Area EMTs take vaccines on the road for homebound Vermonters

By Shawn Cunningham
© 2021 Telegraph Publishing LLC

Last Friday, 30 residents of Bennington County, age 75 or older, received their first dose of the Pfizer Covid-19 vaccine. On its face, that might not seem so remarkable since more than 30,000 Vermonters in that age band have either been vaccinated or made appointments to get the vaccine since Jan. 27.

But in fact, these folks were jabbed in their own homes from Pownal to north of Manchester by a crew of Emergency Medical Technicians coming from West Townshend and working against the clock with a drug that expires just six hours after being prepared for use.

Finding the capacity

As the state’s vaccine program rollout was being planned, officials wrestled with the problem of getting the vaccine to homebound Vermonters. “We realized there’s a substantial population of folks who are just never going to be able to walk into a vaccine clinic,” said Dan Batsie, director of the Division of Emergency Preparedness, Response & Injury Prevention.

The challenges facing the program, according to Batsie, included working with a fragile and time-dependent vaccine and traveling in a state where there’s often no quick route from one place to another. But first, officials needed to identify eligible recipients, and find someone with the capacity to schedule and visit each of them with the vaccine. Not once, but twice.

According to Batsie, the best solution for the first problem was asking local home health organizations – like Visiting Nurses – to come up with lists of people in the age ranges who would qualify. But while nurses are capable of giving the vaccine, they are busy providing health care and also don’t have the people to handle the entire program. That’s where EMS agencies come in.

“They have a lot of reach and a lot of capacity,” said Batsie who is the former state chief of EMS. “There’s 2,800 EMS providers in the state and just shy of 100 agencies.” And in southern Vermont that’s where Rescue Inc. comes into the picture.

The logistical challenge

Just before 7:30 on a frigid Friday morning, emergency medical technicians from Putney, Vernon, Guilford and Londonderry begin gathering at Rescue Inc’s building on Route 30 in West Townshend for a day of vaccinating.

It’s fairly typical of such places: a couple of ambulance bays, a lounge, a kitchen and a bedroom to inhabit between calls. And then there’s the “command center” – a training room where Kris Johnston ferries back and forth between computers at either end of a long conference table, managing a host of logistical variables.

Johnston – or KJ as everyone calls him – is an EMT with an IT background. He uses mapping software to lay out the four routes the EMTs will take to deliver their shots today while Operations Chief Drew Hazelton explains what’s happening.

“Visiting Nurses age banded – based on the governor’s guidance – any patient that’s over 75 years old, and with that they provided us a list of names and addressess. We have over 600 names of eligible people within the four counties we’re serving – which are Windham, Bennington, Windsor and Orange.”

First, Rescue Inc. personnel call all the people on the list to see if they want to be vaccinated. “The challenge for KJ and his team,” says Hazelton, “was to put together time-appropriate travel routes.” These have to take into account the very specific temperatures and timing required by the Pfizer BioNTech vaccine.

“We’re covering I don’t know how many hundreds of square miles … and in Vermont there’s no straight road between anything so the travel distances are killing us,” he says. The travel software helps Rescue Inc. to assemble routes to calculate the distance between stops and the time it will take to observe the person for side-effects after the shot, then the travel time to the next shot, wait time and so on.

“All of that information is tracked here so we don’t waste any vaccine,” says Hazelton. “Yesterday we were out in Orange County and we couldn’t administer one of the scheduled vaccines. So we had an extra vaccine in one of the vehicles and it was KJ’s job to find us someone (who met the guidance) within the six-hour window so we can get it into somebody’s arm and not waste it.”

“Honest, the job these guys do is the easy part,” says Hazelton pointing to the EMTs. “Finding the people and how to get us there? They’re doing the work. That’s the tough part. So far, they’re doing an awesome job. … we’ve had a couple of cases where we were down to the last 10 to 15 minutes. But for the most part we’ve been getting all of our doses in in a reasonable time frame and now we’re running out of people” age 75 and older.

The ticking clock

Deadlines are everywhere in this operation. When a shipment of vaccine comes out of the state’s freezer in Burlington, one clock starts. Johnston says those doses must be used within 120 hours. At the top of a whiteboard is the reminder that the shipment on hand will time out on Monday Feb. 15 at 8:42 a.m.

Downstairs, EMT Evan Martin is setting up to “draw” the vaccines. Once the vaccines are taken from a refrigerator that is between 2 degrees and 8 degrees Celsius there is a two-hour window to reconstitute the vials with saline solution before drawing doses into syringes. EMTs Doug Friant of Londonderry and Dave Mannion pitch in filling syringes while EMT Zach Gilbeau pulls together the paper work, which includes stickers that tell what time the doses were drawn. Six hours from that time, the dose will expire.

