Community paramedicine risk reduction through waste management

Sandwich (MA) Fire Chief John Burke reflects on how properly disposing medical waste has helped safeguard his community against COVID-19, the opioid epidemic and in-house medical care

In 2014, the Sandwich (Massachusetts) Fire Department created the Community Risk Reduction Unit (CRR) to work on key community safety issues, including senior citizen safety, risk reduction, and innovation development and implementation. Located about 60 miles south of Boston, Sandwich is a popular summer vacation spot for tourists and is the oldest town on Cape Cod.

As the deputy fire chief at the time in charge of operations, and after almost a decade spent in the fire prevention force, I saw community risk reduction as a key non-response component that would help solve community-based issues. The creation of the unit resulted in discovering some alarming things happening in our town.

Initially, the program entailed firefighters trained in community risk reduction practices performing wellness visits across homes in the community. During these visits, the CRR firefighters discovered that their assigned clients were storing diabetic needles and finger stick cartridges in buckets and used milk cartons. They had no way of safely disposing of these items because the local landfill and garbage collection services could not accept the waste. This startling trend was prevalent in over 75% of the wellness visits.

Around the same time, I was teaching at the Boston University School of Medicine's Graduate Program in Healthcare Emergency Management, where I was able to review innovative new product lines. One of the product lines was a Boston-based startup company called Sterilis Solutions. Their device, called the Remediator, was a machine no bigger than a standard copier that sterilized and ground used medical waste into a harmless "confetti" substance. The sterilized waste could then enter the regular waste stream.

Discovering the Remediator was a two-fold win for the Sandwich Fire Department. The device could be used for the populations in town who utilized home-based medical sharps and other equipment, but had nowhere to dispose of the waste. The second use was for the medical waste accumulated in our ambulances. The closest trauma center to Sandwich is in Boston, so the majority of our trauma patients were transported by Boston Med Flight, which left the initial treating ambulance with medical waste. The device would allow us to remediate trauma waste quickly and remove the worry on storing and transporting the waste to a hospital when we had another call.

We received a beta test machine from Sterilis in 2014 and upgraded to a full-time machine in 2016. The Remediator had a significant impact on our community since its introduction. The chart below shows the average amount of medical waste that was remediated since 2016 as well as how many residents visited our stations to dispose of medical waste.

YEAR

VISITS

Amount of Waste Remediated

2016

250

500 lbs

2017

300

600 lbs

2018

450

1,000 lbs

2019

525

1,000 lbs

2020

675

1,200 lbs

2021

780

1,300 lbs

TOTALS

2980

5,600 lbs

Since utilizing the device in our community, we have found several key advantages. Dealing with medical waste is a 24/7/365 operation and having remediation technology on hand makes for a smooth and easy removal process. Having the device accessible to the community also makes for more public visits where residents can see first-hand the work being done and engage in dialogue with our responders.

Another unexpected advantage is the safe disposal of needles and syringes used in opioid injections. The heroin epidemic has been significant in the Cape Cod region as featured in the HBO documentary "Heroin: Cape Cod USA." Instead of the sharps ending up on beaches, parks and other public places, the dangerous waste finds its way to the Remediator.

With the introduction of the COVID-19 pandemic, the technology has also helped our community dispose of medical waste generated from COVID-19 vaccinations. The program reached a new level in 2020 when an old 2014 International Ambulance was retrofitted into a Mobile COVID Testing Unit. The Remediator was placed in the vehicle to handle mobile medical waste remediation at COVID testing and vaccination sites. The unit also visited public schools at the end of the year to remediate accumulated medical waste, resulting in savings for the school department.

The program has been a great success and has shown the community that the fire department is committed to community risk reduction, green energy programs, safety from the opioid epidemic and COVID-19 pandemic, and senior citizen care. This innovative community risk reduction program will continue to grow and expand as neighboring departments start their own risk reduction programs for medical waste.

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John J. Burke is a 28-year member of the Sandwich (Massachusetts) Fire Department, where he has served as fire chief and emergency management director since 2018. From 2014-2018, he was the deputy fire chief overseeing operations, community risk reduction and special operations. From 2004-2014 he was the fire prevention officer, and from 1998-2004, served as a firefighter and advanced EMT.

Chief Burke is a graduate instructor at the Boston University School of Medicine's Graduate Program in Healthcare Emergency Management and an adjunct professor in the Fire Science Program at Cape Cod Community College. He holds a bachelor's degree in Fire Science from Columbia Southern University and a master's degree in Healthcare Emergency Management from Boston University.

He is a credentialed Chief Fire Officer (CFO) through the Center for Public Safety Excellence as well as a credentialed Massachusetts Professional Emergency Manager (MPEM) through the Massachusetts Emergency Management Agency (MEMA). He has designed and delivered over 100 hybrid exercises to federal, state and local providers that emphasize learning and integration of private sector resources.