At high risk of COVID, Trumbull EMS to upgrade heart treatments

TRUMBULL — With the reality of life in a pandemic now in its eighth month, medical professionals are continuing to adjust every aspect of patient care, especially among the most critically ill.

In the case of congestive heart failure, the best emergency treatment is the administration of vaporized nitroglycerin, said EMS Chief Leigh Goodman. Nitroglycerin works by expanding the blood vessels, relieving pressure and increasing circulation. But the drug is typically given through a CPAP (continuous positive airway pressure) inhalant mask, which is strongly discouraged under current COVID protocols.

“Because the machine is continually pushing air into the mask, it actually is forcing the patient’s exhalation out through the vents,” Goodman said. “Then you consider that we are typically treating a patient in an enclosed compact environment in an ambulance, and it’s a high risk for our personnel.”

Heart failure is a fairly common cause of emergency medical calls, Goodman said. With the CPAP not an option, the EMS crews have had to use treatments that are either less effective, or more invasive and unpleasant to the patient, she said.

“What we’ve been doing is giving oxygen and getting them to the hospital and into an isolation room at the hospital for treatment as fast as we can,” she said.

For the most critical patients, paramedics use direct tracheal intubation.

“That means we put a tube down their throat,” Goodman said.

And while intubation reduces the exposure of ambulance crews, it is very uncomfortable for the patient, and complicates the patient’s recovery, she said.

The solution may be on the way, as the EMS Commission approved a suggestion by Goodman to purchase infusion pumps to treat patients in critical heart failure. The pumps, which cost between $800 and $2,000 each, allow paramedics to give nitroglycerin via an IV, Goodman said.

The pumps allow precise metering of medication directly into the patient’s bloodstream and means the patient would receive effective treatment before they arrive at the hospital, she said.

In her report to the EMS Commission, Goodman said there was no doubt that purchasing the infusion pumps would make Trumbull safer.

“Administering IV nitroglycerin via infusion pumps to patients experiencing acute CHF emergencies during pandemic COVID-19 is the safest and most effective way to treat these patients,” she said. “Adding this tool to our paramedic treatment line will no doubt save lives.”

Using a needle rather than an inhaler to administer life-saving treatment is the latest change in tactics for Trumbull EMS, Goodman said. As the service continues to adjust to the new reality, there will undoubtedly be more changes, she said.

“We started planning for the possibility that we would have to shelter in place back in January, when it was clear that this pandemic was coming,” she said. “And at the time everyone’s concern was on getting through it, and how can we provide service until the situation passes.”

But the situation is now in its eighth month and if anything the spread is accelerating. For Goodman, a constant reminder of the situation is her exposure tracking spreadsheet that she created as the first cases started being reported.

“When I started it, the thought was we may have to do a 14-day quarantine,” she said. “But just to be safe, I made it to record a month of data. At the time, I thought that was probably excessive. But now I’ve had to go back in seven times to add another month.”