As part of a three-month pilot program launched in October, the New York City Fire Department will no longer use lights and sirens when responding to non-life-threatening emergencies in Queens. The main aim of the pilot program is to improve safety for the public and firefighters by reducing traffic crashes.
Calls for non-fire, non-life-threatening emergencies have increased dramatically in the past 10 years, according to FDNY spokesman Frank Dwyer. Last year, FDNY responded to 194,406 such incidents throughout the city, often sending multiple fire trucks to each call.
“A growing percentage of our responses are not fires or life-threatening emergencies, but many types of non-life-threatening incidents such as water leaks, downed trees and faulty alarm systems,” says Fire Commissioner Salvatore Cassano. “Often, responding to a call can be even more dangerous for our members than the incident itself, and we want to minimize the danger this poses to firefighters and the public.”
Calls that would qualify for less speedy treatment fall into two categories. One group includes reports of water leaks, downed trees and pulled alarm boxes in the overnight hours when there is no secondary source of information. Such calls currently receive a single unit response in emergency mode. Under the “Modified Response Pilot Program,” these calls will still receive a single unit response, but the unit will respond at a reduced speed and obey traffic regulations, without the use of lights and sirens.
The second group includes reports of odors other than smoke (such as gas or fumes), sprinkler and automatic alarms, and electrical and manhole emergencies. Currently, up to five units (three engine companies and two ladder companies) respond in emergency mode. Under the pilot program, up to five units will still respond, but only one engine and one ladder will respond in emergency mode; additional units will respond at a reduced speed and obey all traffic regulations. Upon arrival, fire officers from the first due units will evaluate the incident and make a determination if the additional responding units are needed, or if they should return to quarters and remain in service. Firefighters will still respond using lights and sirens for medical calls and fires.
FDNY fire apparatus respond to some 1 million calls a year citywide, according to the FDNY. If the pilot program is implemented permanently, the new protocol could mean a 30 percent reduction in lights and sirens responses for non-EMS calls. The program may also reduce wear-and-tear on vehicles.
In 2009, there were 148 crashes citywide involving fire trucks that were responding to calls for water and gas leaks, toppled trees, foul odors, false alarms and faulty sprinkler system activations, according to the FDNY.
Dwyer says there are plans to apply the new protocols to some aspects of the department’s EMS division, too: 850,000 of its 1.3 million calls for service last year, almost two-thirds, were for situations that were not life-threatening emergencies. “We are discussing possibly expanding next year with EMS, but since the pilot program is only a few weeks old, it is premature to discuss the exact details,” he says.
But Stephen J. Cassidy, head of the Uniformed Firefighters Association, which represents most New York City firefighters, calls the pilot project flawed and “just another step” toward closing fire companies. In heavy traffic, “It could take you five minutes to go one block,” he told the New York Times.
For more information, go to nyc.gov/html/fdny/html/events/2010/100410a.shtml.
Rural/Metro Corp. Poised to Win Santa Clara County Ambulance Contract
The Santa Clara (Calif.) County Board of Supervisors voted three to two on Oct. 19 to negotiate a new five-year ambulance service contract with Rural/Metro, according to a county news release. The contract is valued at $375 million, reports the San Jose Mercury News.
American Medical Response has been the longtime ambulance service provider for the county, which includes 1.8 million residents and 15 cities, including San Jose. If the board approves the final contract in December, Rural/Metro will take over service in June. In explaining the decision, county officials said Rural/Metro scored higher on the county’s request for proposal.
The split decision was a controversial one, with San Jose officials calling for further review of Rural/Metro’s financial stability. At a county meeting, more than 40 speakers, including school officials fearing the loss of AMR’s driving-under-the-influence prevention program and paramedics fearing job loss, spoke in favor of continuing with AMR, according to the release. A
Rural/Metro spokesperson says the company will retain current qualified employees at their same pay rates or better.
County officials defended the decision. “Although there are differences in the two corporations, there is no evidence to substantiate that Rural/Metro cannot perform up to the standards of the contract, as they do around the nation,” County Executive Jeffrey V. Smith said in a statement. “We have conducted an extensive review of their operating and financial statements and are satisfied that they can meet our requirements.”
The state requires counties that grant exclusive operating areas for ambulance services to issue a competitive RFP every 10 years. Santa Clara County’s RFP was developed with stakeholder input and submitted to the State Emergency Medical Services Authority for approval, according to the release.
View the county’s news release at sccvote.org/SCC/docs/Emergency%20Medical%20Services%20(DEP)/
attachments/10.20.10%20Press%20Release%20Rural.pdf.
New CPR Guidelines Are Here: Time to Get Your Personnel Trained
The American Heart Association’s new guidelines for CPR put more emphasis on high-quality compressions to prevent deaths from sudden cardiac arrest. The 2010 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, published in the Nov. 2 issue of the AHA journal Circulation, were developed after a comprehensive review of the latest and best data on resuscitation and involved 356 resuscitation experts from 29 countries. Some highlights:
- A-B-C is out, C-A-B is in. For years, responders and the lay pubic were taught to follow the A-B-Cs: airway, breathing and chest compressions. But that can cause unnecessary delays while the rescuer does mouth-to-mouth or retrieves a barrier device or other ventilation equipment, according to the guidelines. Instead, what’s most important is getting blood flowing by doing compressions on anyone who is unresponsive and not breathing normally.
- Under the new guidelines, chest compressions come first and are then followed by airway and breathing for infants, children and adults. The only exception is newborn babies during the first days or weeks of life. “This further focuses resuscitation from both lay persons and EMS providers on circulation first,” says AHA spokesman Vinay Nadkarni, M.D., an associate professor of anesthesia, critical care and pediatrics at the University of Pennsylvania School of Medicine and co-chair of the AHA’s International Liaison Committee on Resuscitation.
