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A recent survey concluded that the first response system in Worcester, Mass., often over responds to non-life-threatening medical emergencies with a fire truck, police cruisers and an ambulance, leading to costly inefficiencies.
In 2005, 66 percent of the department’s calls were for medical emergencies, slightly more than the national average.
The report, which looked at first response plans in 35 cities, recommends the city system be restructured by giving the city manager greater authority in emergency medical response and reducing the role of the fire department.
Fire Chief Gerard Dio said the fire department, with its stations scattered around the city and its men trained to treat the injured, makes it an ideal delivery system for first response.
“We’re strategically located throughout the city to get anywhere in less than 4 minutes to stabilize a patient or even just for simple care,” Chief Dio said. “We have 150 firefighters trained as EMTs or further up the scale of medical education and training. It would be foolish not to have us respond.”
This story has stimulated some healthy debate among those in the fire service and EMS, and FireRescue1 wanted to know what its readers thought about this issue. We posed the question: Do you agree with the Worcester Fire Department’s practice of responding to non-life-threatening medical emergencies?
Here are some of the responses that we received:
“I was appointed fire chief of Huntsville Fire & Rescue, in Huntsville, Ala., in June 2005. Huntsville is one of the most progressive cities in the Southeast with a population of almost 175,000. Our department responds with 22 engine companies, 4 truck companies and a hazmat unit, and four district (battalion) chiefs. We have 343 total employees. Prior to my appointment, the department did not provide EMS. In FY 2005 the department responded to approximately 5,000 calls. On Oct. 1, 2005, we started running first responder EMS throughout the city with HEMSI Ambulance providing ALS transport. All vehicles were equipped with a compliment of EMS equipment: AED, O2 Kit, medical kit, OB kit, C-collars, splints, etc. Since starting EMS, our call volume has increased to 24,000 calls during FY 2006 with more than 17,000 medical calls. EMS accounts for about 70 percent of our calls. The program has been great. We have 31 patients who were successfully resuscitated after being in cardiac arrest. However, all is not well. I have been asked by my administration to reduce the number of EMS calls to keep from wearing out equipment and to save fuel. I’m getting complaints for responding fire trucks on EMS calls. What’s even worse is when we respond a ladder truck on an EMS call when the engine at that station is already on another call. I’m also getting complaints from firefighters concerned about making routine life assist (non-emergency) calls. As with all departments, we are making our fair share of non-emergency medical calls. Since we are first responders, should we respond to a facility that has medical personnel on the scene (i.e., nursing homes, physician offices)? Should we respond at the police department’s request on a mace call? We are also getting beat up from running two trucks on wrecks with entrapment. These are issues we all need to work on and come up with some national guidelines. We have ordered four Rescue-Mini Pumpers that I plan to integrate into our department and will use them to run EMS calls and wrecks with entrapment instead of ladder companies. If an EMS call comes in to a certain district then the Mini-Pumper will be the first truck to respond from that station. “Prior to coming to Huntsville, I was a battalion chief with Birmingham (Ala.) Fire and Rescue. In Birmingham the entire EMS system was run by the fire department with all companies providing EMS with 17 ALS transport units. This system had been in place for years, so the administration, public and firefighters were accustomed to the fire department running EMS. If I can be of assistance in serving on a committee to address these problems, I would be more than happy to serve. I have a 35-year background in the fire service in which I have served in several capacities including operations, training and EMS. I still maintain my Paramedic National Registry Certification.”
— Chief Dusty Underwood, Huntsville (Ala.) Fire & Rescue
“I do agree with their response practices, for the most part. I do feel that certain criteria should be met to justify dispatching police, fire and EMS to a call. I have a theory that has worked for us in regards to the use of first responders. It is as follows: ‘It is better to have them and not need them than to need them and not have them!’ I feel that once a first response unit gets on scene and does a size-up, the decision can be made to reduce responding units to a non-emergency mode or disregard them completely. I am impressed with Worcester fire’s statistics on response times and cardiac arrest survival rates, GOOD JOB!!!!! Keep up the good work!”
— Leonard E. Vierling, EMT-P/IC
“I believe that it is overkill to send the fire department on every call. There are great tools our there, such as the National Academy Of Emergency Dispatch’s Medical Priority Dispatch System that help to accurately prioritize calls and decide which ones need everyone to respond and which calls only need an ambulance. I have heard it said that every taxpayer deserves the same service, whether they have a twisted ankle or are having a heart attack. While in theory that sounds great, it isn’t possible to achieve. If while the fire department is on scene with a patient with an ankle injury a call comes in at a residence within that same station’s coverage area for a patient with chest pain, an engine from a station farther away has to be sent. While the person with the ankle injury received great service the patient with the heart attack, who could have actually benefited from a faster response and may have ended up needing defibrillation, received a slower response and worse service. It is great to have the fire department as medical first responders but they aren’t needed on every call. With proper caller interrogation and proper prioritization, it can be predicted which calls to send everyone to and which calls only need the ambulance while keeping the other vehicles available for the next call.”
