2 When you call Who do you want to respond? A Team B Team C Team
3 Introduction Why do fire departments provide EMS?
5 The Real lreason Why do fire departments provide EMS? Better service Core government function Greater good of the community Quality of life Value Similarity of life saving goals
6 The Real Reason Fire Departments Really Provide EMS Every day someone who has had a bad day returns to their normal life lf because of fire based EMS.
7 U.S. Fire Based Facts 95% of career Fire Departments provide EMS at some level ranging from first response defibrillator to advance life support (ALS) with transport. 80% of career firefighters are cross trained multi role firefighter EMTs (BLS) 34% of career firefighters are firefighter paramedics.
8 U.S. Fire Based Facts Prehospital emergency response is one of the essential public safety functions provided by the United States fire service Career firefighters (EMTs and paramedics) respond to medical emergencies for more than 85% of the population
9 U.S. Fire Based Facts Fire service based emergency medical services (EMS) systems are strategically positioned to deliver time critical response and effective patient care.
10 U.S. Fire Based Facts The fire department is geographically deployed throughout the community to minimize response times. When response time is the priority for medical emergencies. Firefighters are in thebest position to respond quickly and provide vital services.
11 U.S. Fire Based Facts Of the 200 most populated communities, 97 percent have the fire service delivering pre hospital emergency medical service response. Additionally, the fire service provides critical advanced life support (ALS) response and care in 90 percent of the 30 most populated United States cities and counties.
12 EMS Defined Much of the dialogue in the public arena today concerning prehospital emergency medical care often focuses on ambulance services and, accordingly, may ignore the important distinction betweenprehospital emergency medical response and the other key uses of the ambulance based based, out ofof hospital providers for non emergency medical and transportation services.
13 Non Emergent Service Sub specialties of ambulance service in the out of hospital arena must not be confused with emergency response. For example, ambulance services are often employed for; interfacility transfers for specialty care need to transfer patients from one hospital to another
14 EMS Defined For government decision makers who do not work in the public safety environment, it may be difficult to appreciate the differences between; emergency response and ambulance transport. Lik l t dfi ll t i di l Likely to define a call to in a medical emergency as needing an ambulance.
15 U.S. Fire Based Facts The ride for the sick or injured person in the ambulance is only part of the system. A comprehensive EMS system includes rapid response, intervention, stabilization, and then transportation to a definitive care facility, if needed.
16 EMS Response Defined Ambulances, of course, are necessary to transport patients to a hospital where more definitive care may be needed. However, the most reliable vehicle to ensure a rapid response generally is the neighborhood fire truck. Recent advances in resuscitative medical care, particularly in cardiac emergencies, what occurs in the first few minutes after onset of the medical emergency will change the long term outcome. In many of these critical circumstances, what happens on scene determines whether the patient lives or dies.
17 EMS Defined Therefore, prehospital emergency response, is not only a key function of each community; it has become, almost universally, a principal duty of the fire service as well.
18 Benefits of EMS The goal of this discussion is to resolve and demonstrate that the use of fire service equipment and personnel to provide emergency response is the best approach for a community regardless of size. If EMS is the intersection of public safety, public health, and medical care The U.S. Fire Service is uniquely yqualified to be at that intersection.
19 U.S. Fire Based Facts Fire service based EMS brings the treatment to the patient wherever they are. Treatment by firefighters begins immediately, even if the patient is trapped in a building that s on fire, pinned in a car crash, or in a collapsed structure. The provision of EMS response, treatment, and transportation by firefighters is seamless. One agency is responsible for the continuity of patient care and provides EMS within an all hazards response model.
20 EMS Response Defined Now equipped with automated defibrillators to reverse sudden cardiac arrest, the fire truck, coupled with bystander CPR, has become one of the greatest lifesaving tools in medical history. Time efficiency is a key component of the best designed EMS systems. Stroke centers to treat stroke within the golden 3 hour window, Cardiac catheterization centers to treat heart attack in the 90 minute door to balloon time, and Trauma centers to treat hemorrhaging patients, The service most capable of rapid multi faceted ut response, rapid identification and triage to the appropriate facility is a fire service based EMS system.
21 Multi Role Responders ll All Hazard Fire service based prehospital Fire service based prehospital emergency medical care systems are more effective from the perspective of scene safety, short response time, integrated rescue and treatment, and transport to a medical facility. Firefighter response is a key element of patient safety, both medically and environmentally.
22 Multi Role Responders ll All Hazard In the eera aof homeland dsecurity threats eatsand dthe spiraling growth of the commercial transport industry, the threat of hazardous materials (Haz Mat) is center stage. Fire service Haz Mat teams are the front line of protection. ti Rapid delivery of medical care can be pre empted by such chem bio threats, butwhere rapid care can be given, it can be expedited directly by cross trained fire service Haz Mat care providers.
23 Most Effective System The U.S. Fire Service based emergency response and medical care system is the most effective, coordinated system worldwide. The National Incident Management System (NIMS) and other nationally defined coordination plans ensure that fire service based emergency response and medical care provides skilled medical services to the patient regardless of; the circumstances the location or condition of the patient.
24 U.S. Fire Based Facts Firefighters are long term workers in their communities. Most fire departments have very low turnover rates. Firefighters know about the needs in their hi communities and firefighters are highly experienced emergency medical care providers.