As Friant carefully loads his syringes into an orange padded case, he explains that in addition to the time constraints, “the vaccine is very fragile, so it can’t sustain any bumps. Normally when you see people drawing up shots they’re tapping the needle to get out all the air, but we   try to do it without tapping the needle.”

By 8:44 a.m., the four Rescue Inc. vehicles head out with 18 syringes. Strangely enough, the quickest way to Bennington from West Townshend is by taking Route 30 to Manchester and then south via Route 7. Consequently, by the time Friant arrives at his first appointment, his vaccine will already be 90 minutes old.

To help speed the process, each car has an iPad loaded with the mapping program and a list of the places where the vaccinators are going. Click on a name, it brings up a map with GPS directions to the recipient’s house.

The iPad is mounted on a stand so it’s essentially hands-free.

When a vaccinator arrives at a home, he or she touches a button to acknowledge that and takes the iPad into the house to use in screening the recipient with a Centers for Disease Control app. But with Vermont’s varying levels of connectivity, the iPads are occasionally useless, so the EMTs carry paper copies of the questionnaire to fill out — just in case. Before they leave, they set up an appointment for the second shot. Friant jokes that giving the shot takes the least amount of time in the whole process.

“We mark in the iPad when we depart so they know back at the command center that we are on to the next recipient. And that may not be the same person who was next on the list when we went into the house,” says Friant. “The command center is constantly updating our lists and telling us where to go.”

After about 25 minutes at his first stop, Friant is on to a second house, where he has two patients.

Resupply restarts the clock

Meanwhile EMT Martin is loading up an ambulance with vials and supplies and heading over to the Bennington Welcome Center parking lot. And, as the EMTs are using up the syringes they took this morning, Martin is reconstituting enough vaccine to draw another 12 shots for them to pick up.

These new shots will be good until after 6 tonight so if a shot falls through there’s still time for KJ to scramble and find another arm. When this has happened, it has not been unusual for an EMT to drive an hour or more to deliver the shot.

“They are finding some innovative ways of approaching this problem and doing some remarkable stuff,” Batsie says of the Rescue Inc. crew. And of course for each vaccine recipient, there’s a second dose that the Rescue Inc. crews will be delivering.

Just before Martin and the Rescue Inc. ambulance arrived in Bennington, the Scott administration announced that on Tuesday, Feb. 16, those Vermonters 70 and older will be able to set up appointments for shots. But paradoxically, that will mean less work for the EMTs. Earlier in the day Hazelton noted that there are far fewer people in the 70 to 75 band and several of the EMTs said they wished the state would open the homebound program to 65 and up. But there might still be some people out there who haven’t been found.

The toughest knot

Now we have to figure out how to find the people who are not on those home-health lists,” says Batsie. “We’ve been getting a lot of calls with people saying ‘how do I get my grandma on this list?’ or ‘how do I get on this list myself?'”

“The challenge is that this is not a simple process and not an inexpensive process,” says Batsie, who notes that four vaccinators and 10 support staff can give shots to 300 people a day in a clinic while four EMTs are driving around vaccinating 30.  “So we want to make sure we are using this resource correctly and we are getting it to the people who need it, not just want it.”

“As soon as we turn outward with this, we’re going to get 10,000 phone calls and we’ll need to triage that,” said Batsie.

Batsie says they are looking for ways to separate the people who just want to be vaccinated at home from those who must be vaccinated at home. On Monday, Batsie said that the state was preparing to open a call center for identifying those homebound Vermonters who have not yet been contacted.

“We’re working the second part of that out and we hope to have some capacity for that next week,” says Batsie.“Of all the knots we’ve untied since the beginning of the pandemic, this is the toughest.”

Those ‘jabbed at home’ grateful

It’s easy to see that the EMTs working on the vaccination project enjoy the work. They are trained to respond to situations in which people are experiencing problems – often serious, life-threatening problems. So it’s a little different to be part of a program that helps people avoid a problem altogether.

Friant, who volunteers with the Londonderry Volunteer Rescue Squad says that the patients he has vaccinated are grateful, often hugely grateful that someone has come to their home to ensure that they will be protected from the coronavirus. But he is also grateful.

“I had the honor of going to someone’s house and vaccinating a woman who was born in 1919,” said Friant. As a baby, his patient had survived the flu pandemic that killed millions around the world and now has a better shot at surviving this.