Editor's note: With EMS Week under way, FireRescue1 takes an in-depth look in the following article at Dallas Fire-Rescue's new EMS Vision draft plan. For further information and resources on EMS Week, check out EMS1's special coverage section.

By Jamie Thompson
FireRescue1 Editor

AP Photo/Donna McWilliam Dallas Fire-Rescue personnel respond to a fire at a gas facility in June last year that injured several people.

Firefighters may be tackling around 50 percent fewer fires than they were 30 years ago, but it's certainly not reflected in their workload. 

EMS responses are making increasing demands on resources, with such calls accounting for up to 80 percent of the total received by some departments.

These statistics signal the time for a fresh approach to how fire departments handle emergency medical services. And Dallas Fire-Rescue — whose calls are 60 percent EMS-related — is at the forefront of adopting a new approach.

Over the course of several months, a range of personnel from the department split into different work groups to brainstorm ideas to improve the city's EMS system for both patients and staff alike.

Some of the ideas in a draft document — EMS Vision — are already in place at other departments. Others could become best practices for the rest of the country to adopt.

"I certainly would be thrilled if other EMS systems looked at themselves critically and looked at other places to see how they do things," said Dr. Marshal Isaacs, the department's medical director.

"EMS is still a very young field. Certainly learning from one another and seeing the best practices that are out there means we can better serve patients, EMTs and firefighters."

The proposals in the draft document include:

Alternative transportation
Transporting patients with non-urgent conditions by means other than ALS Rescue units such as multi-patient transport vans would "better maintain paramedic and rescue resources for patients with emergency conditions." The report added that "the chances of delivering more rapid care to those who truly need rapid intervention will far exceed the rare chance that an occult emergency will be missed."

Increased testing of potential recruits
The draft document suggests introducing occupational and psychological testing of applicants. According to the report, "a more effectively screened recruit base should yield individuals who are more likely to excel in a career of service to the city as a firefighter/EMT-P."

Dr. Isaacs said the current round of testing does not necessarily determine if the applicant will be a good EMT.

"There's not a lot of examination of whether we are hiring people who are really well suited to do the kind of work we are going to ask them to do," he said. "It is a high stress job; you have people's health and lives in your hands." 

Emergency medical dispatch changes
Some of the biggest proposed changes concern the department's emergency medical dispatch. Currently, approximately 99 percent of 911 calls to DFR Dispatch are dispatched Code 3, with just 1 percent dispatched Code 1. The report calls for the introduction of a medical priority dispatch system for EMS calls, something already in place at many departments. Without such a system, the report said, the department's already scarce EMS resources are utilized inefficiently.

"I don't think there are a lot of people in EMS today who don't feel science and technology has now advanced enough that calls should not be prioritized," Dr. Isaacs said.

"They should be. You don't need to go Code 3 every time. That's a major recommendation, but I'm sure it will make some people nervous."

In addition, the surge in "Good Samaritan calls" prompted by the increase in cell phones is also addressed in the report. Current policy at the department is to dispatch an ALR Rescue to these incidents, Code 3.

The inefficient use of EMS resources, said the report, is problematic for several reasons: 

• While responding to Code 3 calls, the Rescue is unavailable for serious calls which results in longer response times to true emergencies
  
• Responding with lights and siren to non-emergency calls jeopardizes the health and welfare of both citizens and emergency responders
  
• Unnecessary use of ALS vehicles is expensive to the citizens in terms of fuel, maintenance and repairs
  
• Paramedic stress, frustration and exhaustion are exacerbated by responding to a large volume of non-emergency calls

Dr. Isaacs said Good Samaritan calls are rising dramatically not only annually but even monthly.

Call volume has risen dramatically but human resources have not.

— Dr. Marshal Isaacs Dallas Fire-Rescue

"Of course we want things reported to 911," he said. "But at the same time, 911 has become something other than what it was designed to be — to provide an emergency medical response.

"The frequency of calls is sending scarce EMS resources to unidentified problems."

The report proposes sending a first responder vehicle with a defibrillator rather than ALS vehicles to the scene of a Good Samaritan call. If it determines the patient requires ALS and/or transport, the report said, the engine can request a Code 3 Rescue response.

If the proposal was brought into effect, Dr. Isaacs said, the responses would be extensively reviewed as a safety precaution.

"If it turns out that 5 to 10 percent of those calls are bad, then we'll need to rethink it," he said.

"But if only one out of a hundred is bad, then I think we might say that that's a reasonable rate."

Next steps
The draft report has already gone before department members and partner agencies. The next step is public consultation before it can be finalized and approved by city officials.

Feedback from department members at least has been positive, according to Dr. Isaacs.

"Everyone is very excited," he said. "Our paramedics for the first time in a long time believe there are people in the department who care about what they do and want to help them to do the best job possible."

With calls mounting every year, the proposed changes cannot come soon enough for many.

Between 1997 and 2005, call volume grew by nearly 20 percent at Dallas Fire-Rescue. In 2006, more than 168,000 EMS incidents and 118,000 fire incidents were processed through the department's Communications Center.

"The numbers tell the story," Dr. Isaacs said. "Call volume has risen dramatically but human resources have not.

"We all know that EMS is the safety net of the U.S. health care system, which everyone knows is broken. Nobody knows that more than EMS and fire departments."