Friday, July 25, 2014

Fire engine responding with ambulance provides manpower, equipment

DIAMOND SPRINGS FIRE CHIEF  Robert Combs talks about firefighting and emergency magement at Station 49 in Diamond Springs. Democrat photo by Pat Dollins

DIAMOND SPRINGS FIRE CHIEF Robert Combs talks about firefighting and emergency management at Station 49 in Diamond Springs.

From page A1 | December 10, 2012 |

As a Mountain Democrat reporter was interviewing Diamond Springs Fire Protection District Chief Robert Combs, a man stumbled into the back conference room, mumbling that he was told by the receptionist that he could find help back there. He seemed out of breath and had trouble standing, leaning against the wall, before falling down. His symptoms indicated there was something very wrong, likely a heart attack.

Within minutes, a flurry of activity was happening in the conference room. Firefighter/paramedics from a fire engine appeared and began diagnosing and hooking the man up to IV bags. An ambulance appeared to take the man away, who would likely not have lived unless the fire engine crew had arrived.

Although, he would have lived anyway — the man was a volunteer for the fire station and the fire engines and ambulance that responded had been there the entire time. It had all been a drill designed to show why fire engines arrive at medical calls alongside and often before the El Dorado County Regional Prehospital Emergency Services Operations Authority (also known as the JPA)-controlled ambulances in the county. There are two main reasons: equipment and manpower.

“You have seven things to grab with four people,” Combs said. The four people would be a county average two on a fire engine — whichever engine in the county is closest — and two in an ambulance, the standard response to a medical call.

“A gurney, drug box, airway bag, cardiac monitor, cervical spine equipment like a backboard,” Combs listed. All the equipment needed could not fit in a single ambulance or fire engine, he said. DSFPD also carries specialized rescue equipment for “every type of forcible entry,” including ropes, jaws of life, litter baskets and saws.

El Dorado Hills Fire Department Chief Dave Roberts said that “all of our engines carry everything an ambulance does (drugs and medical equipment) with the exception of the gurney, so basically an engine paramedic can treat a patient with the same level of care that an ambulance paramedic can with the exception of driving you to the hospital.” EDHFD staffs three people on an engine, four in a truck and two people per ambulance.

For reference, Combs and Roberts explained, a residential structure fire has four engines, one medic, one truck and one chief unit minimum with 15 personnel minimum; a wild land fire, including Cal Fire and depending on location and severity, requires nine engines, a bulldozer, a helicopter, one air attack, two tankers and two chief officers with at least 32 personnel; a vehicle accident has two engines, a medic and a chief officer.

The second reason is manpower. If the fire engine responds first, Combs said, the personnel are “trained to provide care while the ambulance is en route.” If a person needs to be carried out on a gurney or backboard, it could take four to six people to navigate “up and down stairs with the equipment, over a curb and through the woods,” back to the ambulance, he said. “It’s an art in and of itself getting out of a house.”

Not having the necessary personnel to do that could be dangerous to the responders, said Chief Bryan Ransdell. “That’s how you get back injuries — you have weight and limited personnel.” Add in equipment, someone treating the patient who may have a stopped heart and one person just doing CPR, one managing the airway, someone to administer drugs, someone to monitor the patient and people to actually move the gurney, and suddenly the operation is much more complicated, he said.

Roberts agreed, saying, “If you take an average person weighing 185 pounds if you only had two paramedics on scene, each one is carrying 92.5 pounds, just in person weight, not counting all the equipment that they took in to treat the patient. This can get very awkward if stairs or narrow hallways are involved, so it is handy to have extra hands if available. If another critical call comes in, and the ambulance can handle the original call without assistance from the engine, the engine can break away to take the new call.  If the engine can’t break away the next closest engine is dispatched to the call.”

It becomes a ballet or a chess game of moving the pieces — the ambulances — around the county for coverage. “As incidents occur within the county, these ambulance are moved around as a means to cover and maintain balance of response times for additional incidents as they occur… On any given day in the County of El Dorado, there are eight paramedic ambulances covered with trained paramedic/firefighters 24 hours a day,” said Dave Teter of Cal Fire, who are contracted out to work as the Cameron Park Fire Department.

“Additionally, there is another ambulance covered with trained paramedic/firefighters each day for 12 hours from 7 a.m. to 7 p.m.,” or the peak time,” Teter said. Cal Fire ambulances are staffed with three people, while most local fire departments staff either two or three, he said.  The only difference between the Cameron Park/Cal Fire ambulances and the JPA ambulances are shift hours.

“It is not unheard of to have four or five (or more) of the ambulances committed to incidents at the same time, thus causing the remaining ambulances still available to be strategically relocated to cover the areas normally covered when all of the ambulances are available,” Teter said. “In comparison, on any given day in the county, there are a minimum of 19 staffed fire engines on duty (some staffed with a paramedic as well). When an incident occurs, a fire engine is dispatched as well as the ambulance as a matter of routine practice due to the fact the engine is usually going to arrive at scene first and begin to deliver patient care.”

Extra personnel can take on other jobs, said Battalion Chief Mike Pott of the El Dorado County Fire Protection District. An extra person can do paperwork, while the responding captain “goes with the family to get medical history and looks at medications.” For example, the person may need insulin for diabetes.

Pott also mentioned something important that comes up whenever the public asks why an engine also responds: Money. “People don’t get billed for the engine. The medic is not billed until they transport,” he said. “Once they initiate care, they are obligated to take the patient. They take vitals, etc., and give a recommendation.”

Recent union concessions could change some of this, however. Station 72 in Cool could be losing a medic, “but this option is currently on hold,” Pott said. “This option would have allowed the district to save overtime cost by moving, or floating, the Station 72 firefighter/paramedic into daily openings caused by sick calls, vacation, or educational leave and not hiring an overtime firefighter for that opening. An apprentice firefighter working as a third firefighter on another engine would have been moved to the firefighter position at Station 72. The cost savings by using these firefighters as “floater” from Nov. 1 to Jan. 11 was calculated to be $43,516. The district is exploring another option with the same intent of saving overtime cost, but leaving the firefighter/paramedic at Station 72 in Cool.”

Staffing options are also being evaluated, such as “hiring emergency medical technicians through attrition, which would save salary cost,” Pott said. “There still would be two firefighters per medic unit, one being a paramedic and one being an EMT. This is and has always been a staffing option. With the good economy the practice has been to hire firefighter/paramedics in our district to provide an enhanced level of service.”

Each medical call can take between an hour and six hours, Combs said. The typical call, with an average of six calls a day for DSFPD, lasts an hour, but if transport to the hospital is involved, it could take upwards of six with the transport and paperwork. For Combs’ department, between Aug. 10, 2011, and Aug. 10, 2012, there were 1,499 medical calls, about 67.7 percent of calls for the year out of 2,213 calls total. Pott said that EDCFPD’s medical calls represent about 74 percent of calls. Out of 2,293 calls, Roberts said, EDHFD responded to 1,408 medical calls, or 61.4 percent. According to Teter, CPFD’s non-fire-related calls account for about 95 percent of calls.





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