Paramedic Service Is Established With Aid of Public in City of 75,000
What does the small Wisconsin city of West Allis (population 72,000) have in common with metropolitan Seattle, Los Angeles or Jacksonville? Answer: a fire department paramedic team among the nation’s most highly trained. More surprising: the team’s fully equipped medical van was paid for entirely by public subscription, leaving the fire department’s budget untouched.
Why West Allis, of all cities in the Milwaukee area of more than a million residents? Said Fire Chief John Morch, “I guess we just wanted it more than anybody else.” There was federal money available for setting up the program, and a grant was sought early in 1973 with backing from the mayor, common council, and the fire and police commission. On July 3, 1973, the Medical College of Wisconsin and the area’s Urban Emergency Medical Services Council formally awarded the program to West Allis.
That gift basket, unfortunately, held no golden eggs. Only training funds were granted. It was the middle of a budget year for West Allis. No equipment money was at hand. According to Morch, “The mayor thought we might be able to build a community effort to raise money. I was pessimistic, and said it didn’t seem likely—for which I have since apologized to him.
“We started putting on programs for community organizations, to sell the paramedic idea in West Allis. Everywhere two or three people were together on a street corner, we put on a program—a hundred of them altogether. Our men spoke before every civic group. The Chamber of Commerce got behind it. Local business and industry were with us. And they took it to the people. The Jaycees went door to door with a flyer and donation envelope for every home in the city, and they raised $13,000 that way alone.” During nine months more than $50,000 was received.
But it takes more than equipment. Morch asked for volunteers from among his men, and got 30—27 of them already being EMT-1 graduates (an 81-hour course had ended in the spring). Morch, Dr. James Canavan of the West Allis Fire and Police Commission, and Dr. Joseph Darin, head of emergency medical services at Milwaukee County General Hospital, carefully screened these men, finally selecting nine for paramedic training.
These team members were then detached entirely from fire duty for 13 weeks of intensive daily training at County General. They studied pharmacology, drug dosage and side effects, cardiac monitoring and care, and all the many other “book subjects” involved. Considerable time was spent on research projects in the medical library.
After the classroom work, they went into the hospital to work in the various clinics. They learned endotracheal intubation, intravenous therapy, use of air splints, defibrillation, etc. Training was directed by four clinical instructors, two from the hospital (including one registered nurse) and two from the Medical College of Wisconsin. Backing up them were 35 physicians from several area hospitals.
Mockup used in planning
While this went on, use of the money coming in from the public had to be planned. Morch and others involved in the planning visited other cities having paramedic programs, studied their operations, and tried to learn from their shortcomings, if any. To work out the best interior arrangement for the vehicle West Allis would eventually use, a plywood mockup was built and rearranged as ideas developed. (The county purchased a van which West Allis used for several months until their own truck arrived; then it reverted to county use for further training.)
One of the small items given a lot of thought was the best type of container for carrying the many small items needed from the van into the home or other treatment scene. “We finally settled on large fishing tackle boxes,” explained Morch, “and it’s worked out fine. After six months of being carried everyplace, dropped, and banged around, they’re still in good shape.”
One thing there was no real solution for was the fire department’s temporary shortage of manpower while the nine trainees were away from their stations. Fortunately, no fires during the period were serious enough to make the shortage felt. Mutual aid forces are close at hand. “Normally,” said Morch, “I have about 36 men on duty (in three stations). During the paramedic training period there were sometimes only 29 to 31.”
Once the 1000 hours of training were over, the team was divided into a crew of three for each of the three shifts. Using the county-owned vehicle, West Allis’ paramedics went in service November 5, 1973. From then until the end of the year, one of the four instructors (including Nurse Judy Larsen) was with the on-duty crew for the entire 24-hour shift, living at the fire station, riding along on all the runs, continually assisting, advising and learning from the paramedics.
Morch had high praise for the instructors. “They were excellent people,” he said. “Our men came to really admire them. The instructors also developed greater admiration and respect for fire department personnel. They were used to a clean, orderly setting in which to carry out the various life support techniques; they had never worked out in a snowbank, behind a house, or in a garage, so they got a real appreciation of our ability to work under those conditions.” (Nurse Larsen’s overnight stays in the firehouse took some getting used to— another of many “firsts” for the West Allis Fire Department.)
