Since the first lab-confirmed SARS-CoV-2 infection in the United States was detected on January 21, 2020 [1], the COVID-19 pandemic has caused significant health, economic, and political impact as it has continued to spread worldwide. With vaccines currently authorized to prevent COVID-19 in adults, large-scale vaccination programs will require significant workforce expansions.
Emergency Medical Services (EMS) providers are a potential resource and have been used in prior public health emergencies to provide services outside of the routine 911 response role [[2], [3], [4], [5]]. A national survey of EMS personnel revealed 82.7% of respondents felt that EMS professionals should participate in disease prevention. However, EMS agencies and local public health departments do not routinely interact, and in this same survey, only 33.8% had actually participated in these types of services [6].
Vaccination efforts present opportunities for partnership between EMS and health departments. The MedicVax Project in 2003 showed that Paramedics could administer vaccines safely and also demonstrated that EMS vaccine administration resulted in segments of society receiving immunizations which otherwise would not. In their study, 90 paramedics administered a total of 2075 flu shots. 49% of the vaccine recipients had not received the vaccine in the prior year and 34% stated they would not have received it that year had it not been offered by EMS [7]. Walz [4] reviewed Paramedic vaccine administration programs and found them to be effective, but stressed the importance of vaccine documentation and record keeping when giving vaccines in untraditional settings.
There have been no studies to date on the feasibility of utilizing EMTs for vaccination efforts, despite being trained to administer intramuscular injections. The 2020 National EMS assessment shows that there are currently 917,355 certified EMS personnel in the US, of which 63% are EMTs [8]. Incorporating EMTs into vaccine efforts greatly increases the workforce available to deliver large-scale vaccinations.
Starting in September 2020, Orange County, NC (population of around 140,000), began planning and implementing a mass vaccination program for the community utilizing a combined workforce of EMS and health department personnel. A protocol allowing EMTs, Advanced EMTs, and Paramedics to administer vaccines by the intramuscular route was approved by the NC State Office of EMS on 9/16/20.(Supplement Fig. S1).
Orange County Emergency Services (OCES) staffed six influenza immunization clinic days in combination with the Orange County Health Department (OCHD) during the month of October 2020. 16 EMS providers participated in the events (3 EMT, 5 EMT students, 8 Paramedics). A total of 319 vaccines were administered over a period of 6 different clinic days, with 272 given by EMS providers (85%) and the remainder by health department staff (15%). 58% of the total vaccines were given by EMTs or EMT students (Table 1 ).
Table 1.
Flu vaccination staff at six community immunization clinics in October 2020.
| Flu vaccination staff | Number of providers | Total vaccines administered (%) |
|---|---|---|
| Paramedic | 8 | 86 (27%) |
| EMT | 3 | 53 (17%) |
| EMT Student | 5 | 133 (42%) |
| Total EMS | 16 | 272 (85%) |
| Health Department | 47 (15%) | |
| TOTAL | 319 (100%) |
EMS personnel were later incorporated into subsequent OCHD COVID-19 vaccination clinics. EMTs and Paramedics staffed nine clinics with other health professionals. EMTs and Paramedics functioned interchangeably during the clinics. EMS personnel both prepared the vaccines for administration and administered the intramuscular vaccinations without required oversight.
EMS providers staffed nine COVID-19 immunization clinics in combination with the OCHD and vetted community volunteers during the months of December 2020 and January 2021. 52 EMT providers served as vaccinators and 2 EMT providers worked performing vaccination preparation, making up 36% of the overall workforce. 16 Paramedics performed vaccinations, while 7 performed vaccination preparation, making up 16% of the workforce. EMS providers accounted for 61% of the overall vaccinator staffing, 76% of whom were EMTs. When looking at the combined roles of vaccination and vaccination preparation, EMTs made up 36% of the workforce, Paramedics made up 16% of the workforce, for a combined percentage of 53% of overall vaccination staffing. A total of 2424 COVID-19 immunizations were administered during nine clinics (Table 2, Table 3 ).
Table 2.
COVID-19 vaccination staff at 9 community immunization clinics in December 2020 and January 2021.
| Flu clinic staff | Type of provider | Number of providers (%) |
|---|---|---|
| Vaccinator | EMT | 52 (45%) |
| Paramedic | 16 (16%) | |
| Nurse/Other Staff | 41 (39%) | |
| TOTAL | 109 (100%) | |
| Vaccine Preparation | EMT | 2 (5%) |
| Paramedic | 7 (19%) | |
| Nurse/Other Staff | 28 (76%) | |
| TOTAL | 37 (100%) |
Table 3.
