By Benjamin J. Hunt
During many emergencies, every second counts. Survivability can decline as the clock ticks away. According to the American Heart Association (AHA), “For every minute that passes between collapse and defibrillation, the chance of survival from a witnessed Ventricular Fibrillation sudden cardiac arrest declines by seven to ten percent per minute if no bystander CPR is provided” (ACLS Guide 2011, 54). This is just one reason why emergency vehicle response times are paramount for public safety. The continual struggle to improve response times and balance rising costs to provide these services affects emergency medical service (EMS) systems across the world. Many solutions have been proposed and trialed, from increasing EMS units in high call volume areas, to alternative vehicles that provide operational cost savings and improved response times. Although increasing the total number of EMS units may improve some response times and better distribute call volume, the increased costs of staffing these extra units make this a very expensive option and are out of reach for most EMS systems. Europe, Asia, and Australia have been dealing with this problem for many years and have developed a very successful option that provides efficient medical care by using motorcycle paramedics. Motorcycle paramedics can reduce response times and improve patient care while reducing operational costs.
Motorcycles have been used for medical treatment and transport since the early 1900s and were prominently used in World War I. However, the concept did not catch on in public EMS systems until the early 1990s when large cities such as Hong Kong, London, and Singapore implemented them as emergency first responders (Mencl, 7). These programs became instantly successful because of the ability to maneuver through heavy traffic and densely populated areas, reducing response times and improving patient care. Since their implementation and success, other large cities have followed suit and conducted analytical research to evaluate their effectiveness in their own EMS system.
A year-and-a-half-long study published by in American Journal of Emergency Medicine was conducted in a large city in Portugal that had a population of 1.5 million people. The study used medical emergency motorcycles (MEM) to respond in high-traffic areas to reduce response times and assess the need for ambulance transport. The MEM was the first unit to arrive on scene in 63 percent of the 1,972 responses dispatched. There was no need for ambulance transport in 18 percent of the MEM responses, keeping the ambulance available for other emergencies (Soares-Oliveira, 620). In 2009, the Scandinavian Journal of Trauma Resuscitation & Emergency Medicine published a study from Norway conducted over a two-month period. This study showed the MEMs had a full one-minute-faster response time, 23.5-percent non-ambulance transport, and a 38-percent cost savings compared to traditional ambulances (Nakstad et al.). Finally, the European Journal of Emergency Medicine reported on a study from a Dutch city of 265,000 people over an eight-month period in 2003. The emergency motorcycle response vehicles (MRV) reduced response times by almost one minute and referred patients to alternate forms of medical treatment other than the emergency department 72.6 percent more than a traditional ambulance (Van Der Pols, 328).
Western EMS Success
Europe is not the only area that uses EMS motorcycle paramedics. A few departments in the United States have implemented this service. The most prominent of these is the Miami-Dade Fire Rescue Department (MDFR) in Florida. The department began its motorcycle emergency response teams (MERT) in 2002 after a veteran captain toured a London motorcycle paramedic station and brought the idea home. The MDFR used the MERT teams just like their European counterparts by using a roaming system status model to move teams around as call volumes fluctuated. The program had huge success at the outset, reducing response times by 60 percent compared to traditional equipment, with numerous documented saves because of the rapid response; there was also a significant cost savings to the department. The most compelling example of the MERT team capabilities was during a 911 response when a MERT team was dispatched along with a fire engine. The MERT team arrived first and assessed the patient to have non-life threatening injuries, canceling the engine company. Two minutes later, that same fire apparatus was performing a primary search at a well-involved structure fire in its first-due area. This example of unit sparing proves the immense benefits of motorcycle paramedics in any jurisdiction (Madson, 3).
Resistance Within Our EMS Systems
With such successes, it is a wonder why this type of program has not been more widely used in the United States. One possibility is that many people in the EMS community believe it is too dangerous to use motorcycles to respond to emergencies. Although there is inherent risk in riding a motorcycle, police officers use this mode of transportation every day in most medium to large police agencies across the United States. Police departments minimize risk by implementing strict training requirements, using advanced protective equipment, and considering restrictive weather considerations to keep their motor officers safe. Officers do not ride at night or in climate conditions that would make operating a motorcycle dangerous. Furthermore, motorcycle paramedics are set apart from motor officers because a motorcycle paramedic does not have to perform dangerous maneuvers to apprehend speeding motorists as a motor officer does. This allows a motorcycle paramedic to take a safer, defensive driving approach.
A study published by the European Journal of Emergency Medicine in 2008 gathered accident statistics on motorcycle paramedics throughout Europe. The study collected data from more than 3,600 calls over a three-year period. The paramedics were trained in emergency motorcycle operation and were equipped with standard motorcycle protective equipment. Of the 3,600 calls motorcycles responded to, 12 motorcycle falls were recorded. Of the 12 falls, three riders were injured, only one seriously. The first rider suffered minor dental trauma, the second rider suffered minor abrasions, and the third rider suffered a femur fracture. The first and second riders were not wearing their safety equipment properly. The study concluded that MEMs “can impart a quick and efficient response to EMS services in urban areas, if managed with acceptable levels of safety. Defensive driving courses as well as correct use of personal protective equipment can improve security” (Kiefe et al., 40). This study confirmed that by implementing these requirements, a motorcycle paramedic could operate in a reasonably safe manner.