In mid-April 1974 West Allis received its new “Medic 1” emergency medical services van, stocked for extensive treatment (including IV therapy) on at least three clinically-dead patients before supplies are exhausted. Its modular all-aluminum body is replaceable as a unit on the commercial chassis.
Recent state legislation has clarified the status of both EMTs and paramedics in Wisconsin. The West Allis team, according to Morch, has been operating under the basic authority of the physician’s license to practice. Written orders enable the men, up to a certain point, to act as extensions of the doctor himself, just as their van serves as a field extension of the hospital’s emergency treatment facility. “The men are also covered by malpractice insurance taken out by the city,” Morch added.
The West Allis paramedics are not exclusively detached for that duty. They remain in fire service. Medic 1 is dispatched to working fires likely to involve rescue operations. The two men not driving don their turnout gear en route. At the scene, they perform rescues as needed. If that’s not required, they may help hook up lines, bring in tools, or other peripheral support, but remain “uncommitted” to fire fighting and in service by radio to respond elsewhere to medical emergencies. A multiple-alarm industrial blaze April 29 was typical. Medic 1 responded to the fire, aided injured fire fighters, and was dispatched from there to a home elsewhere in the city to assist a patient with chest pains.
Keeping up the level of training is done in three ways. First, monthly critiques are held at fire headquarters with Morch and his staff officers. Doctors bring in records of perhaps a dozen cases from the previous month’s runs, for detailed review of patient handling.
Periodically, the paramedics visit other West Allis fire stations and use their specialized knowledge to upgrade the medical help skills of the fire fighters there.
Finally, by mid-1974 the Medic 1 crews were slated for a two-week refresher at County General Hospital.
A full report on the paramedic operation will not be issued until the end of a full year’s work. However, many lives have already been saved. Widespread newspaper, television and radio publicity throughout the area has kept citizen interest alive. A second Milwaukee County community, the City of Wauwatosa, launched its own paramedic service late in April after putting its men through the same training.
West Allis’ Medic 1 makes six to nine runs daily. In its first six months, there were more than 600 calls logged. At the outset, runs not requiring specific medical services were not included in the total. All responses are being counted now, so the number will rise. In this brief period, “you name it, we’ve seen them all,” said Lieutenant William Beres who heads up one shift. There have been acid spills, industrial accidents, and traffic mishaps, as well as the usual cardiac, stroke, and childbirth cases. More than 80 patients were conveyed to hospitals in the first month alone.
Response to traffic accidents
On traffic accidents, it is customary to dispatch an engine or ladder company along with Medic 1, because the paramedic van has only limited extrication tools. A second kind of “double response” occurs on emergencies outside the three-minute timed travel circle centered on Medic l’s home base. Then, the nearest West Allis Rescue Squad is also sent, to start life support procedures until Medic 1 can arrive.
Time and distance also dictate that Medic 1 conveys patients to only three hospitals, including County General which houses the base communication station for the operation. This station was equipped jointly by county funds plus some money from the National Highway Traffic Safety Administration (a $4000 grant was received early in 1974). Both oscilloscope and printout of EKGs are available there, via either radio telemetry or telephone land wire. (The new model telemetry being field-tested now by West Allis has a handset attachment to transmit vital signs directly over conventional phone circuits in case of radio failure.)
Although radio communications about patient condition is only with County General, phone links from there to the other two hospitals relay data to whichever will receive the patient. Upon arrival at the hospital, the paramedic officer files a written report on the case with the attending physician (he can also leave a hard copy of the EKG).
“Many times,” Morch pointed out, “we can simply bypass the emergency room entirely and take the patient directly into intensive care. Medic 1 has in effect taken the emergency room out into the field. Our people have been accepted by medical staffs in hospitals; continual phone calls come in as to the efficiency of these men. Success of the program is just beyond our belief.”
No small part of that success has been the citizen support that funded the major items of equipment. “The money is still coming in,” said Morch in April 1974. “We can’t seem to shut it off. One of the local businessmen’s groups has put a thousand canisters for donations, in stores all over town, and they keep filling up.” As a result, a second vehicle is being ordered to back up Medic 1, with the possibility that a “Medic 2” may be established.