Faculty Spotlight: Jonathan Kilstrom, MPAS, PA-C, NRP, Lessons from the COVID-19 Front Lines

Jonathan “Jon” Kilstrom, MPAS, PA-C, NRP, has more than 16 years of experience in prehospital emergency medical services and has been in physician assistant (PA) education for four years. He lives in Omaha, Nebraska, where he works in emergency medicine and urgent care in addition to teaching for Yale Physician Assistant Online Program. We recently spoke with Jon about being on the front lines of the pandemic and the role of PAs going forward.

Fortunately for the Yale PA Online Program, since the didactic portion of the curriculum is  online, not much has changed for our first-year students. A few of our other students have been pulled from their clinical rotations, but teaching-wise, my day to day is pretty much the same.  

I diagnosed my first COVID-19 positive patient in mid-April, but the patients I’m seeing more of are alcohol- and substance-use disorder patients. I’ve had several patients come in with a history of liver failure and cirrhosis that have been exacerbated by alcohol use, and I do wonder if there’s a correlation with COVID-19. That’s a potential coping mechanism to those patients, so I wasn’t surprised to see an increase in those numbers. 

Yale Medicine says that admissions for heart attack dropped 38 percent in nine major U.S. hospitals in March. Beth Israel Deaconess Medical Center in Boston reported a drop in medical visits for cancer, heart attacks, and stroke by as much as 65 percent. It’s not that patients suddenly aren’t being affected by these conditions; they’re just too concerned to go to the emergency departments because they’re afraid of being exposed to the virus. So they’re not seeking out care, which obviously has its own implications as well.

Another potential reason the volume of patients has decreased may be that we are doing better with social distancing and hand hygiene, which helps with the common illnesses that we deal with all the time, like strep, common colds, and influenza.

Those populations have poorer outcomes and are more at risk for COVID-19. Part of it is because they don’t have the same access to quality care that the general population may have; and therefore their underlying conditions such as hypertension, diabetes, etc., aren’t being addressed or well managed. And it’s known that those underlying comorbidities can significantly impact patients diagnosed with COVID-19. It makes the illness itself more severe, and they’re more at risk for complications from it.

It’s going to take time, and it’s not perfect yet, but one thing the PA profession—and the Yale PA Online Program specifically—does really well is focus on primary care. If you look at numbers nationally for PAs and physicians, you’re seeing fewer going into primary care and more going into specialties, which compounds the access problem.

The PA profession was developed to help with some of these disparities and to help fill these gaps in care. I really see that in my rural community. Many doctors graduate medical school and don’t want to go to these tiny towns, so we’re seeing a lot of PAs filling that gap. We’re also seeing PAs in the bigger cities stepping in to make sure underrepresented populations are getting the medical care they need.

When I was a student in PA school, it felt like you would learn about rare diseases but never see them in practice. I think this crisis emphasizes why teaching rarely seen diseases is important because you never know when you may see an uncommon disease or a pandemic emerge. 

This crisis is also a good opportunity to teach our students about self-care and the importance of provider safety. Even though we have few cases in the Midwest, every patient who comes in with a cough and a fever must be treated as if they’re a potential COVID-19 patient. We’re all wearing masks throughout the hospital, and we have no-visitor policies implemented, with a few exceptions. And I’m constantly using hand sanitizer that was made by a local brewery. 

The amount of PPE that we have to put on going into these potential COVID-19 patient rooms—you’re taught that at some point in your PA education, but it’s one of those things you don’t think is ever really going to happen. And now you’re coming into contact with a highly infectious disease, and you have to make sure that you’re not only putting on the equipment appropriately but also taking it off appropriately, too, because that presents a higher risk of infection. So it’s just an added stress during your shift. 

If you’re not healthy, or if you get sick, then you can’t help others—what good are you then? You just become another number, and you’re adding to the problem; that’s why it’s really important that you’re taking care of yourself, washing your hands, using appropriate personal protective equipment (PPE) and avoiding getting ill yourself. 

There’s a lot we can learn from this. It’s going to be interesting to look back and see where we did and didn’t do well. I think we’ll be much more prepared in the future.

I still keep my paramedic license active. I went to Creighton University here in Omaha, and I am active with their EMS program and serve on their advisory board. When you’re working in EMS, you’re running into potential dangers quite often. One of the things that gets ingrained in you is scene safety. 

That’s always the first thing you say to yourself any time you go on a call: Is the scene safe? If it’s a car accident—could there potentially be hazardous materials from the accident? Or, if you’re going to a stabbing or other crime scene—is the perpetrator gone? Are the police there?

EMS providers are very well trained to make sure first and foremost that they’re protecting themselves. Unfortunately, given how contagious COVID-19 is and the way EMS providers are out in the community and on the front lines, they are much more susceptible. Even while wearing N95 masks and gloves, it doesn’t take much of a slip-up to potentially expose yourself. It’s an increased risk and danger that’s always top of mind.

In terms of health care, we’re learning a lot, and I think we’re going to be more prepared for major events in the future. Unfortunately, I think there may also be an economic impact that’s going to affect all health care providers, from CNAs to PAs to doctors. We may see clinics close. We may see layoffs. Clinics just can’t afford to stay open, even in primary care, because a lot of them are doing telemedicine now and their numbers are down significantly. 

As for PAs, hopefully this will help shed light on how much we’re needed. We’re doing a good job of filling the gap serving the underserved, but there’s definitely still room to improve. Hopefully this helps more students see the importance of primary care and that it is critical to address underlying disparities in medicine. It’s important that we are addressing chronic medical conditions in all patient populations so that when these acute illnesses emerge, these patients are less affected by complications.

Citation for this content: Yale School of Medicine Physician Assistant Online Program