Another common hurdle for motorcycle paramedic programs in Western EMS is the debate over minimum staffing levels. Most EMS systems in Southern California, for example, dispatch a fire engine equipped with three to four personnel to provide initial patient care before an ambulance staffed with two additional members can arrive. Even if the emergency turns out to be a minor or nonlife-threatening situation, five to six emergency responders are committed on the call until the patient is either transported or released. Like in Miami-Dade, this can compromise fire protection because of the extended response times from out-of-area emergency vehicles. This problem cannot be mitigated for true emergencies, as the staffing is actually required. However, 30-50 percent of all emergency responses in the United States are for minor or nonlife-threatening injuries (Key et al., 339). For these responses, a large pool of personnel is not necessary and a minimally staffed apparatus could provide initial patient care before an ambulance arrives. The fully staffed fire department apparatus could then remain available for true emergencies and fires. This concept worked in Miami-Dade as well as in a Houston (TX) study published by the Academy of Emergency Medicine in which first responders trained to a Basic Life Support (BLS) level responded to provide initial treatment and determine the need for ambulance transport (Key et al., 339).
Risk vs. Gain
Even when the simple hurdles are overcome, EMS professionals are sometimes our own worst enemies. The Miami-Dade MERT program was discontinued after a little more than five years of service, “due to across-the-board budget cuts,” according to Captain Roman Bas of the MDFR (personal communication with author). A similar situation unfolded in Austin-Travis County (TX) EMS where motorcycles in the 911 system saw a brief two-week trial. There, a lack of data needed on the benefits of the program relegated the motorcycles to special events, according to Commander Wesley Hopkins of Austin-Travis County EMS (personal communication with author). There are two primary reasons these successful programs were discontinued: 1) lack of detailed data collected during the operational period, and 2) staffing models. Necessary data includes response times, apparatus sparing, call types, patient outcomes, referrals to alternate means of care, and, most importantly, a complete cost analysis breakdown. The cost analysis consists of total cost savings, total cost to operate, funding allocation, and an apparatus replacement program. Although this may sound tedious, it is necessary to demonstrate to the powers that be a complete cost analysis because, after all, money talks.
Progressive fire departments and EMS agencies such as Miami-Dade and Austin-Travis County are quick to trial innovative programs like motorcycle paramedics. Many fire departments have trouble maintaining these programs because the cost to add one firefighter-paramedic position far exceeds what the agency would save by using a less expensive response vehicle such as a squad or motorcycle. That said, there are a few instances where a career firefighter would be a cost-effective motorcycle operator. One example would be replacing a piece of fire apparatus with a motorcycle, saving on equipment and operating costs. Although this option may work well for agencies using fire apparatus as quick-response vehicles to supplement staffing, it is very expensive to add more fire suppression personnel if they are not already assigned to other first response vehicles. The alternative is staffing the motorcycle with non-suppression personnel.
The benefits to using single-function paramedics on motorcycles are:
- They’re less expensive to staff, allowing the motorcycle to remain available at times when a firefighter may otherwise be performing different functions.
- The motorcycle is more mobile as it is not assigned to an engine company.
In many cases, this staffing model could become self-sustaining (funding-wise) through savings on operational costs using front line apparatus. Whether you’re a fire department or third-service EMS agency considering motorcycle paramedics, choosing the proper staffing model and collecting data to justify risk vs. gain will greatly improve the chances for success.
Motorcycle paramedics are a progressive and beneficial solution to reducing response times and improving patient care while also reducing operational costs. A motorcycle achieves 10-15 times the fuel mileage of a fire engine or truck and has considerably lower maintenance and initial purchase costs. This provides both initial as well as long-term cost savings in fire apparatus maintenance because of decreased wear and tear on front line equipment. Aside from cost savings, improved response times, and a smaller environmental impact, the biggest advantage of motorcycle paramedics is that they accomplish the number-one goal of any EMS system: improved patient care. So why don’t more Western EMS agencies use this tool? The answer may be that many EMS agencies have not heard of motorcycle paramedics; others may be opposed to the idea simply because it is untraditional. Introducing this seemingly radical idea into a Western EMS system may come with heavy opposition, but the benefits are clear. Faster response times are likely to improve patient care and result in higher patient satisfaction.
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Ben Hunt is a firefighter paramedic for the San Bernardino County Fire Department in California. He has a degree in both fire technology and paramedicine and has more than five years of EMS experience in both the private and public sectors. Ben is also a public safety consultant specializing in making EMS more efficient and cost-effective.