Life on the frontline: CMR Service Manager Darren Zimmerman

NSRI salutes our volunteers who are also essential-services personnel. One of these volunteers is Darren Zimmerman. He is the service manager for Cape Medical Response (CMR) and has been the station commander of Station 10 (Simon’s Town) since 2004, and a volunteer with the NSRI since 1991.

"I’ve been fortunate that as the service manager, my frontline work has been limited. I don’t work on the road as a member of the rostered medical team, but I do have a medical response vehicle and mostly respond to larger or more serious incidents. As a station we reduced all our interactions and only responded to the base in the event of a call-out and, when I was able to, I managed the call from my response vehicle.

"With lockdown, the first challenge for CMR was the procurement of adequate PPE and sanitising products. This was a nightmare as South Africans were panic buying all available stock and the suppliers never thought ahead to prioritise the needs of the healthcare community. Fortunately, due to the Department of Health regulations for ambulance services, we already had a high-level disinfecting process in place and some stock of PPE and sanitisers. Following the World Health Organization’s recommendations, we were able to adapt fairly easily to the required levels of cleaning and PPE. The screening processes of each patient would dictate the level of PPE required as well as the level of cleaning. All of this was set out in three stages and easy to implement on paper but, in practice, it proved a challenge in the beginning."

Adjusting to an invisible hazard

"Our culture in the EMS environment is to be aware and cautious of the hazards around us but, for the most part, these are hazards we can see and manage. Covid-19 is a completely different ball game as it is invisible and we knew very little about it. So it was during our first few calls, where the paramedic staff had not adapted their personal protective behaviour or culture, that the system failed and we had accidental exposures that resulted in quarantine periods as well as testing for Covid-19.

"The best way to explain the culture change to our staff was to talk about whether one would jump in front of a moving train to save a patient. Our hazards training taught us that we would never do that. Therefore, teaching the paramedic staff that the risk is the same, except that this train is invisible, really helped them to adapt their culture. It was also very difficult for our staff to have to learn to slow down, assess, don PPE and only then approach the patient. Finding a safe balance between the level of treatment and the paramedic’s risk of exposure, especially when it came to aerosol-generating procedures and the extended time in confined space, which increases viral loads, were all new to us."

Acclimatising to Covid-19 culture

"Covid-19, lockdown and all its implications presented a huge challenge for us. Our CMR staff is like family, so adhering to strict separation and distancing protocols while trying to treat patients with the necessary PPE and face wear took a lot of adjusting. If you look at firefighters, for example, you could ask how they manage wearing heavy PPE in such hot conditions. The answer is simple; they become acclimatised.

"Their training teaches them to walk into a burning building, stay low, regulate their breathing, and get used to the heat and reduced visibility before continuing in deeper. So it was much the same for us.There was a lot of anxiety and stress in the beginning. Understandably some staff were scared and asked why they needed to be at work during these scary times. When I was chatting to NSRI CEO Dr Cleeve Robertson in the early part of the pandemic, he said something very interesting. He reflected on when HIV became a known medical condition during his early days as a practising doctor. He made mention of the near panic that set in when medical practitioners needed to adapt their culture of safe practices, such as wearing gloves and recapping needles. But if one looks at it today, it’s part of our culture and we do it without even thinking about it.

"Dr Robertson was right. We have seen the Covid-19 culture evolve to the point where it is now second nature for our paramedics to slow down, assess, don PPE and engage."