25 U.S. Fire Based Facts The fire service EMS deployment model is more robust than any private for profit ambulance based EMS model. Firefighters are deployed and ready to respond to any type of emergency. Fire Service based EMS provides this pivotal public safety service while also emphasizing responder safety, competent and compassionate workers, and cost effective operations.
26 History of Maltese Cross During the Middle Ages, the Knights of Malta, the forerunners of the fire service, took care of travelers and specifically burn victims from the Crusades and associated battles. Eventually, the Knights of Malta adopted the Maltese Cross as their emblem and it has created a revered legacy for fire departments.
27 History of Maltese Cross Known as the Hospitallers of Jerusalem Hospitallers became firefighters out of necessity weapons of war at that time was the glass fire bombb After rescuing a fellow knight from the inferno and extinguishing the fire, a Hospitaller was awarded a medal, shaped like a Maltese Cross
28 History of Maltese Cross Maltese Cross as their identifying mark on armor More than 1200 years ago, some of the earliest ancestors of the fire service were allhazards responders These are two of the concepts firefighters still believe in today and hold as their most sacred responsibilities caring for the sick and caring for their own.
29 Community Based Community based fire station, with its ready availability of personnel 24 hours a day the unique nature of medicine outside of the hospital, creates a symbiotic i blend of the traditional i public concepts and duties of the fire service with ihrapid dli delivery of advanced dprehospital l9 1 1 emergency response and care.
30 Community Based Fire stations are strategically placed across geographic regions, commensurate with; population densities workload needs All hazard response infrastructure t meeting the routine and catastrophic emergency needs of all communities regardless of the nature of the emergency.
31 Safety Net Prehospital emergency patient medical care is a major part of the safety net for the American healthcare system. Provider of last resort for the needy Fire service based, prehospital l emergency patient medical care provides unconditional i service to all members of the population
33 The Public s Knowledge of EMS Limited Everyone is a Paramedic Don t know ALS from BLS Someone always shows up
35 EMS System Models (Deployment Configuration) Fire service based system using cross trained/multirole firefighters. Firefighters are all hazards responders Fire service based system using employees who are not cross trained as fire suppression personnel. Single role EMS trained responders accompanying firefighter first responders Combined system using the fire department for emergency response and a private or third service provider for transportation support. Single role emergency medical technicians and paramedics accompanyfirefighter first responders to emergency scenes to provide patient transport
36 Study Objectives Determine how; Firstresponder responder crew size, ALS provider placement and Number of ALS providers is associated with the effectiveness of EMS providers.
37 Results: ALS Arrival (Trauma) Crews with 1 ALS on the engine and 1 ALS on the ambulance completed all task 2.3 minutes faster than crews with 2 ALS on the ambulance. Once again the ALS on the First responder crew makes a difference. Analysis of start time and duration of ALS task are still ongoing First Responder Crew Size ALS Tasks Total Time
39 Results: ALS Arrival (Cardiac) First The crews with 1 ALS on the Responder engine and 1 ALS on the Crew Size ambulance performed d2 minutes faster than the ALS Tasks crews with no ALS on the engine and one ALS on the ambulance Total Time
40 Results: ALS Arrival (Cardiac) The crews with 1 ALS on the engine and 1 ALS on the ambulance were able to initiate critical skills earlier and perform them in a shorter time duration. 12 Lead applied sooner Intubation shorter duration to complete 4 person FR crews performed both tasks earlier and in less time than other crew sizes. First Responder Crew Size ALS Tasks Total Time
41 First Responder Crew Size (Cardiac) At Patient ABCs Interview 4 FR Oxygen Vitals 12 Lead Expose 3 FR Arrest Move Patient ABCs 2 FR Defib Pads Shock ABCs CPR 0 FR Airway IV Epi Shock ROSC Lidocaine
42 USA Today. May 20, 2005
43 Policy Maker s Knowledge of EMS Not much different than the public Often get information from private sector Believe that the private sector is free Get bonus points for privatizing
44 Talking Points of Fire Based EMS Continually emphasize service Control emotions
45 Advantages of Fire Based EMS Response time Station locations Quicker start of treatment Marginal costs Human resources Rescue capabilities
46 Paramedic to Patient Side Best chance to save a life Shorter hospital stays Less time in rehab Early pain management Continuity of care Faster return to pre injury/illness condition
47 Items for Detailed Discussions Privates are not free Subsidized through money & personnel Fire departments stop the clock Fire departments begin treatment Extra tahands dsae are needed for services Patient care Patient movement
48 Benefits in Addition to Improved Service Marginal Costs Money stays in community Personnel for fire response Regardless of number of fires
49 Challenges to Fire Based EMS Transport to limited facilities Units out of service longer Won t be available if fire strikes Government should look to privatize Perception that it is a union issue Privates are doing just fine no complaints
50 Preparation Credibility Trust Credentials Knowledge Support of medical professionals Marketing Customer service Professionalism & Appearance
51 Things to Avoid in Discussions Saves firefighter jobs Makes money Not enough fire to support staffing Criticism of privates Anything that appears self serving
52 Fire Service Based EMS Advocates Resources NationalorganizationslikeIAFC organizations like IAFC, IAFF, Metro Chiefs and CFSI FB EMS Advocates White Paper FB EMS ToolKit FB EMS Guidebook (IAFF) Videos (DVD) Right response National Medical Report
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