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Boots on the ground: the EMS response to COVID-19


Coauthored by Mark Liao, MD, and Dan O’Donnell, MD, FAEMS, FACEP

Indianapolis, like many metropolitan cities across the United States, has always needed to consider what is happening globally. The first to face any worldwide outbreak of diseases, be it MERS or Ebola, would likely be front-line Emergency Medical Technicians and Paramedics. This reality came true in March 2020 with the global COVID-19 pandemic. Fortunately, these First Responders were ready thanks to the leadership of the Chief of Indianapolis Emergency Medical Services, Dr. Dan O’Donnell.


Monitoring the developments within Wuhan, China in early January 2020, EMS Medical Directors and EMS Fellows from IUSM Emergency Medicine quickly developed procedures to protect local First Responders, unveiling a “Droplet Zero” protocol designed to limit the spread of droplets and aerosols during prehospital patient care. Further recognizing that many worried-well or those with only minor illness may present a significant burden on the EMS and Hospital system, “Treat at Home” protocols were also developed, which allowed EMS providers to determine who could be safely managed without transport. These protocols were disseminated for use throughout Indiana and served as a model for other EMS agencies. These were developed just in time for the first confirmed COVID-19 Indianapolis EMS transport that was announced on March 15th 2020.


On March 16th, the Marion County Emergency Operations Center began work at its highest alert level, with Indianapolis EMS providing a unified command in conjunction with the Indianapolis Metropolitan Police Department, Indianapolis Fire Department and Marion County Public Health Department. Unlike many disasters – in which there is a defined single event – the COVID-19 pandemic highlighted the challenges of a slowly developing crisis that builds not over several days, but rather weeks and months.

Battle plans at the EOC were drawn up on how to support front-line responders by ensuring they had proper Personal Protective Equipment, in addition to the creation of a hospital diversion plan to distribute COVID-19 patients in case of a surge. EMS Fellows and Faculty alike served as Subject Matter Experts for the dizzying number of recommendations from the CDC and other National entities that had to be digested by the County’s emergency responder agencies, each with unique requirements relevant to their job function. Partnerships, information sharing and transparency were key in ensuring there was order to the chaos. One unique partnership that was also developed was with Indianapolis-based Eli Lilly, who offered COVID-19 first responder testing.


Since the start of the pandemic, the EMS Division has supported innovations in prehospital care such as protocols that allow transport to Urgent Care facilities, thereby offloading busy Emergency Departments, and rolling out of IEMS Community Paramedics. The Community Paramedic program allows for trained paramedics to reach out to high risk populations such as homeless shelters to monitor for worsening health conditions, in addition to following up with patients who might otherwise be struggling to find primary care options.

The COVID-19 pandemic is by no means over and the coming weeks will undoubtedly be challenging for all First Responders. IUSM Emergency Medicine is alongside all of them as we fight COVID-19 – day or night, in the hospital or in the streets.

Click here to more about the Department of Emergency Medicine’s Division of Out-of-Hospital Care (EMS) and meet our current EMS fellows.

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
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Emmy Schram

Emmy Schram is the Communications Coordinator for the Department of Emergency Medicine. She earned her MA in English from Ball State where she taught English Composition while working as a freelance graphic/web designer. She brings with her varied professional experiences which she uses to support departmental communications efforts while finding new ways to combine her passions for marketing and education.