First published in The Record on April 18, 2020

For EMT’s, COVID-19 is the mass-casualty incident without end

  At 8:17 p.m. on a recent Friday, the walkie-talkie emitted two loud squawks. For Dave Epstein, the call held no surprises.

“This is to the Fair Lawn Ambulance corps,” the police dispatcher said. His voice sounded tinny and far away. “It’s gonna be 1215 Saddle River Road, the Maple Glen Center,” a

nursing home in Fair Lawn.

“It’s gonna be a COVID,” said Epstein, ambulance corps’ chief.

“Positive protocol response, 68-year-old male,” the dispatcher said.

“See?” said Epstein. “Protocol response. That means COVID.”

Epstein and Tracy Cornejo, volunteer emergency medical technicians, climbed into a white ambulance. Epstein drove without sirens, a map, or directions on his phone. He knew the way.

“Watch,” said Epstein, 58 and a volunteer since 1982. “We’ll get in there and find him almost dead. And the nurses will say he was breathing two minutes ago. Just watch.”

For EMTs across North Jersey, COVID-19 is the emergency that never ends. Bergen and Passaic counties face some of the highest concentrations of coronavirus in America. Ambulance workers — many of whom volunteer, without pay or health insurance – face the largest health crisis of their lives.

During a normal year, an EMT here may experience only a handful of patients who can’t breathe, or patients with no pulse.  

Now, such dire calls are routine.

When Cornejo and Epstein arrived at the Maple Glen Center, they trotted down a long hallway. A nurse in a yellow gown shouted that the patient seemed fine a few minutes ago.

The patient lay beside two other residents in an open room. Epstein entered the room alone.

“Tracy?” he shouted. “Get the bag!”

The bag is a plastic bladder used to force oxygen into a patient’s lungs. When Epstein called for the bag, it meant the patient could barely breathe.

Cornejo sprinted to the ambulance. Returning with the bag, she helped Epstein wheel the patient to the ambulance. Epstein held a plastic mask to the patient’s face and squeezed the bag, delivering oxygen. The patient’s pulse grew faint. Without help, he would die.

Cornejo phoned a fellow EMT volunteer.

“Can you meet me at Maple Glen? Like now. Now!” Cornejo screamed. “Yes. Hurry. Hurry!”

Reinforcements arrived. In the back of the ambulance, Cornejo and Epstein tended the patient. Up front, a backup driver sped them to The Valley Hospital in Ridgewood. The patient was delivered to the emergency room.

“Remember what I said would happen? That’s exactly what happened,” Epstein said. “We got there, and the call fell apart.”

The permanent emergency

Over the past two weeks, EMTs in six North Jersey municipalities described the COVID-19 pandemic as a medical emergency that never ends.

“A bus crash or a car crash with multiple victims, that’s something we drill on,” said Jacob Finkelstein, 24, chief of the Teaneck Volunteer Ambulance Corps, perhaps the hardest-hit volunteer EMS group in the state. “This is a mass casualty incident in our whole town.”

Ambulance workers in the two largest communities we visited — Passaic and Hackensack — were paid employees, although volunteers in Hackensack also respond to calls on nights and weekends. In Teaneck, Bergenfield, Fair Lawn and Closter, the EMTs were all volunteers.

The only town where the pandemic hasn’t upturned the lives of EMTs is Closter, where few cases of COVID-19 have been reported.

In all the others, the virus brings upheaval and exhaustion. The total volume of calls has not increased dramatically. Rather, the average call is more severe. Most people with minor problems such as sprained ankles, or fallen seniors who need help standing up, aren't calling 911, EMTs agreed. Orders from Gov. Phil Murphy for everyone but essential workers to self-quarantine have resulted in fewer injuries from traffic accidents, they said.

Instead, more patients present life-threatening issues that no ambulance or hospital is equipped to fix. EMTs in every town said that between donning protective gear, dealing with overloaded hospital staff and decontaminating their ambulances after every trip, each call now takes more than an hour, three times longer than normal.

“We have to make sure we have all the protective gear. All patients also get masks and gloves. Parking at the hospital is crazy,” said Johanna Stange, an EMS supervisor in Hackensack. “All of that takes time.”

COVID-19 also increases the emotional stakes of the work. Many patients don’t call 911 until symptoms become unbearable. More of those patients die.

“I’ve had a lot more DOAs,” John Knapp, Hackensack’s EMT chief, said of emergencies in which the patient was alive at the time of the call, but dead when ambulances arrive. “It’s emotionally draining. It creeps up on you.”

All the volunteers and paid personnel interviewed for this story are members of “basic life support” teams. Whether volunteers or paid employees of cities or hospital systems, they are expected to provide first aid and transportation to hospitals. They also help “advanced life support” teams, which are based in hospitals and empowered to perform riskier procedures, including different types of intubations and intravenous injections.

