Medical Calls and First-Due Firefighters

By Brian Carr
 
 
The fire department I work for is undertaking an aggressive program to cross-train all personnel–paid and volunteer alike. An outcome of strategic planning meetings; the need to cross-train was recognized as a primary goal. Previously, training equivalent to emergency medical responder certification was required for newer members, but maintaining quality control over continued competence in emergency medical services was often overlooked.
 
Many firefighters simply ignored the need to update EMS certifications, believing they could perform their due diligence by recertifying their cardiopulmonary resuscitation (CPR). On the other side of the coin, EMS-only providers were equally tolerated for their unique skill set. Individual excellence in EMS and excellence in firefighting were prevalent, but the department overall lacked all-hazards responders. The rationale was that we had two types of personnel for two different jobs. Firefighters fought fires and handled rescue-associated emergencies; emergency medical technicians (EMTs) treated sick and broken people. In the best-of-all-possible scene responses, a sort of seamlessness would be expected to arise, and every member—regardless of their individual skill set—would fall in line with every other member. As we all know, such best-case scenarios don’t really exist.
 
Over time, volunteers and paid members began feeling the pressures of dealing with lackluster response times of engines and secondary ambulances. Until the strategic planning meetings produced new guidelines, it sometimes seemed like the best anybody could do was accept the status quo.
 
But that’s no longer the case. Accountability is the new normal around my department. As former EMTs have become Firefighter/EMTs and former firefighters cross-trained to the EMR level as a minimum (with growing numbers becoming Firefighter/EMTs), a new standard is hoped for. All-hazards responders are now tasked to work up to their level of experience and certification regardless of the emergency. In short, when the tone sounds, go!
 
But are first-due engine members really ready for the medical call? National research conducted by the U.S. Fire Administration estimates that 65 percent of all fire department calls are EMS-based. Additionally, the latest data (2009) indicate calls for medical aid are increasing (up 8.5 percent in 2008), whereas calls for fires declined by 7.1 percent over the same period1.  Add these facts to the reality of shrinking fire department budgets across the nation, and the probability is pretty high that one day soon your engine company will be staring first-due medical calls straight in the face.
 
Unless your engine companies are used to running numerous EMS calls daily, I bet you’re not as ready as you could be. Do you and your members approach medical calls with the same vigor you bring to room-and-content fires? If you don’t, you should. Approaching EMS-based calls with a preplanning method of attack will both increase your crew’s on-scene performance and boost how the community you serve views the breadth of your firefighter skills sets. 

Scenario

Consider the following scenario: 

Dispatch: Medic 2, Engine 1 report to 345 Any Street for a 64 year-old man experiencing shortness of breath and generalized malaise.
 
Engine 1 calls en route with four aboard. As the officer on Engine 1, you realize a few things: 345 Any Street is four blocks away from the firehouse, and Medic 1—your station’s primary medic unit—is currently attending and transporting another patient. Medic 2 is at least 10 minutes out. A local police unit calls en route but is several minutes away. You’re guaranteed to be first due.
 
With two blocks left to go, Dispatch updates the patient’s condition. He’s now pulseless and apneic. His wife is frantic.
What’s your plan? If your engine crew is like many others, you either haven’t really discussed it or plan on operating under an “assign-as-go” system. Either of these approaches puts you behind the eight ball, and that’s never a good place to be. And if you think it can never happen to you and your engine crew, think again.
 
Just like a fire scene, the first five minutes of running a cardiac arrest code will determine how the next five hours go, but the difference is far greater. A house fire might have a life safety issue; a cardiac arrest always does. According to the American Heart Association, although exact survival rates for cardiac arrest are difficult to pin down, estimates suggest that 95 percent of arrest patients will not reach a hospital alive. If you add in early, aggressive, and knowledgeable care (including immediate bystander CPR, rapid defibrillation, and early advanced care), survival rates can increase from a dismal (but historical) 5 percent to higher than 30 percent.2 That puts the pressure on for solid performance.
 
Performance only increases with organization. We all know that a sloppy fire scene runs the risk of escalating beyond the capacity of the first– and maybe even second-due engine company. A sloppy medical scene, although unlikely to grow in size and nature, nonetheless grows in complexity. Complexity means you have to spend time getting it back to straight and direct, which results in time taken away from helping patients. The patient in our scenario doesn’t have time to spare—he needs some serious and immediate help.
         
Luckily, firefighters have, or can easily learn, organization. Heck, members of engine companies already use it on almost every fire call. There are either assigned seats with tasks that go with those seats or tasks are assigned en route. One firefighter has got the hydrant, another the nozzle, and so on. In either case, at most fire scenes, every firefighter knows (or should know) exactly what he is going to be doing as soon as the apparatus brakes engage and his boots hit the ground.
 
That’s organization; if you use it for fire calls, you need to use it also for medical calls. In our scenario, a good crew leader or company officer should have basic medical tasks assigned before Engine 1 arrives on scene. Assign somebody to chest compressions; another firefighter can manage the airway and get a BVM (bag-valve-mask) ready to go; the third will grab O2 to help the airway firefighter and then start prepping the automatic external defibrillator (AED). The company officer can oversee the first few minutes and radio in to the next unit with a decent scene size-up and report of current activities.
 
Of course, for all of this to take place without fumbling for equipment and losing overall rhythm on scene means training to use, and using, an organized engine response to medical calls. This means for every call, not only cardiac arrests. Vitals can be taken and a medical history recorded. You get the idea. There are precious few substantiated EMS calls that need only a single pair of hands. Most need a few. Fire department first responders can provide the needed hands and significantly boost the EMS personnel pool. This enhances patient care, boosts the fire department’s image and reputation, and improves incident outcomes.
 
When Medic 2 does arrive on scene, an organized first-response effort means faster advanced care and, in all likelihood, a quicker transport. That could easily translate into another life saved. And if I remember it correctly, saving lives is the first of every firefighter’s priorities.
 
References
1.     For national data on EMS-based calls, see NFPA’s “Fact Sheet on the U.S. Fire Service”; access at www.nfpa.org/assets/files/PDF/Research/FireServiceFactSheet.pdf; for statistics on fire and medical response, see “National Fire Protection Association Estimates” for 2009; access at www.usfa.dhs.gov/statistics/estimates/nfpa/index.shtm.
 
2.     For these statistics, see “What can be done to increase the survival rate?” at the American Heart Association’s Web site; access at www.americanheart.org/presenter.jhtml?identifier=4481.
 
 
Brian Carr is a firefighter/EMT with Jackson Hole (WY) FIRE/EMS. He is a certified hazardous materials technician and is pursuing a fire science degree through Casper College. In August 2011, he will begin paramedic training at Weber State University. He is the founder and coordinator of Frontier Classics, a scholarly outreach organization dedicated to teaching the value of the arts and sciences through the use of classical education.

No posts to display