Archive for December, 2012

Who Are These People?

Fireman from Sheffield

Friendly fireman.Photo by Frida Eyjolfs.

Why does a doctor care about firefighters (other than putting out fires, of course)? As a Disaster doc, I try to envision an ideal healthcare disaster plan for my entire community – not that I’m ambitious or anything! I have a crazy idea that the more we understand each other’s jobs, the better we might play together in an actual disaster. Since doctors are not used to playing with anyone, I put my money where my mouth is, and arranged to spend a day with our local fire department. Not only did I learn a lot, but I also had a great time.

I don’t know about you, but I was very confused about the whole EMS, EMT, paramedic, ambulance, fireman thing. My doctor mentality thought firemen fought fires and ambulances/EMTs made people show up magically in emergency rooms. Wrong! On the other hand, I am not totally at fault – it is very confusing. Let me see if I can pass on what I learned.

What is EMS? 

American ambulances

Ambulances awaiting dispatch. Photo by William Hartz.

EMS means Emergency Medical Services, including both out-of-hospital emergency medical care and medical transport. EMS is provided by fire departments, ambulance companies, or both. Some fire departments run their own ambulances, while other ambulance services are independent companies.

Training For EMS Providers

People who provide emergency medical services fall primarily in four groups:

  • Certified First Responders (or Emergency Medical Responders – a newer term to confuse us further) have training above first aid, but not truly medical. They give life saving treatment until trained medical personnel arrive. Police receive this training, as do many volunteer firefighters. Even teachers, security guards, and camp counselors can take this training. Don’t confuse them with the generic term “first responder”. This simply means the first emergency service to arrive at a scene.
  • Emergency medical technicians (EMTs) have 120-150 hours of basic medical training, including basic life support (CPR), oxygen, wound/burn care, and fracture/spine injury treatment. They focus on stabilizing and supporting patients during transport.
  • Paramedics have a lot more training. They usually spend at least one year in the field as an EMT, pass college level classes in math and sciences, and then complete a 2 year training program (10 times the hours required for EMTs). They learn invasive procedures such as advanced life support, medications, and intravenous treatment. Paramedics independently diagnose and start treatment in the field, following protocols established with their medical director.

    Firefighter training at Evergreen State College. Photo by Ian Ruotsala.

    Firefighter training at Evergreen State College. Photo by Ian Ruotsala.

  • Professional firefighters undergo around 600 hours of intense training in a fire academy, after passing preliminary training and physical testing. They often have EMT or paramedic training before becoming a firefighter.

Who Works Where?

Staffing for ambulances and firefighting varies drastically from community to community. In Salem, our firefighters are all paramedics, an increasingly common practice for larger fire departments. Our ambulances, which are private, usually carry an EMT and a paramedic. There might also be two levels of ambulance service – basic (staffed by EMTs) or advanced (staffed by paramedics).

In rural communities, you often have volunteer firefighters. Because of time constraints, their fire training isn’t as extensive as a professional firefighter, and their medical training may be at the Certified First Responder level.

Volunteer firefighters in parade.

Volunteer firefighters in Fairfield, Connecticut. Photo by Bob Freund.

Take home lesson on training – not all EMS responders are the same. As a concerned citizen, it helps to understand the credentials of those who respond to your 911 call. From an emergency management perspective, it is essential to understand the training and skills of the EMS programs and responders you work with.

911 Response

When you call 911, who responds? Although other communities may do it differently, our local coordination impressed me. It starts with good dispatchers, who quickly size up a situation based on minimal phone information. For a simple medical call, they send just an ambulance (unless all are busy, in which case the nearest fire truck is back-up). For a more complicated medical situation, both fire and ambulance respond. Once stabilized, the ambulance transports the patient to the hospital.

A car accident with possible injuries gets more attention. Besides the medical component, firefighters extricate victims from the vehicle,  put out vehicle fires, and clean up the accident scene (boy, is there a lot of glass and fluids even with small crashes!). Ambulances show up to help with medical response and transport patients. Police direct traffic and investigate criminal behavior (like the very entertaining drunk on the accident I attended).

EMS Response to accident.

Firefighters and police respond to an accident in Oakland. Photo by Chris Humphrey.

Sharing Resources

Although it may seem excessive, there are benefits to both ambulance and fire responding together. You get double the medical expertise and personnel. The fire truck handles environmental problems at the scene and the ambulance transports patients.  In addition, firefighters carry limited medical resources. They tote around huge bags of medical gear (quite easily compared to operating hoses). Fire trucks have additional supplies, but for multiple casualties or prolonged treatment, an ambulance is better stocked. From my pain control background, I was somewhat distressed at the limited amount of narcotics available, considering the amount of pain expected with trauma. As I discovered when learning triage, pain control is really not a priority in EMS.

Random Fire Truck Spottings

A fascinating tidbit is the fact that working firefighters are inseparable from their trucks. They need to respond immediately at any time and from any place. Need groceries? You take the truck to the store. Training across town? You take the truck. Delivering something? You got it – take the truck! When you see a fire truck in a random location, it might be running errands instead of saving lives. Now I won’t feel so bad about wasting gas if I take my SUV instead of my Mini to the store.

Firefighters win my prize for the most impressive drivers, maneuvering humongous trucks quickly and safely, often through very narrow streets. I’d be holding for dear life in the back seat, but they were unfazed. I’m a wimp in comparison when I complain about the difficulty of driving our camping trailer!

Trick Fire Truck Driving. Photo by Vladimir Kvasov.

Trick Fire Truck Driving. Photo by Vladimir Kvasov.

I know a lot more about EMS now as a result of my ride-along (not surprising, considering how little I knew to start with).  Most importantly, I understand what their training and skills prepare them to do, and I can envision how that might mesh with a healthcare disaster response requiring more than quick treatment in the field with hospital transportation. I thank the great team at Salem Fire Station 2 for my education. Don’t blame them if I got any of this wrong.

I welcome comments from the EMS community with clarifications, corrections, or other information.

Stay safe,

Sheila Sund, M.D.