The Song Remains the Same

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A few weeks ago I posted Wear and Tear Part I and Wear and Tear Part II. In those posts I questioned the wisdom of sending the fire department to most medical calls and listed some of the more common call types that I thought they should or should not be sent to.

At Boston.com today there is an article titled Fire Dept. defends using trucks for medical calls. In the article is this passage.

But some have long questioned whether it is necessary to have both respond. Task forces have studied the issue, and there have been calls over the years to merge the two agencies, including one made last week by Edward A. Kelly, president of the firefighters union. Kelly said he believed that the two agencies could be more productive if they were run together.

I’ll grant you one thing, the fire guys know how to stay on message. The context of Kelly’s comment was the death of BFD LT Kevin Kelly. The inference being that Kelly would be alive if the two agencies had been merged in the mid 1990s. I’m not quite sure how things would have been different and Kelly never explained.

Apparently, this issue was studied in Boston for several years in the 1190s. The article quotes a report from the time, saying,

But over the years, others, including some doctors and paramedics, have spoken out against merging. Some have said the firefighters’ position was motivated by a need to justify their jobs by going out on more calls.

“There is a major issue brewing over the response to medical calls for emergency services,” concluded the Boston Finance Commission, a city watchdog group, in a 1994 report that analyzed the troubled relationship between the two agencies. “It is about jobs and clout and has to be addressed.”

I’m all for protecting jobs, but not at the expense of 1) patients and 2) people who are already doing a good job of patient care. If you look at any of the “mergers” that have occurred in cities such as San Francisco or New York City, you’ll see that the EMS people tend to get the shitort end of the stick. In San Francisco promises of equality of for the medics who formerly worked for the city’s EMS system turned out to be illusory at best. In fact the situation got so bad that in 2204, the city decided to essentially separate the two systems in all but name. Even at that, people in the system note that the quality of care has declined since the days when EMS was a separate system run under the Department of Public Health.

We were on the leading edge in the early 1990s. Now, we’re not there,” said Art Hsieh, chief executive officer of the San Francisco Paramedic Association. “We might be just an average or below-average system. The leading EMS systems in the Bay Area today are Alameda County, followed by Santa Clara County.

As in Tulsa, documentation seems to be an issue here,

‘Always, we’re seeking to improve the way we perform our jobs,” Hayes-White said. “When we deliver the service, we deliver it in a high-quality way. We need to improve the documentation.”

New York is even worse, as they never made even the pretense of treating the two parts of their combined system equally.

Back to Boston and today’s article.

The practice of sending both an ambulance and a firetruck, equipped with defibrillators, oxygen, and other first aid essentials, to a medical call is widespread nationwide. And the reason, fire chiefs say, is simple: With fire stations located strategically throughout a city and paramedics often tied up for an hour on a single call, firefighters, even firefighters driving a bulky ladder truck, can often get to an emergency faster than an ambulance.

There is no arguing with this. Firefighter’s can indeed get to calls faster than EMS providers in many cases. The question remains as to what calls require a rapid first response. The answer in reality is very few. Yes, any call can turn out to be a cardiac arrest, no system of phone triage is perfect. The alternative to using phone triage and getting most calls essentially right, is using no triage, getting only an address and sending a maximal response to every call. No doubt, the fire service would like that approach, but given the costs of doing so, financially and otherwise, I don’t see that as a practical approach.

“People call and say, ‘I’m having trouble breathing.’ Can they afford to wait 5 1/2, 6 minutes, for an ambulance? No,” Jenkerson said. “So we get there first, stabilize, and wait for the ambulance.”

How do you know that Chief Jenkerson? As I stated in Wear and Tear, there is scant science to show that the arguably faster response by the FD is beneficial to the patient. Other than cardiac arrest, airway obstruction, and life threatening hemorrhage there is no proof that faster response improves patient outcomes.

One last quote and comment,

Why do you need a firetruck unless there’s a fire?” said Margaret Leoni, vice president of regulatory affairs for the Massachusetts Senior Care Association, a trade group representing the state’s nursing homes and assisted living centers. “I guess I can’t appreciate, from the Fire Department’s perspective, why they would send a truck unless someone calls and says, ‘I have a fire.’ “

Why indeed Ms. Leoni?

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After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it? I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs. I still write about EMS, but I'm adding more and more non EMS subject matter. Thanks for visiting.

1 COMMENT

  1. Regarding this: “The practice of sending both an ambulance and a firetruck, equipped with defibrillators, oxygen, and other first aid essentials, to a medical call is widespread nationwide. And the reason, fire chiefs say, is simple: With fire stations located strategically throughout a city and paramedics often tied up for an hour on a single call, firefighters, even firefighters driving a bulky ladder truck, can often get to an emergency faster than an ambulance.”You missed a greater point. Assuming the FD and Ambulance Transport were within the same agency, what changes? The ambulance paramedics could STILL be tied up for hours on a single call, regardless of the company patch on their sleeve. NOTHING would change. Nothing. But don’t tell the chiefs that. They’re out to save lives, or some such.

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