News

Calls Validate Kentucky FD`s Expansion Into EMS

James Mayse

01/17/2017

Jan. 15--In November 2006, the Owensboro Fire Department expanded its mission by beginning to respond to all medical emergencies inside city limits.

At the time the expansion was proposed in 2004, OFD was already responding to motor vehicle accidents with injuries. But when then-Fire Chief Fred Hina first proposed the change, some city firefighters expressed doubt there was a need for the additional service.

Today, most of the runs made by city firefighters are for medical emergencies. That's also true of the Daviess County Fire Department and for many volunteer departments spread throughout the county.

"Seventy five percent of all our calls are EMS and rescue," city Fire Chief Steve Mitchell said recently. Of about 7,700 calls made by the department in 2016, about 6,000 of them were medical emergency calls, he said.

The philosophy behind fire departments conducting medical runs is that firefighters/EMTs can stabilize a patient and begin offering treatment before an ambulance can arrive. The Daviess County Fire Department goes a step further by offering advanced life support, meaning department paramedics can do anything a Yellow Ambulance paramedic could do in terms of care.

Having a fire unit reach an emergency even just slightly before the arrival of ambulance service paramedics makes a difference, Mitchell said.

"When (a patient's) treatment starts earlier, their recovery is quicker," he said. Also, damage to vital organs such as the heart is reduced by early intervention.

"The save rate for cardiac arrests has improved" since the fire department began responding to cardiac emergencies, Mitchell said. "You don't necessarily save a life every day, but you improve their chances."

22 Calls a Day

The most common emergencies to which city firefighters responded in 2016 were respiratory problems and cardiac arrests. Those runs totaled 1,180 respiratory emergencies and 875 cardiac arrest reports.

City firefighters also responded to 842 reports of traumatic injuries, 395 seizures, 205 possible strokes, 271 diabetic emergencies and 214 attempted suicides, and 714 calls listed as "other/unresponsive."

On average, the city fire department responds to 22 calls of all types daily.

"We get more 'Thank-yous' off the EMS program than anything else," Mitchell said.

The department responds to everything from traditional medical emergencies to opioid overdoses and suicide calls.

"We did a Narcan save" recently, Mitchell said in an interview last week. Narcan is a drug that counteracts overdoses of opioids such as heroin and prescription painkillers. The fire department began carrying Narcan kits last year.

"The person was in full cardiac arrest" form the overdose, Mitchell said. After Narcan treatment, "the person was up and talking in the back of the ambulance."

Most of the city's firefighters are EMTs, and there are three department paramedics. Battalion Chief Colter Tate, who handles training for OFD, said it is not a requirement to have be an EMT to join the fire department, but new firefighters are immediately sent to Owensboro Community & Technical College to begin their EMT training. A firefighter must obtain an EMT license within their 18-month probationary period to stay with the department.

"The history of EMS used to be you threw them in the back of the van and got them to the hospital," said Battalion Chief Colter Tate, who handles training for the city fire department. "Now, we're treating the patients and relaying information to the hospital, so when (the ambulance service arrives), they are ready ... and treatment has already begun."

Every EMT has to receive 40 hours of additional training every two years to retain certification with the National Registry of EMTs. Firefighters regularly receive additional training.

"Things change quite a bit in the EMS field and the fire service field," Tate said. Firefighters have to be informed about emerging threats, for example, and new information comes from medical studies. Some techniques were learned from the military.

"You see agencies carrying tourniquets now, and law enforcement carrying tourniquets," Tate said. "They fell out of favor, but we have seen the practical benefit of those in Iraq and Afghanistan."

Like law enforcement, firefighters responding to issue such as a suicide attempt have to have training in crisis intervention.

"We do behavioral health and mental health training," Tate said. "We talk to our personnel (about) how they should approach the situation, how they should talk to the patient and what treatment path they should go down."

1,900 Medical Runs

The Daviess County Fire Department's two stations made 1,900 medical runs last year, county Fire Chief Dwane Smeathers said. At the department's east county station, 1,250 of its almost 2,000 total runs were for medical emergencies.

At the west county station, 711 of its 1,460 runs were for medical calls, he said.

The county fire department has been doing advanced life support for about 12 years and has been providing basic EMT services for decades, Smeathers said. The department is able to provide all the services of the ambulance service, except for patient transport.

