Sometimes paramedics don’t wear seatbelts. The medic seat in the back is across the ambulance from the stretcher, and with a seatbelt you can only reach the arm of the patient: not the head, not the chest. Being a paramedic is seen as an ambulance blaring through a red light, or the urgency of CPR, or rushing the stretcher into the hospital. There is more to it, of course. Much more.

But in the pandemic, everything changed.

“Nothing is an emergency anymore,” said one Ontario paramedic, who like the other paramedics in this piece asked their name not be used so they could speak frankly. “Not in this situation.”

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“Usually when something sounds like an emergency, someone is in cardiac arrest, trauma, etc., we move pretty quick,” the paramedic said. “We can’t do that now. Putting on all the (personal protective equipment, or PPE) properly takes time, and for us could be a matter of life and death as far as our safety goes. So we don’t rush.

“It might take a few minutes to get to a patient’s side now. Those minutes might alter the outcome for that patient but selfishly, our safety is our number one priority.

“So nothing is an emergency for us. Everything slows down.”

As hospitals hold but long-term-care homes are ravaged, paramedics are another front line in the battle with COVID-19. The system is hanging together, though there remains PPE rationing everywhere, mixed with stress and fear.

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And for paramedics, a societal emergency has made nothing urgent. One Hamilton paramedic estimated ordinary response times would be two to eight minutes, but that it’s between five and 15 minutes within city limits.

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“We’re all shocked by how our care has to change,” said another paramedic in the Peel region.

“PPE slows us down. My partner has to take off her stuff and wash before she gets in the front to drive. That means she can’t get in the back to help when I need a hand or something changes. We would typically stop on the side of the road to fix an issue: troubleshoot an airway, defibrillate.

“We’re also having to consider the public when we arrive at a hospital. I can’t put the people on the sidewalk at risk, like the security walking to get a coffee as I roll by doing CPR. Treatment has to stop so I don’t spread droplets, until we find a safe place to work again.”

Many say the practice of even attempting CPR has almost stopped, and that firefighters have pulled back their response to cardiac events. CPR has a very low chance of success at the best of times — some studies say less than 10 per cent outside a hospital, and some peg it lower — and a high chance of potential infection. But more, patients who might be borderline resuscitation cases are often being pronounced dead at the hospital. Transporting the pulseless patients feels pointless.

“The chances of surviving aren’t there,” said the Peel paramedic. “Too much risk. Medicine to get them to discharge with any quality of life usually takes weeks; those systems don’t exist now.

“The resources in hospital are quickly disappearing. The chance of getting COVID while in hospital is increasing. The majority of my patients are COVID symptoms plus something else. COVID and a fall. COVID and drunk. COVID and cancer. COVID and anxiety attack. Medics have understood the daily risks of our job: seatbelts, assaults, regular infections, mental health and suicide. It’s worse now.”

Protocols keep changing. Support from superintendents is often seen as distant. Every single moment, PPE has to be a focus; it is exhausting.

“It’s true we knew the risks: that’s why I feel for grocery store workers,” said the Hamilton paramedic. “They didn’t sign up for this. If it’s overwhelming all of us, I can’t imagine how it’s directly affecting people like them.”

“Often it’s just my partner and I, since the fire department has stopped responding to cardiac arrests in the usual way,” said an Ottawa paramedic. “We know that some of us will get sick; we know there is a chance some of us may die.

“I can’t imagine being a paramedic near the end of their career, the men and women in their 50s or early 60s. I have a new heightened awareness of my own mortality and vulnerability, and I’m young and healthy.”

And then there are the vulnerable cases: one paramedic talks about three tradesmen he found in separate homes: one drunk and sick with the coronavirus, one so sick he had passed out and fallen down the stairs. He figured they had been working in Ontario construction, or doing jobs for cash.

They also know that any COVID patient might never see their family again, and those conversations can be hard. The minor calls, relatively speaking, which go up with people afraid to go to hospitals, and still put paramedics at risk, feel even more enervating in a pandemic.

“Compassion fatigue,” said the Ontario paramedic, “is a real thing. I’m not someone who experiences job stress very easily, thankfully. But the emotional toll is pretty high.”

“I think it’s getting perilously close to a flood of burnouts,” said the Hamilton paramedic. “Like a storm.”

One paramedic says he was taught in school that most of them last an average of seven years. As in policing and the military, the job already produced divorces, drinking, all the dimensions of damage. Many paramedics talk about how to leave the profession, but it’s hard when you are well-paid and get time off.

That’s harder to do now. Everything is harder. They walk up to the house, to the sidewalk, to the emergency, and they stop. They put on the gear. The virus could be anywhere. Like every health-care worker, they live in that space every day.

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“I slept alone for the first three weeks,” said the Peel paramedic, who has two children. “Showering at work, not touching my family, bleaching anything I touched. I broke. I couldn’t do it anymore. I can fight this virus for a few months. We can rally and battle. I cannot fight in these trenches for years.”

Maybe they won’t have to. But they are tiptoeing through the plague in the glare of the lights, seatbelts on, robbed of urgency. They, like so many of us, are trying to survive.