Texas Fire Chief - Fall/Winter 2008 - (Page 32)

this review reads: “Advanced life support levels of care of patients with an ALOC does not significantly change outcome compared with those receiving BLS care.” In another article in Prehospital and Disaster Medicine (2005) titled “Does Advanced Life Support Provide Benefits to Patients? A Literature Review,” I found more information that seemed to downplay the importance of ALS. The article concluded that “in trauma patients, there is poor evidence that ALS care improves survival,” and also that “ALS provided no benefits over rapid defibrillation” in cardiac arrest victims (rapid defibrillation in this context meant BLS with an AED). The article went on to say that evidence does not yet exist to fully compare ALS and BLS care, so it is difficult to draw conclusions. Some of the information presented in these articles seems to defy our common sense strategy, which had led us to believe that higher trained first responders equated to a better level of service to our community. NFPA 1710, Standard for the Organization and Deployment of Fire Suppression Operation, Emergency Medical Operation and Special Operation to the Public by Career Fire Departments was my next source. I was comforted by the fact that this standard suggested that our department was aiming in the right direction by offering ALS first responders. Specifically, the emergency medical service delivery deployment section of the standard recommended the deployment of at least two paramedics and two EMTs within an established response time. Since the private EMS agency serving our community only staffs its units with one paramedic and an EMT, it is up to us as first responders to provide an additional paramedic and EMT in order to meet the standard. Now convinced that our direction with ALS care was justified by NFPA 1710, I began to gather and analyze data from our 2007 fi rst responder incident reports. My two purposes for analyzing the data: to determine how often our ALS first responders were needed, as well as how often we were able to meet NFPA 1710’s recommendations on staffing and response times for medical incidents. Reviewing data on our 2007 firefighter/paramedic staffing levels, I found we were able to staff our first responder units with a paramedic 80.7 percent of the time. To meet the recommendation of NFPA 1710 of having at least two paramedics on all incidents, I calculated that we needed to add five paramedics to our staffing from the ranks of the firefighters. These additional firefighter/ paramedics would allow coverage for the shortages caused by leave time. Referencing NFPA 1710 for response time recommendations, I found that first responders are recommended to be on-scene in less than four minutes on 90 percent of all medical incidents. A look at the data for 2007 incidents revealed that we had an average medical response time of three minutes 47 seconds, yet arrived on scene in less than four minutes for only 68.7 percent of our incidents. Our department’s solution for meeting this 32 recommendation is simple: we need to add a fire station. Currently, we operate out of two fire stations; annexations and growth have created an increase in call volume and longer responses. A strategically placed third fire station should improve our response times and at least bring us closer to being inline with NFPA’s response time recommendations. Additionally, a new station would require us to examine the way we respond to medical incidents. Unless we hired a substantial amount of new firefighters to increase our staffing levels, our current program of using firefighters on first responder units would have to be discontinued. The most cost-effective way to staff for a new station would be to abandon our first responder units and respond engine companies on medical calls. The personnel we currently use to staff the first responder units would be reassigned to create a new engine company for the new station. To demonstrate the need for our ALS care, I studied patient care reports from 2007. I found that we established patient contact prior to the arrival of the private EMS agency on 9.7 percent of our incidents. On these occurrences, we performed an ALS skill 36.7 percent of the time. In situations where the private EMS agency initiated patient care prior to our arrival, I found that our first responders performed an ALS skill 5.4 percent of the time. The data showed that we are utilizing ALS care and as our call volume increases in the future, so will the need for our ALS services. After research of “expert opinions” and reviewing incident report data, I finally came to an answer for my initial question: What level of care (ALS or BLS) should we provide to our community? The answer: it depends. Each community can only answer that question for themselves. For our situation, I feel that we should provide ALS care. We are small and the differences in the costs of providing firefighter/paramedics as opposed to firefighter/EMTs are negligible. Published debates in EMS on ALS vs. BLS are based on little evidence. Assuming that a higher trained individual can provide a higher level of service is the most reliable information I found for justifying ALS care. And, NFPA 1710 proved to be a valuable resource for providing measurable performance objectives to draw comparisons of where we currently are and how we measure up. References Adams J: “Does the Level of Prehospital Care Influence the Outcome of Patients with Altered Levels of Consciousness?” Prehospital and Disaster Medicine 1996; 11(2): 101-104 Isenberg D: “Does Advanced Life Support Provide Benefits to Patients? A Literature Review.” Prehospital and Distaster Medicine 2005; 20(4): 265-270 NFPA 1710 Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations to the Public by Career Fire Departments; 2001 edition: 7-9 TEXAS FIRE CHIEF Fall/Winter 2008

Table of Contents Feed for the Digital Edition of Texas Fire Chief - Fall/Winter 2008

Texas Fire Chief - Fall/Winter 2008 Contents Executive Director’s Report Texas Fire Chiefs Academy Project Reports Southwest Fire Rescue Conference Program Membership Application Customer Service Orientation in Fire Rescue Departments A Visit to the E-One Plant Index to Advertisers

Texas Fire Chief - Fall/Winter 2008

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