Twenty calls a day: Ambulance teams at work during the pandemic

June 4

During the pandemic, it is ambulance paramedics who are the ones who are the first to have to rush and help a person complaining of a high temperature, shortness of breath, or any other likely coronavirus symptoms or if somebody starts panicking. A doctors’ duty is not only to stabilise a patient’s condition, or to arrange treatment at home but also to assist  a patient to be calm. A doctor may also have to send a patient to hospital.

Paramedics working for the Alexander Puchkov Ambulance and Emergency Care Services, Maria Kulikova and Roman Kuznetsov spoke with They respond to calls from patients with confirmed or suspected COVID-19. The doctors explained in which cases patients will be taken to get a CT scan and when they will be sent straight to hospital and why they smear shampoo onto their protective goggles and how they deal with stress when they have to risk their own health every day.

Question: How has your work changed since the epidemic?

Roman Kuznetsov: Ambulance services are dealing with a much higher workload; there have been more calls for emergency help. I’m working with a team responding to COVID-19 cases. We take an average of 20 calls per day. Before the epidemic, we handled about 15 calls on a daily basis.

Maria Kulikova: I work nine or ten shifts a month because I took up 50 percent more hours. The most difficult period was between mid-March and the end of April. Now we can tell that the incidence rate is going down – probably thanks to the introduction of self-isolation regime.

Maria Kulikova, paramedic at the Alexander Puchkov Ambulance and Emergency Care Service

Question: How long do people have to wait for an ambulance now? Is the waiting time longer?

Maria Kulikova: No, they don’t need to wait long. We get a call on our team’s tablet; everything is done really fast. Of course, it all depends how far we need to drive,  in general, we can reach our destination within say 20 minutes and if the call is extremely urgent, we try to make it in 14 minutes.

Roman Kuznetsov: All the ambulances are on call. We have enough people working. So we always make it on time.

Roman Kuznetsov, paramedic at the Alexander Puchkov Ambulance and Emergency Care Service

Question: You are mostly going out on calls to people with suspected coronavirus. How do you determine that a person may have COVID-19?

Roman Kuznetsov: Call operators at the ambulance station question people and forward their calls to us. Usually we get a note saying that it is someone with suspected or confirmed COVID-19. The major symptoms include a high temperature, a dry cough, and loss of smell plus taste. All these are common symptoms of a respiratory infection.

Sometimes before calling an ambulance, people in Moscow call the doctor on duty at their regular outpatient clinic. These are usually the people who are not experiencing shortness of breath, chest pain or loss of consciousness.

Maria Kulikova: Yes, on the first day, а visit from a local doctor should be enough and they will carry out a primary examination, give some recommendations and prescribe what treatment is needed. If a patient’s condition worsens, it is better to call an ambulance.

Photo: Press Service of Moscow Mayor and the Moscow Government. Maxim Mishin

Question: What kind of patients usually call an ambulance if they suspect COVID-19?

Roman Kuznetsov: All kinds of patients. Children, senior citzens, young people – just about anyone.

Maria Kulikova: I think young people can handle pneumonia easier than people over 55. Especially because older people often have other conditions that could aggravate the disease.  There are still some senior patients who handle their disease quite normally. 

Question: What is one of your shifts like?

Maria Kulikova: My shift starts at 9 am and finishes at 9 am the next day. When I arrive at work, my job is to inspect my vehicle to see if it is ready for a 24-hour shift. All the equipment must be in working order and we must have all the essential medicine and medical devices that we need. Of course, we always check as well if we have enough PPE.

Photo: Evgeny Samarin

Question: You wear protective clothing but how often do you have to change it?

Roman Kuznetsov: Good question. We put on our scrubs when we are in the ambulance before we go to visit a patient. Our protective gear consists of scrubs, a respirator, a mask, goggles and two pairs of gloves. It feels hot and stuffy inside the gear but you get used to it in the end. For example, you can apply an anti-mist substance to your goggles. Some people even smear on shampoo to prevent their goggles from misting up. All medical workers know about these little tricks.

Maria Kulikova: We dispose of the PPE according to the regulations after every call. We have disposal bags specifically for this purpose that we put in designated bins. There is a PPE disposal room at the ambulance station.

