A new study issued by a broad coalition in the scientific, firefighting, EMS, and public-safety communities shows that the size and configuration of an EMS first responder crew and an advanced life support (ALS) crew have a substantial effect on a fire department’s ability to respond to calls for emergency medical service.
Performed by a broad coalition in the scientific, firefighting, and public safety communities, the study shows substantial differences associated with first responder crew size.
The new study is the first attempt to investigate the effects of varying crew configurations for first responders, the apparatus assignment of ALS personnel, and the number of ALS personnel on scene on the task completion times for ALS level incidents.
The increasing number of EMS responses point to the need for scientifically based studies to measure the operational efficiency and effectiveness of fire departments responding to medical calls. Fire departments typically deliver first-on-scene, out-of-hospital care services, regardless of whether or not they provide transport. The design of fire-based EMS systems varies across communities. Some departments deploy only Basic Life Support (BLS) units and personnel, some deploy a mix of BLS and Advanced Life Support (ALS) units and personnel, and a few departments operate solely at an ALS level.
But every one of those system design decisions affects the emergency medical response and care, when each second counts.
Field experiments for the new study revealed that crews with three- or four-person first responders completed patient removal between 1.2–1.5 minutes faster than smaller crews with just two first responders. All crews with first responders completed removal substantially faster (by 2.6-4.1 minutes) than the ambulance-only crew.
Four-person first responder crews completed a trauma response faster than smaller crews. Towards the latter part of the task response sequence, four-person crews start tasks significantly sooner than smaller crews.
Additionally, crews with one ALS provider on the engine and one on the ambulance completed all tasks faster and started later tasks sooner than crews with two ALS providers on the ambulance. This suggests that getting ALS personnel to the site sooner is vitally important in providing patient care.
For trauma patients, when assessing crews for their ability to increase on-scene operational efficiency by completing tasks simultaneously, crews with an ALS provider on the engine and one ALS provider on the ambulance completed all required tasks 2.3 minutes faster than crews with a basic life support (BLS) engine and two ALS providers on the ambulance. Additionally, first responders with four-person first responder crews completed all required tasks 1.7 minutes faster than three-person crews and 3.4 minutes faster than two-person crews.
Results for cardiac patients mirror the result for trauma patients.
Regardless of ALS configuration, crews responding with four first responders completed all cardiac tasks more quickly than smaller first responder crew sizes.
In the critical period following cardiac arrest, crews responding with four first responders also completed all tasks more quickly than smaller crews.
Crews responding with one ALS provider on both the engine and ambulance completed all scene tasks more quickly than a crew with a BLS engine and two ALS providers on the ambulance. This suggests that ALS placement can make a difference in response efficiency for cardiac arrest patients.
Finally, when assessing crews responding to cardiac arrests for their ability to increase on-scene operational efficiency by completing tasks simultaneously, crews with an ALS provider on the engine and one ALS provider on the ambulance completed all required tasks 45 seconds faster than crews with a BLS engine and two ALS providers on the ambulance.
Regardless of ALS configuration, crews responding with four first responders completed all cardiac tasks from the ‘at patient time’ to completion of packaging 70 seconds faster than first responder crews with three persons, and 2 minutes and 40 seconds faster than first responder crews with two persons.
Additionally, after the patient arrested, an assessment of time to complete remaining tasks revealed that first responders with four-person crews completed all required tasks 50 seconds faster than three-person crews and 1.4 minutes (1 minute 25 seconds) faster than two-person crews.
The study’s principal investigators were NIST’s Jason Averill, Lori Moore-Merrell of the International Association of Fire Fighters and Kathy Notarianni of Worcester Polytechnic Institute. Other organizations participating in this research include the International Association of Fire Chiefs, the Commission on Fire Accreditation International-RISK, the Urban Institute and the University of North Carolina.
The report was funded by the U.S. Department of Homeland Security, Federal Emergency Management Agency’s (FEMA) Assistance to Firefighters Grant Program.
The study can be downloaded from the partner websites or may be requested from any of the study partner organizations. The report is also available at www.firereporting.org
The International Association of Fire Fighters, headquartered in Washington, DC, is the leading advocate in North America for the safety and training of firefighters and paramedics. The IAFF represents more than 298,000 full-time professional firefighters and paramedics who protect communities in every state in the United States and throughout Canada. More information is available at www.iaff.org