- EMS personnel should spend no more than 10 seconds checking for a pulse before starting CPR, then use a defibrillator when it’s available. While the previously recommended ratio of 30 compressions to two breaths has not been changed, the guidelines emphasize, above all, the importance of getting oxygen-rich blood moving throughout the body before ventilating.
- The guidelines read: “It is reasonable for healthcare providers to tailor the sequence of rescue actions to the most likely cause of arrest. For example, if a lone healthcare provider sees a victim suddenly collapse, the provider may assume that the victim has suffered a sudden VF cardiac arrest; once the provider has verified that the victim is unresponsive and not breathing or is only gasping, the provider should immediately activate the emergency response system, get and use an AED, and give CPR. But for a presumed victim of drowning or other likely asphyxial arrest the priority would be to provide about 5 cycles (about 2 minutes) of conventional CPR (including rescue breathing) before activating the emergency response system. Also, in newly born infants, arrest is more likely to be of a respiratory etiology, and resuscitation should be attempted with the A-B-C sequence unless there is a known cardiac etiology.”
- Push harder and deeper. The previous guidelines, published in 2005, called for a compression depth of 11/2 to 2 inches in adults. The new guidelines call for a depth of at least 2 inches. For infants and children, chest compressions should be a depth of at least one third of the anterior-posterior diameter of the chest, or about 11/2 inches in infants and 2 inches in children. Rescuers should also avoid excessive ventilation.
- Doing high-quality compressions also “primes the pump,” so to speak, and increases the chances that defibrillation will work, Nadkarni says.
- Push faster. Instead of doing about 100 compressions per minute, the AHA says doing at least 100 compressions per minute is optimal.
- Minimize interruptions. Every interruption in chest compressions interrupts blood flow to the brain. “Everyone deserves good-quality compressions,” Nadkarni says. “You can’t have long pauses. It’s all about doing and continuing good compressions.”
- Adjust oxygen levels. Instead of boosting oxygen levels to the maximum possible, adjust oxygen to maintain a blood saturation of 94 to 99 percent after resuscitation. Preliminary data show that high concentrations of oxygen may be toxic to the brain, Nadkarni says.
- Pay attention to exhaled carbon dioxide. Exhaled carbon dioxide levels are an indicator of the effectiveness of chest compression and intubation quality. Quantitative waveform capnography should be used to measure carbon dioxide output and monitor CPR quality. Capnography can also tell EMS crews if breathing has resumed spontaneously without having to interrupt compressions to check, Nadkarni says.
- Atropine is no longer routine. Atropine is no longer recommended for routine use in managing and treating pulseless electrical activity or asystole.
- Train your staff. The guidelines also discuss the importance of teamwork in CPR, Nadkarni says. If you haven’t already done so, make sure your staff members are trained in the new guidelines and are doing CPR optimally, either by observing them in action or using compression-quality monitoring devices. “It’s really critically important for people to rapidly adopt the important principles of the new guidelines,” Nadkarni says. “There is no new miracle drug or miracle treatment. The miracle is that in improving each link in the chain of survival and implementing the tenants of the guidelines in your system, you can triple or quadruple your survival rates.”
For more on the new guidelines, see heart.org or circ.ahajournals.org/cgi/content/full/122/18_suppl_3/S640.
Longtime EMS Chief of St. Louis Fire Department Dies
Robert Hardy III, chief of the St. Louis Fire Department’s EMS division, died on Oct. 13 at age 54. Hardy had suffered a heart attack the night before at a dance hall; he died the next day at the hospital, his wife, Pamela, told the St. Louis Post-Dispatch. She and her husband met in 1978, when both were paramedics at Homer G. Phillips Hospital.
Comings and Goings
Jerry Overton has been named chairman of the International Academies of Emergency Dispatch (IAED) Clinical Advice System & Standards Board. According to a news release, Overton will “oversee the processes that clinically and technically combine emergency medical dispatch protocols and nurse triage for health care access management.”
Overton spent 19 years as executive director of the Richmond (Va.) Ambulance Authority. He was one of the first directors of a large EMS system to adopt the Medical Priority Dispatch System, developed by Jeff Clawson, M.D., founder of the IAED and the National Academies of Emergency Dispatch. Among other accomplishments, Overton has provided technical assistance to numerous EMS systems throughout the United States, Europe, Russia, Asia, Australia and Canada. He also designed an implementation plan for an emergency medical transport program in Central Bosnia–Herzegovina. Overton was most recently president/CEO of Road Safety International in Thousand Oaks, Calif.
“He is the backbone of everything the Academy, EMS, and public safety stand for,” Clawson said in the release. “His knowledge in both EMS management and Priority Dispatch go hand-in-hand in refining EMS system design and management.”
Doug Lowe, director of Davidson County (N.C.) Emergency Services, resigned in October after being charged with multiple counts of embezzling about $15,000 from the Thomasville Rescue Squad over a period of more than five years, according to The Dispatch, a local newspaper. Lowe was treasurer for the rescue squad.
Jullette Saussy, M.D., director of New Orleans EMS, resigned Oct. 1. A city news release offered no explanation for her departure. Recently, the New Orleans Times-Picayune had published a series of unflattering reports about her working for more than a year at Vidacare, a Texas medical device company that makes an infusion device used on New Orleans ambulances. Read more at nola.com/politics/index.ssf/2010/09/post_363.html.