Actually, for every visit, regardless of whether your patient has respiratory symptoms, confirmed COVID-19 or not, you must wear gloves, goggles plus a face mask. Even if someone complains about stomachache, you must take precautions. A patient could say they have stomachache but you arrive and see that they have certain symptoms of a respiratory infection. The patients may simply not feel them.

Photo: Evgeny Samarin

Question: How do you work with patients? What is the algorithm for suspected coronavirus?

Roman Kuznetsov: We assess the patient’s condition, check the symptoms and medical history. We ask the patient about any recent travel and who they’ve been in contact with. If, based on this background and current condition, it could be COVID-19, patients with mild symptoms can stay at home and sign a consent form to receive outpatient care. Then we hand over this patient to a clinic and a GP will make home visits to prescribe the treatment and whatever is required as a follow up. In mild cases, patients experience a temperature of around 37 degrees and sometimes loss of smell but usually no shortness of breath.

In more serious cases, the temperature can rise up to 38.5 degrees and it is harder to breathe. This is when the oxygen saturation level goes below normal. This could be pneumonia so we take the patient to the nearest 24-hour computer tomography centre and they’ll be given a CT scan and, if necessary, a GP will call an ambulance and send the patient off to hospital.

Maria Kulikova: Yes, but if there is only minor pulmonary damage and the pneumonia is mild, the doctor may decide to just prescribe some medicine and allow the patient to recover at home.  

Photo: Evgeny Samarin

Roman Kuznetsov: If there is an obvious shortness of breath, chest pain, a high temperature and general mental confusion, we immediately take the patient to hospital. We put a call through to the hospitalisation department, report the preliminary diagnosis and describe the patient’s condition. Based on this information, the call operator will tell us where to take the patient.

Question: What about patients? Do they sometimes refuse to go to hospital? Or do they ask to be sent to hospital?

Roman Kuznetsov: People are different. Some want to be treated in hospital when they don’t really need it. Some don’t want to go even if they should. But in general, people understand what is going on. We explain everything to them.

Maria Kulikova: When this whole thing just started, there was a lot of panicking. In early March people thought: “How could I get the coronavirus? I have not been in contact with anyone.” Then we had to explain how it goes. But around the end of March, people already took it easier – probably because the officials and the media have been keeping people well informed.

Photo: Maxim Denisov

Question: Are volunteers helping the ambulance services? What kind of duties are they given?  

Maria Kulikova: Yes, volunteers have been very helpful. They deal with food deliveries and offer moral support to people. I remember they came and wished us happy Easter. I think their volunteer movement is incredibly well organised.

Roman Kuznetsov: Volunteers visited us and offered help. They brought us donations such as lunch including pizza sometimes. It was a nice gesture.

Question: Every day you are dealing with people who may have the coronavirus and you are risking your own health. How are you handling tiredness and stress?

Maria Kulikova: I can’t say that it’s too hard for me because I’m used to it. There has been more work and I could feel it. I was physically worn out. I’m trying not to think about the risk of getting ill. At home I make sure to forget about work and distract myself. If you get fixated on this thing it will become unbearable. My family is supporting me. I have a daughter.

Roman Kuznetsov: The most difficult thing is to simply realise that you can actually get infected yourself. You must take the protection seriously. All the other aspects of our work remain the same. I’m not feeling stressed more than usual. I come to work, I do my job and go home. It is very important to get enough sleep. Sleep really matters. 

Question: What safety precautions do you follow to protect your family?

Maria Kulikova: My life is not much different from it was before; we are not doing anything too extraordinary. Of course, we wash our hands but it’s always been a rule even before the pandemic. We are observing self-isolation and wearing face masks and gloves whenever we need to go shopping. We always carry sanitisers. We are following the rules.

Roman Kuznetsov: I’m living at home. My wife is a doctor too (her job is in administration) so she understands how it works.  

Question: When and why did you decide to become an ambulance doctor? What do you like about this job?

Roman Kuznetsov: This is how my life turned out. I completed paramedic training and I have already been working for ten years in this field.

Maria Kulikova: I followed in my relatives’ footsteps. Both of my grandmothers and my mother were ambulance doctors. I have been a paramedic for 11 years and never regretted this decision. I think I can be of great help to my family and friends. I can give medical advice and help in certain situations.

Now, during the pandemic, my family members, friends and other people I know call me whenever they get even minor respiratory symptoms and ask for advice. I try to explain everything to them so that they won’t panic, and get through this illness easily and stay rational and calm.


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