Abstract
In this manuscript, we discuss the implementation and deployment of mobile integrated health and community paramedicine (MIH/CP) testing sites to provide screening, testing, and community outreach during the first months of the 2019 coronavirus disease (COVID-19) pandemic in the metropolitan region of Charlotte, North Carolina. This program addresses the need for an agile testing strategy during the current pandemic. We disclose the number of patients evaluated as "persons under investigation" and the proportion with positive severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) results from these sites. We describe how the programs were applied to patient care and include considerations on how additional staffing, scalability, and flexibility of these services may be applied to future patient and health care crises. This is a descriptive report of the implementation of MIH/CP test sites in our health care system's early response to the COVID-19 pandemic in March 2020. Retrospective data on the number of patients and their associated demographics are reported here as raw data. No statistical analysis was performed. Between March 15, 2020, and April 15, 2020, our 6 MIH/CP test sites evaluated 4342 patients. Of these, 401 patients (9.2%) had positive test results, 62.8% of whom were women. The estimated duration of each patient encounter under investigation was 3 to 5 minutes. The paramedics were able to perform a brief history, specific physical examination, and screening for signs of hypoxemic respiratory failure. There were no cases of accidental exposure or failure of personal protective equipment for the MIH/CP paramedics. In our health care system, we pivoted the traditional MIH/CP model to rapidly initiate remote drive-through testing for COVID-19 in pre-screened individuals. This model allowed us to test patients with suspected COVID-19 patients away from traditional health care sites and mitigate exposure to health care workers and other patients.
Highlights
Determining effective strategies for testing patients with suspected 2019 novel coronavirus disease (COVID-19) remains a challenge as the outbreak continues to spread in the United States
A total of 4342 patients were tested at our mobile integrated health and community paramedicine (MIH/community paramedicine (CP)) sites between March 15, 2020, and April 15, 2020 (Table 1)
While the authors are aware of other efforts to conduct off-site drive-through medicine for both COVID-19 and other simulated and real-world pandemics, we did not identify published literature describing the re-deployment of community paramedics from existing roles to perform this function
Summary
Determining effective strategies for testing patients with suspected 2019 novel coronavirus disease (COVID-19) remains a challenge as the outbreak continues to spread in the United States. According to the Centers for Disease Control and Prevention (CDC), screening for upper respiratory illness should ideally take place before patients enter a health care facility. The CDC supports the use of telemedicine to minimize disease transmission and exposure to health care workers.[3]. Health systems worldwide have developed strategies to perform testing of suspected COVID-19 patients outside of clinical settings to augment containment strategies and reduce the likelihood of disease transmission within the health care system. In London, 1 such strategy involves dispatching health care personnel to suspected patients’ homes for in-home testing after an initial telemedicine screening to determine appropriateness for screening.[4]
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