The patient-first philosophy
By Rodney Schmidt
All the negative stories regarding fire departments providing first and co-response EMS services have led me to wonder who is being served by not playing nicely in the sandbox. Certainly these us-versus-them situations fail to put the customer. or patient, first.
Members of the High Level Fire Department (HLFD) are part of the patient-care process, even when EMS is on scene first. Our system is based on a patient-first philosophy and it works; perhaps other regions can learn from us.
High Level, located in northwest Alberta, is a community of just under 4,000 people. With an initial response area including a 40-kilometre radius of the town as well as highway response 200 kilometres to the north, 100 kilometres to the south, 40 kilometres east and 70 kilometres to the west, the HLFD has a large responsibility. One of those services is medical co-response.
The HLFD is part of the Alberta Medical First Response Program, which was developed by Alberta Health Services (AHS) when it took over responsibility for EMS in 2009. The program has grown and the HLFD is growing along with it. The EMS service in High Level is provided by a contracted service to AHS. The company, Aeromedical Emergency Services, has a longstanding, great working relationship with the HLFD.
The HLFD is a volunteer service with three staff (two full-time equivalents) providing administrative direction and command capability to the more than 35 volunteers. The HLFD has always provided assistance to EMS at a first-response level, but since the development of the Medical First Response (MFR) Program, the working relationship has grown with the service level. Approximately half of the HLFD staff have medical training above first aid; this includes four staff trained as emergency response technicians (EMTs) who are primary-care paramedics, and eight emergency medical responders (EMRs), all of whom are registered with the Alberta College of Paramedics. Another six staff members are trained as first medical responders (FMR), which is similar to an EMR, with 80-hours of classroom training. The majority of the volunteers all have standard first-aid with additional training on spinal immobilization, stretcher operation and oxygen administration, as well the ability to operate the department’s monitors/defibrillators (LP12s). Firefighters have medical training built into weekly training nights, and dedicated medical training nights are scheduled every six weeks for currency training. The HLFD also uses an online learning-management system for additional training. Staff from Aeromedical regularly attend training nights. All new Aeromedical staff meet senior HLFD staff and tour HLFD facilities.
The HLFD provides up to basic life support care to first-response calls and carries advanced airways, as well as epinephrine for allergic reactions, ASA for heart attacks, instant glucose, D50W and Glucagon for diabetic emergencies, and Atrovent and Ventolin for respiratory distress. Some medications are approved for use by FMR/EMR staff and the rest are reserved for use by EMT staff. The department is adding Narcan – an opiate antidote – once training is complete.
The HLFD responds to all Delta- and Echo-level calls (potentially life threatening) as well as any call with an ambulance delay of 15 minutes or more. In 2015, EMS calls comprised about 56 per cent of the HLFD call volume (178 calls). This percentage is not uncommon in Alberta, where the majority of MFR programs utilize similar parameters; the difference lies in the proud and seamless working relationship between the two agencies.
When HLFD staff arrive, usually with a crew of between four and six personnel, some firefighters are assigned to assist with patient care with the paramedics, and some ready the stretcher or start preparing whatever device is required for patient transport. Once on-scene treatment is complete, HLFD members assist with the patient in the ambulance. This may involve starting IVs, taking vitals, assisting with patient airway or anything else that is within the scope of training.
HLFD members attend in the back of the ambulance on approximately 75 per cent of co-response calls; this improves patient care and helps firefighters stay current on skills. Once at the hospital, firefighters assist with patient transfer and, when requested, even assist nursing staff. If firefighters are not required to assist at the hospital, the fire crew that follows the ambulance to the hospital will help to ready the ambulance for the next call by preparing the stretcher, cleaning the ambulance interior or assisting where needed to ensure that the EMS crew can have a quick turnaround.
When not training or responding, both services attend social events together and co-operate on joint public presentations. It is this type of community effort and co-operation that shows what can be accomplished when services set aside differences and do what is best for the community.
Rodney Schmidt is the fire chief and director of protective services for the Town of High Level, responsible for fire protection in an area spanning more than 37,000 square kilometers in Alberta’s northwest. firstname.lastname@example.org