Bangor Fire Department paramedics Brian Cochrane (right) and Nick Chapman wear full face shields during a simulation of how they respond to EMS calls with positive or inconclusive cases of COVID19. Full face shields are used to protect them from any splatter.

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Almost seven weeks before the first coronavirus case was confirmed in Maine, emergency medical responders were on the lookout for people who might be carriers of the highly contagious virus.

Those who transport sick or injured people are among those at greatest risk of catching the coronavirus because of their close contact with people as they respond to medical emergencies at their homes and care for them in ambulances. The new protocols crews started using in late January give them tools to suss out if a patient might be a carrier of the virus so they can respond accordingly.

[Our COVID-19 tracker contains the most recent information on Maine cases by county]

Even those measures do not dispel the unease that comes with being on the front lines of the pandemic. That means heightened precautions will likely continue even as the state starts a phased reopening, responders say.

The state first put responders on the lookout for the virus on Jan. 24 because its spread seemed likely, said Matthew Sholl, medical director of Maine Emergency Medical Services. The new protocol for responding to emergency calls came three days after the country’s first case was confirmed in Washington state, but as the Maine Center for Disease Control and Prevention was saying the overall coronavirus risk in Maine was low.

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“EMS crews have been a part of tracking and maintaining situational awareness of infectious diseases around the globe,” Sholl said. “But I’ve never seen something of this nature with so many ramifications.”

The state directed emergency dispatchers and responders to start asking 911 callers whether they had experienced a fever, cough or shortness of breath — common coronavirus symptoms — or whether they had been around anyone experiencing those symptoms. They also asked about their travel history.

On March 3, the state activated its emergency infectious disease tool as a way to track the virus. It included additional questions on whether the patient worked in health care or had been around someone exposed to the virus. It also included codes the dispatchers who take 911 calls began using to warn responders of the virus’ presence at the site of an emergency.

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A Positive 21 call indicates someone who is either confirmed to have the virus or exhibiting similar symptoms. The travel question has since gone away because of the presence of community transmission in four of the state’s 16 counties — York, Cumberland, Penobscot and Androscoggin.

But even if someone is negative or inconclusive, emergency crews still approach scenes with caution.

Crews are told to wear masks, gloves and protective eye gear on every call. They ask patients to meet them outside when they arrive if possible, and only one crew member assesses a patient rather than the whole crew. If someone is confirmed positive, responders don a gown and are instructed to put a face mask on a patient. They judge whether someone in an emergency could stay at home rather than go to a hospital and risk infection or take up a needed bed.

Philip Hamm, assistant chief of the Bangor Fire Department, said emergency crews spend a little longer at the scene of a call now. Crews will often re-interview patients at the scene, in case they forgot a key piece of information during the 911 call that could put them in the positive category for coronavirus.

Despite the changes, the emphasis is still on treating patients with compassion.

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“We treat people just like they’re our mom and dad,” Hamm said. “We may look a little different but we’re treating them the same.”

In Portland — Maine’s biggest city located in the heart of the county that has seen the most coronavirus cases — city emergency crews have responded to 139 calls in which the patient was COVID-19 positive since the week of March 19, according to city data. The number of calls went from eight during the first week to 35 last week.

The city has a vehicle dedicated to decontaminating the ambulances when there is a COVID-19 patient. It has been deployed two to eight times a day since April 7.

Departments are also doing temperature checks when staff report for work and throughout their shifts. Those precautions help responders prepare, but Portland Fire Department Capt. John Brennan said the anxiety of catching the virus and bringing it home to their families never really goes away for first responders.

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“This is something a lot of us have never seen before, aside from 9/11,” he said. “This has changed our whole makeup.”

In rural York County — the Maine county with the second highest case total — the nonprofit York Ambulance Association provides services to York, North and South Berwicks and Rollinsford, New Hampshire. Chief Karen Tucker said she is seeing an influx of visitors on the weekends despite beach closures.

Tourist season brings with it more car crashes and trauma-related injuries, such as broken bones, and more potential exposure to the virus for emergency responders. Tucker worries reopening of the state — allowing more business to return to regular operations — could bring an overwhelming surge of cases.

And even when the pandemic ebbs, she does not see a return to normal for emergency workers in the near future.

“For the next year or so, we’re going to be responding with N95 masks, face shields and gloves,” Tucker said, “because we’re not going to know if someone still has it.”

Watch: State sets up hotline for health care workers

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