From Crisis Start to Paramedics —EMS Growth in Springdale, Ark.
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Springdale, Ark., Fire Department
The announced termination of private ambulance service created the crisis that placed the ambulance service in the Springdale, Ark., Fire Department. Over the years, that service has improved and expanded so that it outnumbers fire calls 5 to 1.
In November 1966, the local funeral home operator formally informed the mayor and the Springdale City Council that he could no longer economically afford to furnish ambulance service for the community and would terminate this service at year’s end. A city council committee was appointed by the mayor to seek a solution to the problem. After a month of effort in which the committee learned, among other things, that no one wanted the ambulance service, a rather unpopular decision was made to put it into the Springdale Fire Department until a more permanent operator could be found.
The funeral home operator agreed to donate his two ambulances and all their equipment to the city, reserving the right to reclaim them if the service was assigned to a profit organization or any other agency not under the direct control of the city. This proved to be a turning point in enhancing the smoothness of the transition of the service to the fire department and, perhaps, had some effect on an unforeseen drastic change in fire fighters’ attitude about getting into the ambulance business. The addition of six positions in the fire department also had some effect on the turnabout of opinion in the department. Some of these positions were worked by fire fighters on a voluntary overtime basis, giving them experience in ambulance work as well as additional income that in most cases exceeded that earned on moonlighting jobs.
Our fire department medical officer at that time was Dr. James Greenhaw, a local physician. He agreed to take on the training program to try to make effective ambulance attendants out of us. Everyone had had Red Cross basic first aid, little of which had even been put into practice. We had an old E & J resuscitator that everyone could operate and was occasionally used on a heart attack or breathing difficulty call. That was the extent of our training related to sick and injured people, and everyone in the department readily accepted that this was going to be insufficient.
Training program started
There was no such term as emergency medical technician at that time, and initially, Greenhaw had to run the training program by ear. We did find and purchase the original manual of the American Academy of Orthopaedic Surgeons, “Emergency Care,” a complete ambulance training in 127 5 X 7-inch pages. This manual was a godsend and a key to the beginning of a highly successful operation.
Training bred confidence; confidence bred efficiency; efficiency bred pride and an almost unbelievable response from the public in support of the fire department-operated ambulance service. It seemed for a while as if almost every call we responded to resulted in a compliment being extended to the fire department directly, through city hall, or through a citizen’s letter to the local newspaper. The newspaper had also watched the transition closely from the beginning and reported frequently that the firemen were building quality into emergency care that had not been known before.
Fire fighters win decision
About six months after the ambulance service had been moved into the fire department, a local business group made a proposal to the city council to take over the ambulance service as a privately operated system for our city and the surrounding area. The fire fighters said “no” and produced convincing evidence that no private agency could run an ambulance service for Springdale either as efficiently or as economically as the SFD. With that, the ambulance service became a permanent division of our department.
The years to come saw rapid and vast changes in emergency care. Locally, our entire hospital, medical staff, and inservice department became strong supporters of the EMS concept as practiced in Springdale. The hospital took over our training and initiated the practice of fire fighters assisting in the emergency room in late 1967. When the classification of emergency medical technician came to life, Springdale Memorial’s in-service staff, headed then and now by Mrs. Virginia Clevenger, R.N., B.S.E., set up a program to certify our people. Upon completion of this course, the first field EMTs in Arkansas were certified through the State Health Department and soon thereafter through the National EMT Registry.
During the mid-’70s, there was strong feeling within our hospital and our fire department that more lives could be saved and better services rendered if our EMTs could be authorized to perform advanced field care practices. However, our state was slow in establishing criteria for the certification of paramedics. Finally, in 1975, the frustration seemed to peak and a contingent of local physicians pushed hard for the advanced training with local certification. This was the conception of advanced care and shortly after, it was born.
Start of paramedic training
Springdale Memorial’s staff of physicians participated in the development of a training program along with the in-service department and the fire department. We borrowed samples of training programs from other states and developed one that suited our needs as judged by our physicians, hospital administration, nurses, and fire fighters. Mrs. Clevenger agreed to implement and manage the training program and we were on our way. The medical staff unanimously agreed to help with the training and to assume responsibility for the work of the paramedics after they demonstrated adequate proficiency to a sampling of the physicians.
