This month’s topic is the Emer-gency Medical Operations component of the proposed National Fire Protection Association (NFPA) 1710, Standard for the Organization and Deployment of Fire Suppression, Emergency Medical Operations and Special Operations to the Public by Career Fire Departments, and NFPA 1720, Standard for Volunteer Fire Service. The fact is that EMS incidents play a large role in our day-to-day operations.
The proposed 1710 (2-3.2) states: “The fire department’s organizational statement shall ensure the fire department’s emergency medical response capability includes sufficient personnel equipment and resources to effectively and safely deploy at the first responder level with automatic external defibrillator (AED) or higher treatment level.”
The proposed standard again provides response guidelines similar to those for fire response ( 3-3.4.3.2): …. “First Responder with AED within a (4) minute response time ninety (90) percent of the time.”
In Toledo, all firefighters, regardless of rank, are trained as a minimum to the Emergency Medical Technician-Basic level. Seven of our 17 engine companies are advanced life support (ALS)-capable. We hope to have this equipment on all ALS engines in the near future. Staffing is the current stumbling block in our ALS engine goal. We simply do not have enough paramedics to staff all 17 engines and the five (two paramedics) transport life squads we currently have. We need to train more firefighters to the paramedic level. This takes time and funding. We are also looking to add provisions that will require all new hires to participate in the paramedic program.
Every response vehicle (engines, trucks, heavy rescue squads, field operations chiefs, life squads, and the 24-hour safety officer) is equipped with an AED. This equipment has been on the rigs since 1998. Police officers will soon also be trained in and carry AEDs in specific areas of the city where ALS response is lacking.
As the proposed standard relates to response, our response time is beyond the standard’s proposed four-minute, 90 percent of the time response by 30 seconds. Our response time on EMS incidents is 41/2 minutes 94 percent of the time.
John (Skip) Coleman,
deputy chief of operations, Toledo (OH) Department of Fire and Rescue;
author of Incident Management for the Street-Smart Fire Officer (Fire Engineering, 1997); editorial advisory board member of Fire Engineering; and member of the FDIC Educational Committee.
Questions: Is your department trained to the first responder level? Does your apparatus currently (or are you planning to) carry AED equipment?
Ronald Hiraki,
Chief of Training,
Seattle (WA) Fire Department
Response: Our de-partment trains all firefighters and company officers to the Emergency Medical Technician (EMT) level and in how to use AED equipment following local protocols. Every engine company, ladder company, and basic life support (BLS) unit carries AED equipment.
Seattle firefighters have been trained to the EMT level since the early 1970s. The fire department participates in studies with the University of Washington Harborview Medical Center and local manufacturers to develop protocols, conduct research, and document the success of emergency medical procedures. Consequently, we have successfully been using AED equipment since the mid-1980s.
The Seattle Fire Department is a leader in the field of emergency medical services. In the late 1960s, Dr. Leonard A. Cobb, a cardiologist at Seattle’s Harborview Medical Center, had a vision of saving the lives of heart attack victims through prehospital care. Cobb enlisted the support of then Fire Chief Gordon F. Vickery to create a program to train firefighters to perform specific medical procedures and to allow those firefighters to perform those procedures in the field. Today, Seattle’s Medic One program continues under the supervision of Dr. Michael K. Copass, director of emergency services at Harborview Medical Center. Copass also serves as director of Seattle Medic One and of paramedic training.
The Seattle Medic One program employs a layered response that uses firefighters, paramedics, and CPR-trained citizens. Department dispatchers’ abilities to determine the help needed at the scene of a reported medical emergency are critical to the layered response system. The closest unit, whether a fire engine or medic unit, is dispatched as needed. Seattle citizens’ willingness to respond to dispatcher instructions for rendering aid prior to the arrival of the fire department and the citizens’ expertise in responding to these instructions have added to the program’s success.
Frank C. Schaper,
Chief,
St. Charles (MO) Fire Department
Response: When discussing the EMS portion of NFPA 1710, we must remember that it is still in the formative stage. No doubt this draft standard will be scrutinized carefully, criticized roundly, and drafted several more times before it passes muster-if it ever gets passed. Be that as it may, let’s address the questions at hand.
Our department is celebrating the 25th anniversary of its entrance into the emergency medical response arena. According to our records, ours was one of the first departments in the state of Missouri to provide this service.
