Heroism in the Face of the COVID-19 Pandemic

Since the beginning of the COVID-19 pandemic, firefighter-certified first responders, emergency medical technicians, and paramedics have been the tip of the spear fighting coronavirus. First responders have triaged, resuscitated, and transported thousands of people affected by coronavirus disease 2019 (COVID-19). The American people owe a debt of gratitude for the heroic work they have done.

In this issue of JAMA Cardiology, the report of Lai and colleagues¹ highlights the dramatic burden that COVID-19 has placed on first response systems. At the height of the pandemic, New York City (NYC) emergency medical systems (EMS) responders attended to nearly 6 times the number of out-of-hospital cardiac arrests compared with the same period in 2019. This represents the tip of a massive iceberg; at the same time, the cumulative incidence of EMS calls for respiratory symptoms and fever skyrocketed. Although the typically bustling NYC streets remained eerily deserted, the characteristic cacophony of sounds of the “City that Never Sleeps” was replaced by sirens wailing all hours of the night.

Despite this surge, Lai et al¹ report that quality of care delivered by NYC EMS responders remained remarkably stable, with response times for out-of-hospital cardiac arrests from the first 911 call only rising from 5:05 to 5:56 minutes. The observed excess in out-of-hospital cardiac arrests probably represents a combination of severe COVID-19 infection and deterioration from other illnesses. The rate of successful resuscitations declined in the COVID-19 period compared with the control period, partially reflecting changing out-of-hospital cardiac arrest demographics in the pandemic (eg, older patients and a greater proportion presenting with asystole or pulseless electrical activity). Although the relative success of resuscitations fell, NYC first responders achieved a return of sustained spontaneous circulation in 423 adults between March 1 and April 25, 2020.

First responders to out-of-hospital cardiac arrests in the COVID-19 era place themselves at extremely high risk, in some cases without optimal personal protective equipment. Cardiopulmonary resuscitation measures dramatically increase the risk of exposure, particularly when they occur emergently and outside the hospital. Sadly, many first responders have fallen ill to COVID-19 infection. Like the first responders who rushed into the World Trade Center towers on September 11, first responders in NYC and across the nation have and continue to put their lives at risk to save lives.

On behalf of the editors of JAMA Cardiology, we commend the courage and dedication of first responders in NYC and across the nation, and we thank them for all they do. As of June 1, 29 United States EMS workers and volunteers have died of COVID-19.² We honor the memory of James Villecco, Gregory Hodge, Tony Thomas, Mike Field, John Redd, Idris Bey, Richard Seaberry, and Sal Mancuso of New York; Israel Tolentino, Reuven Maroth, Liana Sá, Kevin Leiva, Frank Molinari, Robert Weber, Robert Tarrant, Solomon Donald, Scott Geiger, John Farrarella, John Careccia, Bill Nauta, and David Pinto of New Jersey; Kevin Bundy, Robert Zerman, and Jeremy Emerich of Pennsylvania; Paul Cary of Colorado; Paul Novicki of Michigan; David Martin of Mississippi; Billy Birmingham of Missouri; and John “JP” Granger of South Carolina. We offer their families, friends, and colleagues our sincerest condolences and honor their memory with our highest respect and gratitude.

Published Online: June 19, 2020. doi:10.1001/jamacardio.2020.2493

Corresponding Author: Robert O. Bonow, MD, MS, Northwestern University Feinberg School of Medicine, 251 E Huron St, Galter 3-150, Chicago, IL 60611 (r-bonow@northwestern.edu).

Conflict of Interest Disclosures: Dr Kirtane reported receiving institutional funding to Columbia University and/or the Cardiovascular Research Foundation for research, speaking engagements, and/or consulting from Medtronic plc, Boston Scientific Corporation, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens AG, Philips, and ReCor Medical; and travel expenses/meals from Medtronic plc, Boston Scientific Corporation, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, ReCor Medical, Chiesi USA, OpSens, Inc, ZOLL, and Regeneron Pharmaceuticals, Inc. Dr Mehran reported receiving grants and/or research institutional funding from AstraZeneca plc, Medtronic plc, Janssen Pharmaceutica, Bayer AG, Beth Israel Deaconess, CSL Behring, DSI, Novartis International AG, OrbusNeich, Novartis Pharmaceuticals, Sanofi/Regeneron, and Boston Scientific Corporation; personal fees from Sanofi SA, Medscape/WebMD, Roivant Services, Siemens Medical Solutions, Boston Scientific Corporation, Janssen Scientific Affairs, and Medtelligence (Janssen Scientific Affairs); grants, personal fees, and other support from Abbott Laboratories; grants and other support from Bristol-Myers Squibb; personal fees to her spouse from Abiomed and The Medicines Company; consulting relationships with Idorsia Pharmaceuticals Ltd, Regeneron Pharmaceuticals, Inc, and Spectranetics/Philips/Volcano Corp; participation in a data safety and monitoring board for Watermark Research Partners; service as an associate editor to the American College of Cardiology and the American Medical Association; and equity in Claret Medical and Elixir Medical Corporation outside of the submitted work. Dr Navar reported receiving funding for research to her institution from Amgen, Inc, Janssen Pharmaceutica, Amarin Corporation, Sanofi SA, and Regeneron Pharmaceuticals, Inc, and honoraria and consulting fees from Amgen, Inc, AstraZeneca plc, Janssen Pharmaceutica, Esperion Therapeutics, Inc, Amarin Corporation, Sanofi SA, Regeneron Pharmaceuticals, Inc, Novo Nordisk A/S, Novartis Pharmaceuticals, The Medicines Company, New Amsterdam, Cerner Corporation, 89bio, Inc, and Pfizer, Inc.