In the recent past, BLS and ALS workers were directed to “load and go” in cases of cardiac arrest, the EMTs said, packing patients into ambulances and rushing them to the nearest hospital. Recent research, as well as advancements in EMT training and equipment, have turned ambulances into de facto mobile emergency rooms. This enables many critical patients to be treated right where they lay, for as long as required until they’re stabilized.

“Your main goal was to get the heck out of there and book it to the hospital,” Finkelstein said. “Now there have been studies that some patients are more likely to have a positive outcome if you set up the ER where they are.”

In a few cases, EMTs become the patients. Israel Tolentino, a Passaic firefighter who also worked as an EMT in the city, died from coronavirus complications on March 31. Kevin Leiva, another EMT, died after exhibiting similar symptoms a week later.

On Easter Sunday, in the barnlike garage on Grove Street that serves as Passaic’s EMT headquarters, black and purple banners hung from rafters in honor of the fallen men. It was another busy day. There would be no holiday, no time to cry.

The women and men inside the garage were asked about their dead friends. The silence that followed was uncomfortable. Talk among the EMTs, usually garrulous, grew clipped.

 “I was close with Izzy. I was close with Kevin,” said Vinnie DeRosa, a supervisor. “I took off last weekend to grieve. And now I’m back.”

“I’m tired. Overwhelmed,” said Passaic EMT Jerry Tlatelpa, 25. “Scared.”

Uneven protections

At 10:28 a.m., a radio inside the Passaic garage erupted in static and garbled words. Tlatelpa translated: Henry Street. A 62-year-old man couldn’t breathe.

Fifteen minutes later, Tlatelpa and his partner, George Isler, carried the patient down a flight of stairs on an orange stretcher. The patient’s son, Joel Rosario, followed the EMTs to the waiting ambulance. He expected to stay by his father’s side.

The EMTs said no. To slow the infection’s spread, visitors are not allowed.

“So I can’t go into the ambulance? I can’t see him in the hospital?” said Rosario, 16. “It’s just us. He’s my only family.”

Tlatelpa and Isler wore Tyvek suits. Isler’s suit was patched with duct tape. Now the tape hung loosely. The suit flapped open down the middle, from Isler’s throat to his waist. Another tear ran down his left leg. After driving the patient to St. Joseph’s Medical Center in Paterson, Isler wore the same ripped suit to at least two more calls. The suit was decontaminated with soap and water after each call, and Isler was protected by a respirator mask and gloves.

Dave Lutzker, a volunteer in Fair Lawn, was even more cavalier. At 8:55 p.m. on a recent Thursday, Lutzker walked into the COVID ward of The Valley Hospital emergency room in Ridgewood. Nurses and doctors wore full gowns, goggles and face shields.

Lutzger wore no eye protection. His torso was covered by a gray fleece, his hands and mouth by gloves and an N95 mask. This was sufficient so long as members wash their hands and decontaminate their clothes after every call, said Epstein, the chief.

“The mask is the thing,” Epstein said. “And I know the mask works, because otherwise I would have been dead by now.”

In Hackensack and Bergenfield, EMTs don full protective gowns or Tyvek suits the moment they arrive on scene. In Teaneck, volunteers don’t even leave the EMT garage without gowns.

“At this point, it doesn’t matter what the call is for,” said Finkelstein, the chief. “We’re treating every call as if it’s COVID.”

House to house

Over the course of two dozen emergency calls in five North Jersey municipalities, patients’ symptoms and EMT responses ran the gamut. In Bergenfield, volunteers used stretchers to retrieve two patients from houses and one from a nursing home. All were driven to Englewood hospital.

“I’m not going to lie. People are exhausted,” said Ryan Shell, chief of Bergenfield's EMT corps. “Everybody knows somebody who died who shouldn’t have died. So everybody’s terrified.”

At a house on Gregory Street in Passaic, Tlatelpa positioned himself on the steps below a patient. He reached up and pressed his gloved palm against the patient’s chest, steadying the man as they walked to the ambulance. Seven hours later, a Passaic resident on Palmer Street called 911 complaining of labored breathing. When the medics arrived, they advised her to stay home.

“We’re being straight with people,” said Knapp in Hackensack. “If you don’t have COVID yet, a hospital is one of the best places to go and get it.”

Identical calls often ended differently. In Teaneck, a family called 911 because a relative had trouble breathing. By the time the ambulance arrived, the woman was dead.

In Fair Lawn, Cornejo arrived to a fashionably modern home where a grandmother lay on the basement floor. By the time she was wheeled on a stretcher into Blue Room 20, inside The Valley Hospital’s emergency room’s COVID ward, the patient pulled on the handrails, straining for air.

Five minutes later she slumped back, exhausted by the effort. Her diagnosis had changed from a simple slip-and-fall with a little trouble breathing to suspected COVID positive.

“Nyet. Nyet. Nyet,” she said, repeating the word “no” in Russian.

Outside, in the hospital loading dock, Cornejo peeled the gloves from her hands.

“It’s overwhelming,” Cornejo said. “We can only do so much.”