Since the outbreak of COVID-19, lots of energy and guidance has been directed toward protecting emergency medical responders—maximizing their safety with patients, in homes, and in ambulances and hospitals.
And then there are the staffs in 9-1-1 communications centers—emergency professionals who share a common workplace, just like those in many other industries.
A March 25 webinar from NENA, the National Emergency Number Association, examined comms center issues, with a particular focus on what’s allowable and not when dealing with affected employees as well as infected patients.
The first speaker, attorney John Kelly, ENP, of the Illinois firm of Ottosen, Britz, Kelly, Cooper, Gilbert, & DiNolfo, Ltd., opened with some important news: The day before, the Department of Health and Human Services’ Office for Civil Rights issued guidance clarifying that HIPAA-covered call centers can share the protected health information of patients infected with or exposed to COVID-19 with emergency responders, including EMS and police, as well as public health authorities, if the disclosure is needed for treatment or if responders may be at risk of infection.
Not all 9-1-1 call centers are covered by HIPAA, but those that are now have specific legal cover. The OCR specifies entities like hospitals can provide info on COVID infectees to EMS dispatch, which can in turn inform personnel responding to calls (but only on a per-call basis). Call centers may also ask screening questions of callers—for example, about temperatures, coughs, or difficulty breathing.
In general, while most ambulance services and healthcare providers are HIPAA-covered entities, most dispatch agencies are not, with possible exceptions if they dispatch only EMS.
Union contracts may also be modifiable in the current crisis, Kelly said. Centers can adjust schedules, cancel vacations, and limit time off, but they can’t alter compensation packages—the overtime requirements of the Fair Labor Standards Act still apply. Neither can they likely restrict employees’ off-duty travel. They can, however, limit secondary employment, Kelly said, if it could result in increased coronavirus exposures.
How to Keep Running
NENA’s 9-1-1 PSAP and operations director, April Heinze, ENP, noted it was vital for comms centers to have continuity-of-operations plans should they become contaminated or require vacating for a deep cleaning. COOPs should encompass all hazards with clear policy and guidance to ensure personnel and resources can be relocated as needed and critical functions continue. (There are two examples of PSAP COOPs on NENA’s COVID-19 resource page, and the organization asks others to share theirs. A template will be posted soon.)
Comms center COOPs should include explicit steps for every stage of an emergency (monitoring, elevation, worsening, emergency declaration). They must identify critical functions, alternative facilities to which they may be relocated, and personnel with essential knowledge and roles; and specify procedures for alerting, notifying, activating, and deploying employees when an emergency develops. Specific elements should address visitor limitations, locking down if necessary, operations during cleaning, and testing both primary and backup equipment.
“During this time it’s more important than ever that you work with your surrounding agencies and backups before you have to call them and say, ‘We’re bugging out of here, we’re coming your way,’” Heinze said.
What the Law Allows
Kelly represents more than 40 9-1-1 centers across Illinois and shared some common questions he’s been getting:
Can comms centers take employees’ temperatures when they report to work?
Refer here to the Equal Employment Opportunity Commission’s resource document on pandemic preparedness in the workplace and the ADA, but the answer is a clear yes, Kelly said. Typically they couldn’t, as it’s considered a medical examination, but this is allowed in pandemic flu-type situations, which the COVID outbreak has been determined to be.
Be cautious, though: Do it for all employees all the time, rather than based on symptoms, Kelly advises, or it may be construed as discrimination. Also, individuals’ temperatures are protected information, so keep access to them limited.
When a comms center employee calls in sick, what can they be asked?
Previously the law permitted bosses to ask generally about the nature of the illness and how long the employee expected to be out. Now they can ask specifically about fever, cough, flulike symptoms, etc.
Can ill employees be sent home?
Oh, yes, no question here. Tell the employee to see their physician and follow their recommendations. It’s OK to require workers to use their sick time in these cases.
Caring for Your Team
Jamison Peevyhouse, ENP, NENA’s immediate past president and training coordinator for the Tennessee Emergency Communications Board, tackled the issue of caring for your comms team both physically and emotionally during this trying period.
Physically it’s about cleanliness. Follow the CDC’s guidance on hands and garb and devote extra effort to cleaning the work environment. Shared surfaces are breeding grounds for bacteria in general: keyboards, microphones, phones, headsets, etc. But also don’t neglect items like chairs, consoles, and cabinets. Pay special attention to rest rooms, of course, as well as appliances, lockers, and doors.
The emotional aspect may be even more challenging for public safety communicators. Major events, prolonged stress, and the 24/7 news cycle can affect call-takers and dispatchers as much as anyone on the team. Considering limiting that news coverage inside the PSAP.
Remote work is difficult in the 9-1-1 environment, but utilize it where possible, Peevyhouse urged. Administrative, IT, QA, and clerical functions may be able to be moved elsewhere. Look at hosted solutions or temporary site sharing where possible.
If you have a backup PSAP, of course keep it sterile for use if needed, or consider splitting staff and having half work from each PSAP to reduce the risk of spread. EOCs or mobile command units might work in a pinch.
Work with your IT folks today on ways to implement these ideas, Peevyhouse said—and don’t forget your vendors as stakeholders who may have solutions to contribute.
Take some time also—and this is wise not only for comms centers but also across the EMS landscape—to just check on your people and ask how they’re faring: Are there any family concerns or unmet needs with which you can assist? Emphasize the known tactics of stress management/health maintenance, including sleep, diet, and exercise. EAP and peer support may need modification in the current environment but can still function. NENA offers a post-tragedy care plan checklist on its COVID resource page.
Returning to Work
Comms centers must have clear return-to-work guidelines. When an employee has been diagnosed with coronavirus or even just quarantined, make sure to get a release from their doctor clearing them to come back. Cleaning the comms center becomes a priority with an infection (and know where you’ll go while that happens), and it may be prudent to quarantine and test the subject’s shift colleagues.
Employers should likely inform their personnel if one of them has tested positive. “I think employers have an obligation,” said Kelly. “That is information employees have a right to know.” Don’t name the employee; just say a member of the team. If an employer doesn’t do everything possibly to prevent the virus’ spread in such a situation, it may trigger a Worker’s Comp claim.
In March President Donald Trump signed H.R. 6201, the Families First Coronavirus Response Act, legislation that provides paid leave for workers affected by the virus who can’t perform their jobs and payroll tax credits to offset the costs for employers. It applies only to companies with fewer than 500 employees and is not mandatorily applicable to emergency responders. While emergency responders is not defined in the bill, Kelly interprets other federal guidance as encompassing comms center employees among them. Therefore its provisions are voluntary for governmental employers.
There are concerns the bill’s latitude could cripple call centers. Kelly told of one director who had eight of her 10 employees with children home from closed schools—if they all took their newly allowed leave, that center couldn’t operate. “Certainly that is not the intention of the act,” Kelly said, noting the bill was passed hurriedly and the Department of Labor will promulgate further guidance.