A steady stream of reporting has focused on emergency rooms, intensive care units and the crumbling hospital workforce as they grapple with the overwhelming demands of the pandemic. But Ava Kofman’s story was the first to focus on the struggle of first responders – the most critical and overlooked node of our healthcare system. Kofman’s investigated the emotional toll of the explosion in Covid cases on EMTs, who not only had to confront the suffering of their patients but also the inadequacy of their ability to help them. The story was widely praised for providing a panoramic diagnosis of the long-standing flaws in the emergency medical system, which has long prioritized profits over patients. Told as an immersive narrative, “The Broken Front Line” took readers deep inside an emergency medical system on the brink of collapse to show how its foundations had been shaky all along, with the pandemic accelerating its cracks.
The story was a reporting coup. Kofman gained unprecedented access to EMTs, who allowed her to shadow them during their punishing 24-hour shifts. For three weeks, during the height of the pandemic’s most devastating surge in Los Angeles, she embedded with an ambulance crew as they treated some of the county’s sickest and poorest residents. She hunted down documents that confirmed long waits and backlogs at hospitals, studied medical literature on moral distress, and researched the history of LA County’s EMS system. While her portrait focuses on the moral distress suffered by two EMTs, Kofman made sure their stories were broadly representative of the industry and interviewed two dozen ambulance workers – including dispatchers and supervisors – to gain a fuller view of the world of emergency medicine.
All of this helped her to bring readers intimately into the mind of Michael Diaz, a veteran EMT who, at 31, is responsible not just for consoling his patients but also, as a union leader, his colleagues. Narrated in almost real-time, Kofman captures the agony of trying to be a caregiver when resources were so constrained that it was almost impossible to actually provide care. EMTs like Diaz were forced to do things they’d never done before, like pulling multiple all-nighters in a row or waiting for 14 hours outside a hospital with a patient. But the most painful change to the status quo was the fact that EMTs were forced to ration fundamental life-saving tools. Kofman recounts in painful detail what it was like for Diaz and his colleagues to deny oxygen to patients gasping for air. Nieman Storyboard called Kofman’s descriptions of Diaz’s interior thoughts “a tour de force of real-time reportage and narrative reconstruction that reveals, with withering clarity, a system overwhelmed by the pandemic.”
This portrait also addresses structural issues, including the effect that being owned by private equity firms has on ambulance companies. The stakes could not have been higher. Diaz and his colleagues at the nation’s largest private ambulance company are not just fighting a pandemic: They’re also fighting management and management’s response to the pandemic. Kofman unspools a panoramic diagnosis of the long-standing flaws in the emergency medical system, which has long prioritized profits over patients.
The trauma for the EMTs was only beginning to surface as Kofman wrote her article, but she captured how they’ve been changed by it. Diaz does his best each shift to keep morale up. Yet as Kofman shows even he finds himself becoming inured to scenarios that would have been previously unthinkable. He no longer notices when every patient in the emergency room is intubated. He’s indifferent to the high-pitched ring of the alarms that signaled the end of the hospital’s oxygen supply. Of course, some detachment is natural, even necessary, in a profession that routinely deals with the worst day in someone else’s life. But these days he has trouble feeling anything at all.
Kofman’s story asks pointed questions about the moral distress brought about by our country’s deadly mishandling of the pandemic. As the U.S. reaches the second anniversary of the start of the pandemic, what will the long-term psychological effects be on first responders? What happens to caretakers who can no longer properly care for patients? Will their sacrifices have mattered?