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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.
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