Copyright 2006 The Commercial Appeal, Inc.
By DR. JOSEPH A. WEINBERG
The Commercial Appeal (Memphis, TN)
Ambulances save lives. The firefighter paramedics manning Memphis’ ambulances make a difference in our lives every day. They might be rushing your mother to the hospital to get brain-saving drugs during a stroke. They might be breathing for your toddler who fell into a swimming pool. They might be shocking your own heart back to life after a heart attack. This lifesaving work is happening every day in Memphis — right now, while you read this newspaper.
So kudos to the Memphis City Council’s budget committee for operations and maintenance for demanding, at its May 8 meeting, that the city find a strategy to restore $1 million to the Fire Department’s operating budget for the next fiscal year — vital dollars needed to implement phase two of the reconstruction of its Emergency Medical Services (EMS) Division.
Rebuilding the capabilities of our city’s emergency ambulance service is not an optional add-on to the operating budget. EMS constitutes a core safety function of government — along with fire, police and public health. Emergency medical responses account for over three-quarters of the calls received by the Memphis Fire Department. Having firefighters available to put out fires is critical for all of us. But we all also count on that ambulance promptly rolling up when needed. Having skilled paramedics there to treat our car and bike wrecks, our heart attacks and strokes, our children is also critical for all of us. Both of the Memphis Fire Department’s crucial missions, fire suppression and emergency medical response, must be adequately and responsibly funded.
Memphis runs the largest EMS service in Tennessee, with 31 ambulances responding to over 91,000 calls annually — 65,000 of which require ambulance transport. In comparison, Metropolitan Davidson County transports approximately 55,000 citizens annually.
Unfortunately, due to a prior restructuring gone awry, the EMS Division command and training structure had virtually disappeared prior to the arrival of Memphis Fire Services Director Richard Arwood two years ago.
Our EMS Division consists of one deputy chief and 186 paramedics. Only one of these paramedics is permanently assigned to administrative duties. National standards call for one field supervisor for every four to five ambulances in service. Thus we should have six to eight lieutenants as supervisors in the field on each shift. We are now up to three field supervisors per shift. With no officers, the division has been rotating paramedics to temporary higher ranks and also pulling paramedics from the field to restart a training program.
Fortunately, with the support of the mayor and City Council, Arwood has brought to the Fire Department a new appreciation of the importance of EMS. Last year he successfully recruited Gary Ludwig, a nationally known EMS consultant from St. Louis, to become deputy chief and rebuild the division. Alas, Ludwig has been assigned no clerical or secretarial support and has not yet been able to promote anyone to division chief, battalion chief or lieutenant.
Dr. Joseph Holley, medical director of the emergency department at Baptist Memorial Hospital-Collierville, is also Tennessee’s medical director for EMS and by far the most knowledgeable EMS physician in the region. Holley has agreed to be the medical director for Memphis Fire. Ludwig’s reconstruction plan won approval last year from the mayor and the City Council, to be implemented in three phases. Phase one was funded in this year’s budget. It is the $1 million for phase two (and possibly the phase three money) that is now imperiled.
The confusion that’s been reported in a number of ambulance-response calls over the past few months should be a call to action for the whole region. The City of Memphis finds itself short of in-service ambulances every day. Ambulances are caught unnecessarily at area hospitals for hours waiting to transfer care to overburdened emergency nurses or are tied up with minor calls. Inadequate supervision prevents EMS from unblocking these clogs. We are all at risk when an ambulance has to come from too far away. This past year, the American Heart Association promulgated new standards for resuscitation. We are all at risk when crews do not get needed training.
These risks should not be allowed to continue. We must get the vital supervisory, training and quality management programs in place. The several years of delays proposed in the mayor’s budget are far too risky for all of us. The city must continue to fund the EMS reconstruction plan now.
Mayor Willie Herenton and Arwood have commendably assembled the core of an excellent EMS management team, but that team cannot succeed without necessary resources. The budget committee, through the leadership of Councilman Jack Sammons and sharp questioning by council members Carol Chumney, Barbara Swearengen Holt, Scott McCormick and Joe Brown, seems determined to provide the necessary funding. The physicians of the Memphis Medical Society urge Herenton to work with the council to ensure that EMS is there for all of us when we need it.
Dr. Joseph A. Weinberg is senior consultant with Pediatric Emergency Specialists P.C. and former director of emergency services at Le Bonheur Children’s Medical Center.