"Everything we have on our trucks is the same the ambulance service has, except for a stretcher," Smeathers said.

Being able to provide the same services as Yellow Ambulance is beneficial, he said.

"Not being upset with the ambulance services, but they wouldn't be able to have an ambulance everywhere," Smeathers said.

While the ambulance service does have set response times it meets, "we've got the advantage of we're already out in the county," while an ambulance might have to come from inside the city, he said.

"We require our guys to get out the door within two minutes" of receiving an emergency call, Smeathers said.

Shaun Blandford, an assistant county fire chief who also works with the ambulance service, said applicants to the fire department must already have a minimum level of medical training.

"Historically, EMT basic (life support) is a requirement" for being hired, Blandford said. The department has 22 EMTs, who can provide basic life support, and seven paramedics.

"We have a paramedic for every shift and every station," Blandford said. "There is always a paramedic for the truck."

While county EMTs receive regular required training, and are encouraged to attend paramedic school, becoming a paramedic is not mandatory.

"It's not cut out for everybody," Blandford said.

The department holds training sessions every Friday with the sessions open to all other area departments. To provide advanced life support, department EMTs must recertify annually on advanced cardiac, pediatric and trauma life support.

"We have instructors for all those disciplines on staff," Blandford said. "We save quite a bit of money by having instructors on staff."

Training on emerging threats comes from the state Board of Emergency Medical Services and other agencies.

"We work closely with the health department and the hospital," Blandford said. The department also has an agreement with Yellow Ambulance that has the ambulance service resupply the department with medical equipment used on runs.

"They restock us, and the ambulance (service) bills that patient," Blandford said.

Volunteer Involvement

The county volunteer fire departments also make numerous medical runs. In 2016, Thruston-Philpot Fire Department made 647 medical runs, according to Owensboro-Daviess County 911 dispatch. The Airport-Sorgho department had 239 medical runs, Yelvington made 160, Masonville made 258, Utica responded to 109 and Knottsville firefighters went to 108 medical calls.

The Moseleyville, Stanley and St. Joseph fire departments each responded to less than 100 medical runs last year. That may not sound like a lot, but there's another way to look at those numbers. At the Stanley Fire Department, for example, there were 50 times in 2016 when volunteers had to leave work or leave home, day and night, and rush to a medical emergency. The same is true for firefighters at Moseleyville, St. Joseph and the other volunteer departments.

"Regardless of when it is, you have to get out of bed and go," said Dan Matthews, chief of the Utica Fire Department. Volunteer fire departments "provide a lot more service to the public with medical runs than with fire" calls.

At Utica, "about two-thirds of our runs are medical runs," Matthews said.

Because volunteers aren't always at the stations, they carry medical equipment with them, Matthew said. That allows a firefighter to go right to a medical emergency rather than first going to the station.

"Our firefighters live all over the Utica fire district. They might live a few houses down" from the emergency, Matthews said. "It might be their next-door neighbor."

Volunteer firefighters who are not EMTs have training in CPR and first aid, so they can begin assistance if they are at a scene. New volunteers are made aware that medical calls are a big part of the fire service, Matthews said.

"We emphasize that it's an important part of our service to the community," he said.

Pat Thompson, chief of the Airport-Sorgho Fire Department, said medical runs are not a burden on the department. Rather, the runs are what keep the volunteers involved.

"I think it keeps the interest of some of our volunteers," Thompson said.

Because fires are not commonplace, emergency medical runs are the bulk of what volunteer stations do, he said.

"If you're trying to hold interest (without doing medical runs), you'll lose interest," he said.

In the more rural areas of the county, the volunteer departments are "able to provide service in a very timely manner," Thompson said. In one notable instance, department responders were able to revive a man who was unresponsive after a heart attack.

"We were able to get there within minutes and begin CPR and keep things circulating" until a defibrillator arrived on the scene, Thompson said. That man is living a normal life today, he said.

"The volunteer fire departments are strategically placed throughout the county, which allows us to be within an arm's length of a neighbor," Thompson said.

"There have been dozens (of people) that wouldn't be here if the fire department had not been there" to provide medical services, Matthews said. "That is part of the fire department that is overlooked a lot ... I think a lot of people don't realize we do that, until they dial 911."