Our two ALS ambulances are staffed by paramedics and operate from two of our five stations. All of our companies are ALS units. Consequently, all new hires are required to possess a medic’s license. This system provides an average three- to four-minute response time anywhere in our city. The medics who staff the ambulances are also firefighters and are included in our fireground operations.
Our department does not use AEDs at this time. Because we operate with paramedics on all of our rigs-ambulances and engines-we are able to provide a higher level of treatment using monitor defibrillators.
Garry Morris,
Assistant Chief,
Phoenix (AZ) Fire Department
Response: All members in the our Operations Division are certified to the emergency medical technician or paramedic level (355 paramedics). All our fire stations currently have at least one ALS company assigned. Forty engines are ALS; 12 are BLS. All of our BLS engines and ladder and rescue (ambulance) companies are equipped with AEDs. Several other support vehicles also carry them.
The department also took the lead in getting council approval for funding the purchase of 200 AEDs for city facilities. Forty of the units will be assigned to Sky Harbor International Airport. As the units are delivered, appropriate training will be given.
Rick Lasky,
Chief,
Lewisville (TX) Fire Department
Response: As was the case with the proposed section in NFPA 1710 regarding the initial alarm assignment to a structure fire, the Lewisville Fire Department can meet and exceed the response requirement of four minutes or less for first responders and eight minutes or less for the arrival of an ALS unit.
We staff our ambulances with firefighter/paramedics and supplement our ALS services by staffing most of our engines with a paramedic. We are currently in the process of adding more paramedics. The goal is to have all of our engines and trucks provide ALS services. Personnel not trained as paramedics are certified at the EMT-Basic level; a small portion are being trained to the first responder level. Currently, our paramedic ambulances each carry an AED with both three- and 12-lead monitoring capabilities. Our engines and trucks each carry an AED that provides three-lead monitoring capabilities. All of our EMS personnel are under the supervision and guidance of our department’s EMS coordinator. Like most fire departments, EMS is the majority of our business, and we are constantly reevaluating our EMS program in an effort to improve our delivery system.
Bob Oliphant,
Lieutenant,
Kalamazoo (MI) Dept. of Public Safety
Response: We have had AEDs for approximately 10 years and are continuing to expand their use. All apparatus that generally respond to rescue calls are equipped with AEDs. Additionally, patrol vehicles assigned to larger geographic sectors of the community carry AEDs. Personnel are trained to the Medical First Responder level.
Our current AEDs will be replaced as the result of a grant obtained by a local hospital. Some of the older equipment will be refurbished and distributed to local departments that do not have such equipment.
Larry Anderson,
Deputy Chief,
Dallas (TX) Fire Department
Response: All of our firefighters are already trained to the first responder level. We placed AEDs on all 54 engine companies in 1985 and have had good results with them. In 1990, we added AED capability to our truck companies. Until that time, only engines answered as first responders. Being able to include truck companies as first responders added 21 additional AEDs to our service delivery. One of our ARFF response vehicles at the local airport also carries an AED. All told, we have 76 AEDs available for first responder service.
Because our department provides all ALS service in the city, we have the added advantage of having paramedics available on first responder apparatus. Each of our ALS units has four or five paramedics assigned, but only two ride it at a time. The paramedics not riding the “box” during a particular shift ride fire apparatus and are available as first responders.
Leigh Hollins,
Battalion Chief,
Cedar Hammock and Southern Manatee Fire Districts, Florida
Response: Cedar Hammock-Southern Manatee has been equipped with AEDs since June 1998, when we used EMS grant funds to purchase our first devices. We currently have 11 AEDs within our eight-station department. Each first-out engine and the battalion chief’s vehicle are AED-equipped.
All personnel in the Operations Division are trained in AED use. Approximately 70 percent of them are EMTs; 10 percent are paramedics. Most others receive first responder training in recruit school; our Training Division provides AED training.
Our department does not operate ambulances or provide ALS services. We respond to a certain “menu” of medical calls, such as cardiac- and respiratory-related calls and those involving unconscious patients. We do not normally respond to medical calls of a less serious nature unless EMS arrives and requests rescue “backup.” We also respond to vehicle accidents and trauma-related incidents. Our AEDs are used approximately twice a week. The statistics show that the AED “conversion” rate is about 40 percent. Statistics on “saves” are not available because our department does not transport the patient. The patient’s final outcome, therefore, is not determined by our crews.
