Significant stress, strain and pressure is now being placed on paramedics and emergency medical technicians from the Global Medical Response of T&T (GMRTT), as they attempt to keep up with the demand for their service which the recent spike in COVID-19 cases has created in recent weeks.

Stretching into its 14th month, GMRTT CEO Paul Anderson told Guardian Media that the emergency care system in this country has been tested at an unprecedented level never before seen, with the virus posing mounting challenges.

The uptick in positive COVID-19 cases in the last few weeks, Anderson said, has resulted in GMRTT’s 811 hotlines being bombarded with emergency calls, its 330 staff members facing burnout syndrome and the intake of patients at the parallel health care system now at near capacity.

“Certainly, it has been a challenge. To this point, we have been able to manage, although it has certainly stressed the organisation,” Anderson admitted.

“Our COVID caseload now, in this surge, is about two times what it was when it (virus) peaked in 2020. What we are experiencing over, say, the last four weeks… our COVID caseload is approximately doubled. The problem that we have run into now is that we are having to do that on a daily basis and that obviously stresses the personnel, resources and the vehicles.”

GMRTT is the exclusive provider of emergency ambulance service for the Ministry of Health.

The company has a fleet of 48 ambulances that serves the public.

The number of emergency calls GMRTT receives on its hotlines may vary on any given day, Anderson said.

Of the 160 to 200 calls registered daily, Anderson said the bulk is COVID-19-related.

“One day it may be 40 the next day it may be 55. This virus has hit every corner of the country. It is affecting people in every community. Name a community, we have had a case there. Naturally, you would see more saturation in densely populated areas, but as far as the dispersion… it is across the island.”

The country had recorded 19,444 total COVID positive cases as of yesterday’s Ministry of Health update.

There were 7,765 active positive cases and 365 reported deaths.

Since the imposition of the State of Emergency and 9 pm to 5 am curfew last Monday, Anderson said more COVID-infected individuals have been accessing their free service.

“Interestingly, to a small extent, the non-COVID related 811 calls that we receive are down a little bit. That’s because of the lockdown, shutdown and curfew. Now, COVID overfills the void that is created from that flight we have left from the volume. What we are seeing predominantly is people with very low oxygen saturation and what we are seeing now is even more profound in what we call desaturation or decompensation.”

While in transit, patients with laboured breathing are monitored and provided oxygen by paramedics until they reach a medical facility, he said.

“That is what is driving the occupancy rates…it’s the people who require oxygen,” Anderson said.

After dropping off a COVID patient for medical attention, the ambulance must be properly sanitised before responding to another distress call.

It can take between 30 minutes to over an hour for GMRTT to decontaminate one ambulance, Anderson said.

“It all depends on the level of contamination of the patients, who can exhibit mild to severe symptoms. It is a process where an aerosol plug is used to make sure that any bio elements are on any flat surfaces are killed. Then there is a process of airing out that needs to occur. All of that adds to what we call tax time,” Anderson said.

This process can sometimes result in a delay in their response time.

However, he said they cannot afford to cheat on this process, as sanitising must take place to protect the staff and the next person utilising their service.

Pressed on if patients would sometimes have to wait inside an ambulance until health care providers find an available bed space, Anderson said, “There are times but it is not routine. There are times where there is some coordination that needs to be done. It’s limited but it does happen on occasions just because the system is under such stress.”

Workers exhausted

Anderson said when something reaches its peak, challenges can occur and things can get complicated. He said he knows his workers are exhausted from the current high work demands.

“There is a toll that comes with that. This is a global pandemic and it has had that kind of pressure. How this differs from anything that I have dealt with in my 30 years in this business, is that this has been a slow burn crisis for the last 14 to 15 months. That is a different stress than a traumatic event that someone suffers.”

As T&T battles the pandemic’s third wave, Anderson said his staff has to be constantly reminded to protect and safeguard not only themselves but their families, peers, friends and the public.

There is no room for slip-ups or shortcuts.

Anderson said handling COVID-19 cases is far more complex and time-consuming.

“These calls take much longer to handle. Oftentimes, the transport distance is much longer…because we’re not necessarily taking someone to a facility near to where they live. We may have to go nearly across the country in some cases. They take a lot more time for us to manage. There is more involvement with the crew.”

He said, however, that his crew, which has had to be separated into those who deal with COVID-related cases and those who deal with other medical-related cases, has been going beyond the call and stepping up and handling the task at hand.

“Everyone acknowledges the workload that we are faced with. It has been unrelenting. When you add all of these things together, it very much stresses the system.”

Similar sentiments have been echoed by the Ministry of Health senior medical team during the weekly COVID-19 updates. They have noted that the medical professionals are facing tremendous strain as they deal with the crush of COVID cases now coming before them.

The stresses on their job, Anderson admitted, have pushed some workers to seek Employee Assistance Programme (EAP) services.

This gives an indication, Anderson said, “that people are recognising the psychological and emotional toll it is taking and they are doing things to protect and look after themselves.”

Asked if any of his employees had tendered their resignations as a result of mounting stress, being unable to cope with the caseloads, or were generally fearful of handling COVID patients, Anderson said he was not sure.

“I don’t think if someone did they would necessarily disclose that.”

Staff constraints increase

The biggest challenge for GMRTT, Anderson said, was dealing with staff constraints, which have increased now with some of the protocols that people are being forced to adhere to as the level of COVID contamination spreads countrywide.

He said whenever a close family member of a GMRTT employee is quarantined now, that worker also has to self isolate.

“And so we lose staff to that. Presently, we have somewhere between 15 to 20 people under a quarantine order. There are new challenges in people being able to report to work. There are new challenges while they are at work and new challenges just associated with the volume (of COVID-19 cases) that we are dealing with.

“Put that all together…and that sustained over a long period of time, that puts people and that puts an organisation under a lot of pressure,” he said.

Earlier this month, relatives of a father and son Premnath Ramkalwan, 66 and Nigel Ramkalwan, 36, who died from the COVID-19 virus, claimed paramedics failed to respond in time to take them for Intensive Care Unit treatment.

Asked to respond to the issue, Anderson expressed condolences to the families who lost their loved ones.

“Doing this kind of work and leading this organisation, you have to develop a very thick skin because, of course, someone who suffers that kind of loss, they are going to grieve and their interpretations are going to be distorted. And whether it is a COVID-19 case or a regular ordinary emergency, minutes turn into hours while you are waiting for an ambulance to come for your family member,” he said.

“And so, I absolutely empathise with that. But I am not going to get into any kind of tit-for-tat…or no, to say this is the actual facts.”

Anderson also pleaded with the public not to chastise his staff if their response time exceeds their expectation.

“You should not take it out on them because you are talking about people who have been working the hardest days in their lives for a year and a half.”