— Tim Warsop, Denver, Colo.
“I am a volunteer EMT-I and also work PRN for two ambulance services. When I arrive at the scene of a medical emergency, we find the extra help always a blessing. Overkill is better than not having enough help. It would be foolish to not have the fire department there and just sitting in the station doing nothing. Our volunteer fire crew does not respond to medical calls at all. There have been times when they would come in handy for more CPR help and for lifting heavy patients, or just getting into tight places. You never know what you have until you get to the scene. The sooner they all get there the better.”
— Cliff Neeley
“I am from a real small town in Rhode Island; we do the same. They dispatch the police to the scene, then as we get to the fire station we have an engine follow in on all calls. How do you know if it is routine until you arrive? I have gone to medical aid calls only to find out it is very serious and help is needed. Well if it is already there, I don’t have to wait to call for more help. Also, the world is not getting any smaller lately. Sometimes carrying that 500-lb. person you need extra people. I agree with Worcester and I hope they keep fighting to keep their policy!!”
— Gail Warner
“Eliminate the police department responding to the EMS calls. The Town of Irondequoit outside of Rochester, N.Y., did this 24 years ago and it has worked out fine. The policy was: If we needed the police, we would call them. The only time the police department responded immediately was for multiple vehicle accident calls.”
— Elmer Leusch, St. Paul Blvd. Fire Department Commissioner
“I think it is a bold and positive move that the Worcester Fire Department is doing this, especially with public mentality and its abuse of and toward EMS/911. However, this department isn’t in the forefront of this ‘new’ process. Okaloosa County EMS was (and to the best of my knowledge still is) separate from the fire department. Their fire department would only respond to medical calls at the request of EMS for assistance (movement of morbidly obese patients for example), and for specific emergencies. Often it was rescue that would respond to scenes with the fire department and result in ‘stand-by’ situations. The two were separate, but together. Make sense? While most units actually stayed in the same ‘house,’ some EMS rescue units had stations of their own, separate from the fire department. Thank you for your time and energy.”
— William Schoonover, RN, EMT-B
“You’ve got to be kidding me! I am disgusted with all city councils that have the mentality of bean counting. You jerks, these are peoples’ lives we save; don’t you get it? If you are trapped, slightly injured, or heaven forbid, we just hold your hand as you slip to the other side, money has no right to be part of that. All you politicians give your bean-counting heads a shake and think outside the box and then the grey matter won’t be clouding your sense of thoughtfulness and compassion. Your brother and citizen in Canada.”
—Alex
“As a firefighter/first responder, I completely agree with being available to respond within our first-due areas to assist the ambulance crews with potentially life-threatening emergencies. Unfortunately, most of the calls our engine companies respond to do not fall within the category of life threatening. Our dispatchers are not trained in Emergency Medical Dispatching protocol. Due to the lack of training, dispatchers send out an engine company with an ambulance on literally every incident, including general illness, ground level falls and chronic medical conditions where the patient is ‘just tired of being sick,’ and the list goes on. We usually wind up simply taking baseline vitals, helping the medics load the patient into the ambulance, and then going back in service. I feel that these types of calls are definitely a response overkill. It costs the taxpayers in apparatus wear and tear and could very easily put the company out of service for ‘true emergencies.’ As we all know, the more pieces of apparatus responding to a call, the greater the chance of an accident. We do not need to stop responding engine companies to assist the ambulance crew completely, but we do need to re-define exactly what needs a response from ‘police, fire, ambulance’ and what type of call just needs an ambulance.”
— Bob Black
“I agree 100 percent! Worcester EMS is run out of two hospitals, UMass Memorial and UMass Medical Center University campus. Worcester EMS runs four units in town and a unit in the neighboring town of Shrewsbury, while Worcester fire has trained first responders and EMTs in 11 stations manning 23 units (engine companies, ladder companies and a heavy rescue unit) that can respond from their stations and be at a medical emergency in their districts within minutes, establish care, take vitals and obtain medical histories so the patients can be transferred over to the care of the paramedics when they arrive. I know a few Worcester EMS paramedics and a lot of Worcester Jakes. The people of Worcester do not have a problem with their fire department responding to medicals … the bean counters at City Hall do.”
— Ronald Ayotte
“YES!!!!!! Police officers have plenty to do without having to be responsible for AED deployment. And according to the new guidelines, it’s better to start CPR right away than a AED.”
— Don Dahl
“If the responders at the scene know who’s in charge, why does it matter? How many times have we responded to a ‘non-life-threatening’ emergency only to find out that it IS life-threatening/serious? How wonderful to already have another unit there for support. And if every call bears the same importance, the department lessens the risk of apathy among its employees. Kudos Worcester, Mass.!”
— Person’s name withheld by request