PRESCOTT - When you call 911 for a medical emergency like a heart attack, the Fire Department responds along with a Life Line Ambulance.
That's five people - three on the fire engine and two on the ambulance - to care for you, and in the case of a heart attack, they all have a job to do.
When you call 911 for a medical problem like a broken hand, the Fire Department responds along with a Life Line Ambulance.
That's five people who, most likely, are not all needed to care for you.
There's a move in Prescott to re-evaluate this kind of one-size-fits-all dispatching of medical resources. In these times of reduced budgets, it may become important to dispatch as some other cities do, with what's sometimes called a "priority" or "tiered" system.
Life Line Ambulance CEO Glenn Kasprzyk pointed to Gilbert as an example of a city in which "there's calls that just the fire department responds to, there's calls that just an ambulance responds to, and there's calls that everybody responds to."
Kasprzyk said there are times when more hands save lives.
"For a critical patient, there is an impact when you have less people. People who are in cardiac arrest - somebody's doing CPR, somebody's ventilating the patient, somebody's starting an IV and preparing medication."
But, he continued, "There's a large percentage of our calls that, whether there's two people there, four people there or five people there, it doesn't necessarily change the way we treat the patient."
That's not efficient, Kasprzyk said, and it needs to be reconsidered.
"The health care model, prehospital-wise, is changing. And as a system, we need to make changes to better service our community, versus the older traditional model of sending all the resources on every call."
But the model that Kasprzyk describes works much better in a pure urban or suburban environment, said Rob Barth, Yavapai Regional Medical Center's director of Emergency Services, and we don't have that here.
Cities using it generally "don't have that geographical footprint of 300 square miles (which EMS covers in Yavapai County) ... and they have built-in redundancies in that system."
Fewer fires, more medical calls
It's no secret that fire departments nationwide fight fewer actual fires these days. With improved building codes and materials, and the widespread use of sprinklers, there aren't as many structure fires as there once were.
Firefighters nowadays find that their call load is up to 85 percent medical-related responses. Given that they are in a fire station and ready to go 24 hours day, it made sense to shift the medical load to them, and firefighters are trained as paramedics and emergency medical technicians. They carry a lot of the same gear found on an ambulance in the fire engine. About all they don't do is transport patients to the hospital.
But, for years, fire officials have had to answer the question, from both the public and elected officials: "Why are you driving that huge fire truck to a medical call?"
The answer, fire officials have always said, is simple: If the firefighters are canceled from the call or when they finish with it, and a fire or rescue situation is reported, they can respond directly to it, rather than spending time driving back to the station to get the fire engine.
For emergency responders, it's all about time.
"Time is tissue," said Christopher Lampe, MD. An emergency department physician at YRMC, he said 10 years' experience has shown him that the longer the delay in treatment for critical care, the worse the patient outcome.
"Every few minutes that your heart is without (blood), you're going to be killing off heart tissue," Lampe said. "Strokes are another one where we have a window to give the clot-busting agent. If you fall outside the window ... there's no option for it."
Barth said that of those patients that were in acute respiratory/cardiac arrest, he could project that 28 per month, or over 400 a year, experienced a situation where response time "was the difference between death and walking out of the hospital."
"It's critical that a resource gets there fast," Kasprzyk said. "Whether that's the fire truck first or the ambulance first, that a paramedic gets there to start initiating care."
A new model?
Central Yavapai and Chino Valley Fire Chief Scott Freitag said rumored changes coming in Prescott Fire Department procedure that could lead to fire crews no longer answering medical calls (see related story) "changes a 50-year model of how EMS works in the country."
He met with Yavapai Regional Medical Center officials on Wednesday, Feb. 10, to discuss the situation, and said his agencies were working up several "contingency plans."
Those plans address a possible closure of two Prescott Fire stations, a potential plan for Prescott to drop emergency medical responses, and both contingencies.
Freitag says each would have a "dramatic impact, not just on the citizens of Prescott, but on the entire system."
It takes a minimum of four people to properly care for patients on several types of critical calls, so if the city were to eliminate firefighters from medical runs, it would then take two ambulances to supply enough personnel to care for patients - which would then put one out of service for the duration of the call.
This ambulance shortage is not theoretical. It already happens, Freitag said.
Rachel Sink, an emergency department nurse at YRMC, described a situation in which she was injured in a mountain biking incident on Thumb Butte about three months ago. The bike crash was bad enough that her helmet was split in two, and she was experiencing symptoms of spinal cord damage.
"The first people who were there ... was Prescott Fire, and I was with them for an hour before I ever saw an ambulance," she said. "If I had been there without Prescott Fire ... if they weren't responding to trauma calls, that could have been a personal life changing situation."
Freitag said the other problem to be considered is that the fire and rescue crews here cover 300 square miles with only two hospitals.
"Some of these transports from the outer rural areas can be 30-40 minutes," he said. "That's not the fault of anybody. The area is spread out."
And, Freitag said, the number of calls is rising, so fielding fewer units can only slow response times.
"I don't support saying, 'We're not going to send the fire department on any call,' because I think that hurts the system," Life Line's Kasprzyk said.
"Those are things in healthcare we don't want to do."