COVID-19 vaccination staff at nine community immunization clinics from December 2020–January 2021.
| EMS Staffing at Orange County NC COVID Vaccination Clinics - Vaccinator & Vaccine Preparation Staffing | |||||||
|---|---|---|---|---|---|---|---|
| Date | Number of EMTs (%) | Number of Paramedics (%) | Total EMS (%) | Total EMS as Vaccine Prep (%) | Number of RN/Other Staffing (%) | Total Staff | Total Vaccine Administered |
| 12/30/2020 | 8 (53%) | 3 (20%) | 11 (73%) | 0 of 1 | 4 (27%) | 15 | 275 |
| 12/31/2020 | 9 (47%) | 4 (21%) | 13 (68%) | 1 of 3 (33%) | 6 (32%) | 19 | 329 |
| 1/6/2021 | 11 (50%) | 5 (23%) | 16 (73%) | 2 of 6 (33%) | 6 (27%) | 22 | 140 |
| 1/7/2021 | 13 (72%) | 0 | 13 (72%) | 1 of 5 (20%) | 5 (28%) | 18 | 171 |
| 1/11/2021 | 1 (13%) | 4 (50%) | 5 (63%) | 0 of 2 | 3 (37%) | 8 | 106 |
| 1/12/2021 | 4 (36%) | 0 | 4 (36%) | 0 of 2 | 7 (64%) | 11 | 246 |
| 1/14/2021 | 4 (18%) | 5 (23%) | 9 (41%) | 3 of 8 (38%) | 13 (59%) | 22 | 436 |
| 1/15/2021 | 2 (9%) | 0 | 2 (9%) | 0 of 8 | 20 (91%) | 22 | 444 |
| 1/17/2021 | 2 (22%) | 2 (22%) | 4 (44%) | 2 of 2 (100%) | 5 (56%) | 9 | 277 |
| Vaccinator Only Participation | 52 (45%) | 16 (16%) | 68 (61%) | N/A | 41 (39%) | 109 | 2424 |
| Overall Staffing of Clinics | 54 (36%) | 23 (16%) | 77 (53%) | 9 (24%) | 69 (47%) | 146 | 2424 |
This study demonstrates that Paramedics, EMTs and EMT students are all able to successfully integrate into a community vaccination clinic and administer intramuscular immunizations. EMS providers are uniquely equipped to participate in mass immunization efforts. They are inherently mobile and can easily deploy to outlying areas within their service district, helping increase access to citizens who may otherwise be unable to reach county facilities. They would be comfortable setting up vaccination drives in parking lots, school buildings, or other community gathering sites without relying on formal medical facilities, and patients may even prefer these locations for their ease of access [9]. Finally, they are trained and prepared to treat any allergic reaction which may occur after an injection.
Utilizing EMS providers in the vaccination effort is also beneficial to local health departments. Health departments have faced decreased funding and operational difficulties since before the pandemic [10]. As seen in this study, EMS providers can fluidly integrate into the health department's response and help staff clinics and administer vaccines. This reduces the need for the health department to hire new staff and develop new contracts and allows them to focus their limited resource on maximizing healthcare delivery to the community.
Participating in vaccination clinics is beneficial for EMS providers as well. It provides an opportunity for EMS professionals to interact with community members in a non-emergent setting, helping to establish trust and confidence in the EMS system. It also allows the EMS providers to practice clinical skills which they otherwise may perform infrequently and only in high-acuity situations such as allergic reactions (epinephrine) and opioid overdoses (naloxone). Participating in immunization drives allows EMT's to practice their injection skills and establish the motor memory necessary to maintain proficiency with these skills.
EMS providers are uniquely positioned to participate in mass immunization efforts as they are inherently mobile and already have the clinical skills to administer the vaccinations. Participating in vaccine clinics benefits EMS providers by increasing their interactions with community members in a non-911 setting and increasing motor memory with performing relatively rare skills. Finally, utilizing a workforce of both EMT and Paramedic providers in mass vaccination programs can greatly expand the outreach and capabilities of local health departments to address the vaccination needs of its population.
The following is the supplementary data related to this article.
Orange County EMS vaccination protocol.
Supplementary data to this article can be found online at https://doi.org/10.1016/j.ajem.2021.02.047.
Declaration of Competing Interest
None.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Orange County EMS vaccination protocol.