The first group of trainees (four men) completed the training program in 14 months. The training was modularized, and the trainees were certified to perform certain advanced functions (IV administration, cardiac defibrillation, some drug administration, etc.) upon completion of the appropriate module. Fortunately, by the time the first course ended, the State Health Department had a certification examination process and the men were able to go to Little Rock and become state registered paramedics shortly after completing training at Springdale Memorial.
Since the beginning of the paramedic operation with four men, five more have been certified both locally and by the state.
Two of our paramedics are now engine company lieutenants at an outlying station. We have outfitted their pumper with a “right now” paramedic kit (endothracheal tubes, fluids, bag mask, etc.) for calls that they can get to before a paramedic squad. Our engine companies have always responded routinely on EMS calls and performed basic EMT functions. Thus the transition to paramedic capabilities on Engine 2 was easily accomplished.
Because of our manning crunch (normally two-man companies backed up by off-duty and volunteer response) not only do our engines assist our squads, but a squad responds on all structural fire calls. The squad fights fire, sets up an emergency care sector, or performs whatever assignment is given it.
Monitors aid response
All units are dispatched out of their stations by radio and each member of the department has a home monitor and a portable monitor. It is a common occurrence on any emergency call for one or more off-duty or volunteer fire fighter/EMTs to be on the scene on the arrival of our first unit. This system resulted from a fire protection master plan which was done in our community in 1975-76. Numerous incidents can be recalled where the quick arrival of a fire fighter who lived in the neighborhood or happened to be a few blocks away at the time of an alarm was instrumental in a life-saving operation. We also have had experiences of fires being extinguished or knocked down and held in check before the arrival of the first fire company by someone who was close at hand.
Emergency medical service as a system in our city and as a division within our fire department is now a commonly accepted thing after 14 years of operation. Moreover, the recognition and strong public support keep coming. Springdale Mayor Charles McKinney recently stated that the “EMS division of the fire department is the most highly complimented service of the City of Springdale.”
The first six ambulances put into service by our department were donated by local citizens. The last two ambulances were purchased and equipped with combined donated funds and federal revenue sharing funds. Our first paramedic squad was outfitted with telemetry through local donations, primarily from our hospital auxiliary. Our first heart monitor/defibrillator had been donated earlier by a local business. We’ve often wondered where our fire department would be today if we had succeeded in our initial efforts to keep the ambulance service out of it.
We currently are responding to about 2000 ambulance calls and 400 fire calls annually. A medium duty rescue truck also responds with the squad and an engine company on serious auto accidents and other incidents where extrication sounds likely.
Training is continuous
Paramedic and EMT training are continuous for our men. The emergency committee of Springdale Memorial Hospital critiques our incidents, establishes training priorities, promulgates patient care protocols, and helps schedule physicians and others to lecture and work with our people. This committee consists of the hospital administrator and assistant administrator, six physicians (a family practitioner, a surgeon, a cardiologist, and three emergency physicians), the director of nursing, the director of in-service training, the assistant fire chief, and the fire chief.
Currently, our department is deeply involved with our hospital and a number of local supporters in a community CPR project which has the defined goal of certifying one-half our city’s population in CPR by the end of 1982. A full-time coordinator for this project has been employed by the Springdale Memorial Hospital. A massive on-going publicity program on the community CPR project has resulted in almost overwhelming interest by the public. One letter in the local paper was from a woman praising this program after taking the course, because her husband had a heart attack within a few days and she “recognized the symptoms and knew what to do.” Her husband returned from the hospital within a few weeks.
While our system appears to be strong, we are constantly looking at ways to improve our capabilities. We believe the greatest potential for improving ourselves lies in the areas of training and training-related projects and in studying the innovations and successes of other EMS programs. We feel we have gained much of what we have by observing other operations and capitalizing on the things that impressed us.
