has to be isolated for 14 days. If the crew members had on PPE’s and was taken to the hospital, they would not be restricted or isolated.

Victor Stratman said the district could pay the wages the crew member missed. Opoka said 95 percent of MOAD crew members have full-time jobs elsewhere. Laura Stratman asked how they would know which job the crew member was working for when he/she was exposed to the virus.

Board Vice President Steve Maxwell asked about worker’s comp insurance and if it covered these situations. No one was sure but Opoka asked Office Manager Carla Butler to find out. Opoka said even with worker’s comp, it does not completely cover an employee’s wages, just a portion of it. Laura Stratman said workers comp would be a start.

Victor Stratman said it would be something. “How can we get people to work part-time for us if it jeopardizes their other job?” Opoka said it is the risk MOAD runs with its part-time employees. MOAD does pay worker’s comp and they will find out if it will cover virus exposure.

Butler said if an employee is hurt on their other job, the employee could not collect from MOAD and vice versa, just from the employer where they were injured. Board President Don Lanning agreed. Butler asked if there was FEMA money for this and Opoka said not at this time.

Large Group Limits

Opoka said he received a text message from a part-time employee at his full job who said the employee’s full-time employer said they could no longer work part-time at an EMS job because the full-time employer needed to ensure they are healthy and they wanted to limit exposure to the virus. This was from a large, urban fire department. Opoka said this will “trickle down to us” and has the potential to take out 90 percent of MOAD’s employees. If a large fire department says, “No EMS as part-time,” the board members need to keep this in the back of their minds as it could happen. Victor Stratman said he understands the fire department’s point. Opoka said, “When a large fire department does this, they get followers.” Maxwell agreed that the no part-time EMS rule will spread out.

Right now, Opoka noted, there are no cases in Maries County. MOAD has four full-time employees that MOAD is their only job. All the others have full-time jobs doing the same work somewhere else.

Take it Seriously

Laura Stratman asked how serious the virus is. Opoka said in Maries County it’s hard to say as there has not been an outbreak in this area. The governor has put out regulations. In the Kansas City area where Opoka lives, unless a person is an essential employee, they are asked to stay at home for 30 days. “People are not listening to it,” he said as there was heavy traffic when he drove to his essential job and there should not have been. People are asked to stay at home in order to cut down the spread of the virus. Opoka works for the largest nursing home in Missouri, with 3,500 elderly persons living on a three-acre campus. They don’t have any cases yet but there have been all around them. Their residents are very vulnerable and for him and his work, this is extremely serious. If they don’t take it seriously, there can be mishaps and exposures.

He said all the people who work on the ambulance trucks have been given tools, procedures and protocols. If they practice these, it will take care of a lot of the problems. “I don’t know how serious the people in Maries County are taking it,” Opoka said. “We have crew members who are anxious. I can feel the fear in their voices and text messages.”

Victor Stratman said people are not getting around in Maries County as they were as he noticed there are not as many cars in town. Opoka said as an essential employee, it is “disheartening to see all the traffic.”

Board member Eileen Smith said the governor shut down state offices except for essential employees. Lanning said the nursing home was locked down to visitors; only employees can come into the building. Maxwell said the people of Freeburg are taking it seriously as he noticed there are not many customers at the restaurant. Laura Stratman said she is working from home.

“We’ve never experienced this anxiety and fear,” Maxwell said. “The young people are not taking it seriously. It’s disappointing as they are living their lives as usual. The old folks, we take it seriously.”

Employee compensation

About compensating employees, Maxwell said on the compassionate side he says yes, but on the other side can MOAD afford it? Laura Stratman said they can pay what MOAD would regularly pay them because economically they can’t do more. Also, Maxwell said MOAD can’t afford to lose too many crew members, especially if they lose the ones who work elsewhere. It comes down to the best they can do, he said.

Opoka said he has been having multiple conference calls daily and is up-to-date with CDC, EMS Bureau, the medical director and he will keep the crews informed. “This is a virus and there is no vaccine and there are panicked people,” he said. “We need to be calm and cool-headed and take care of our patients.”

Opoka said MOAD is unique with no employee benefits and there is no way of comparing it to other districts because of it. He made a suggestion as a bare minimum, to see if an affected employee could receive worker’s comp plus a supplement from MOAD of what they would make if they were working for the district. Most of the employees work somewhere else. It needs to be handled on a case-by-case basis.

“Let’s hope we don’t have to face it, but we need to be prepared,” Laura Stratman said.

Opoka suggested they discuss it again when they know all the facts. He thinks 14 days of compensation of 100 percent of what MOAD would pay them is the best. This is his recommendation. But, it will be the board’s decision.

In-Person Meeting Cancelled

Lanning suggested they cancel the April in-person board meeting and do a conference call meeting instead. Opoka said with where he is living, he doesn’t think the board members would want him in Vienna. Maxwell said with the regular people who attend the meetings each month, it surpasses the limit of 10 people per the governor’s order. Laura Stratman agreed it is best to avoid personal contact. The meeting is set for April 13.

“You’re doing a fine job. Keep up the good work,” Maxwell said to Opoka. “It’s a scary time we’ve never went through it. The EMS personnel are trained. We will be fine and keep up the good work. Stay safe.”

Opoka said, “We will get through it and all will get back to normal.”