Home-based SARS-CoV-2 Testing by EMS Personnel Improves Care of Vulnerable Populations
- Facility-based SARS-CoV-2 testing is often inaccessible to people who are homebound, chronically ill or without private transportation
- In the early days of the COVID-19 pandemic, Mass General Brigham partnered with local ambulance agencies to design a home-based SARS-CoV-2 testing program
- Paramedics and emergency medical technicians were trained in nasopharyngeal swab collection, specimen handling and safe use of personal protective equipment
- By April 2020, the hospital system was operating up to two teams of emergency medical services providers per day, testing up to 20 patients daily depending on the distances between homes
- As of April 30, 2020, the program had performed 477 home-based tests
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Insufficient testing has been identified as a critical shortcoming in the early response to SARS-CoV-2 in China and the U.S. compared with countries that launched aggressive testing programs from the start.
The current practice of testing for SARS-CoV-2 at facilities (e.g., hospitals, drive-in clinics) compounds that shortcoming. Testing is inaccessible to many people, including those who are homebound, chronically ill or without a means of private transportation. What's worse, many such individuals are at high risk of COVID-19 due to comorbidities and socioeconomic risk factors.
Recognizing these problems, a Mass General Brigham team including Charles T. Pu, MD, FACP, CMD, attending physician at Massachusetts General Hospital, Christine Seel Ritchie, MD, MSPH, director of research in the Division of Palliative Care and Geriatric Medicine and director of the Mongan Institute Center for Aging and Serious Illness at Mass General, and Scott A. Goldberg, MD, MPH, of Brigham and Women's Hospital, and colleagues designed a home-based SARS-CoV-2 testing program that leveraged a resource already available in most U.S. communities: ambulance agencies. They describe the program in the Western Journal of Emergency Medicine.
Rationale for Using Emergency Medical Services (EMS)
Like community health workers, paramedics have ties to their neighborhoods and cultural competency, and they are well versed in evaluating and managing complicated patient populations. Together with their high level of medical knowledge and procedural skills, these insights make them uniquely prepared to serve the communities most affected by COVID-19.
Developing the Program
In the early days of the pandemic, Mass General Brigham worked closely with a partner EMS agency to develop the program. Initially, six paramedics were trained in nasopharyngeal swab collection, specimen handling and safe use of personal protective equipment. The standardized training lasted two hours. During the first week of the program, the workforce was expanded to 17 paramedics and emergency medical technicians.
Once a clinician deems that a patient requires testing, a team of at least two EMS providers goes to the patient's home. While one provider collects the specimen, the other watches for any PPE breaches, then puts the specimen into a sterile receptacle. The team transports the specimen to the appropriate testing facility.
By April 2020, up to two teams of EMS providers were testing up to 20 patients daily, depending on the distances between homes. As of April 30, 2020, the program had performed 477 home-based tests.
So far, the service is principally hospital-funded. The Centers for Medicare and Medicaid Services has said it might reimburse for SARS-CoV-2 testing of patients unable to travel, but how or whether this will be implemented remains unclear.
Plans for the Future
Mass General Brigham hopes to incorporate home visits and remote monitoring of COVID-19 patients into the program and expand operations that offer inpatient-level care at home. These efforts will remain necessary for addressing the disparities in health care that COVID-19 has accelerated.
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