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Sunday, April 27, 2014

Why Does The Fire Department Respond?

One of the questions we get quite often is why we send "big red" on medical calls. After all, isn't that what ambulances are for? Isn't that a waste of fuel/time/resources for a simple medical call?

Before I answer these questions let me just say that fire engines don't respond to medical calls all around the country. Every area has a slightly different system in place. I am going to talk about my system (since it's what I know best).

Where I work we have a private ambulance company that responds to and transports patients to the hospital a la AMR/Westmed/Rural Metro.. They are usually staffed with one paramedic and one EMT. They have, under their company's contract with the county, between 8 and 10 minutes to respond to critical EMS calls depending on where the call is (more rural locations have longer time allowances).

So why does the fire department respond to medical calls?

First off, state law in California requires two paramedics to respond to medical emergencies. Some places do that by staffing two medics on the ambulance. We do it by staffing one on the ambulance and one of the fire engine/truck. Every engine and truck in the county in which I work is staffed with at least one paramedic.

So why do we choose this method instead of staffing the ambulance with two medics and letting just the private ambulance respond?

Ambulances, especially those belonging to private ambulance companies, are spread pretty thin. Private companies are in this game to make a profit so the fewer ambulances and crews they need to staff to get the job done the better. However this can mean longer response times. Fire stations and crews are more plentiful and usually closer to any given incident (at least with career departments) allowing for faster response times.

An example of why this isn't in the best interest of some patients. There was a call in my district (on the other shift) a couple of days ago. The call came in as a lift assist. This is usually for your stereotypical "I've fallen and I can't get up" scenario. No big deal.

While on their way to the call the woman that called 911 for her husband noticed that her spouse was no longer breathing. The firefighters were on scene within a minute or so and were able to render life saving care (yes, he made it). The ambulance on the other hand took 8 minutes to get to the scene. According to Wikipedia "Without special treatment after circulation is restarted, full recovery of the brain after more than 3 minutes of clinical death at normal body temperature is rare."

Who would you want responding to your spouses untimely death?

Another reason the fire department responds is manpower. On most calls you only need a couple of people. But often you need more. CPR in progress, vehicle accidents with multiple patients, obese patients and other similar calls require more manpower than the ambulance crew can provide.

So if the fire department is going to respond why send the big fire truck and not just a small vehicle with EMS gear?

We respond with the big fire engine/truck is that we are always ready to respond to an emergency. If we were just clearing the scene of a medical call and we had responded in a small pick up truck only we wouldn't have the correct tools with us to respond to a structure fire. We would have to go back to the station and change vehicle. In a job where time matters we have to always be able to respond. No matter the emergency.

There are other methods out there such as the Squads LA County Fire use but those require more personnel. I know LA City Fire has used firefighter/Paramedics riding on motorcycles to get through traffic. But again, that requires special staffing unless you want an engine or truck crew to be without their medic for a while.

Our system may not be the best but it's better than any other EMS system I've worked under so far. I'm curious to see how we adapt to future needs of our citizens.

Thursday, April 10, 2014

Ending It

I'll warn you now, this post may be a bit graphic. But it represents a part of my job and I post it so that others who may be interested in a job in the fire service or EMS can better understand what they are in for.

At the very beginning of the shift the tones went off. At times like that you hope that all your equipment was left in good shape by the preceding crew.  Especially on calls like this one.

We were responding for a full arrest. PD had received a 911 call stating that a person had hung themselves. The call was in the neighboring district (engine 110 was out on another call) so we had a longer response time than usual.

We pulled up and parked behind a couple of police cars. The officers in our city are great. They have no problem responding to critical medical calls and getting in and helping where they can. One of the officers came out and met us. He informed us that only I, the medic, needed to go in. This told us that I was simply determining death and that there was no need for everyone to go in and disturb a potential crime scene.

Inside I found another officer taking photos for his investigation. On the floor was the body of a man in his late 30's. Rigor mortis had set in and it didn't allow his body to lay completely flat on the floor. Because he was in rigor determination of death was made, 0752 hours.

Looking closer at the face of the man I could see that it was distorted. The officer stopped taking pictures for a second to explain that he had walked in and found the man hanging from the pull up bar in the doorway to his bedroom. He had used a leather belt to do it. The belt had slid up around the cheeks and the face "froze" in that position after death. The bar was to low for the man to hang completely so his legs seemed to be dragging on the floor behind him.

The worst part of this entire call was that the dead man's mother was the one to find him. She walked out in the morning and there he was. We contacted a clergyman from a local church to come and comfort the old lady. We then cleared ourselves from the call in case we were needed for another emergency but stayed with the mom until the clergyman arrived.

Wednesday, April 2, 2014

No Relaxing

All of the chairs were pushed back out of the way and the table had been moved near the wall. In the middle of the conference room was our patient. He was sitting on a chair cradling his left arm. 

I introduced myself and asked him what had happened. He said that during a meeting he had leaned back in his chair and stretched both of his arms toward the ceiling (I guess is was a boring meeting). During mid stretch his left arm popped out of its socket.

I asked if he had ever dislocated his shoulder before. He hadn't. He had no medical history and wasn't taking any medications. But he was in a lot of pain.

After starting an IV I gave him some morphine. My patient felt much better after that. So much so that he started cracking jokes. Hr started asking if I would write a note to his wife stating that his injury would preclude him from changing any diapers for the next 6-8 weeks.

Good luck with that one.
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