By Heather Rawlyk
The Capital
Copyright 2008 Capital Gazette Communications, Inc.
ANNAPOLIS, Md. — When a heart stops beating, the time starts ticking for county paramedics to get to the patient’s side.
But often, the paramedic team stationed nearest to an emergency is tending to another person in distress — forcing dispatchers to call on the next closest firehouse to send an ambulance to the scene.
That scenario has caused some county paramedics to fall short of the national standard on their times to respond to medical emergencies in recent years, with some going as much as 5 minutes over the limit, said Battalion Chief Matthew Tobia, a county Fire Department spokesman.
But fire officials are crediting a pilot program to strategically use their paramedics with turning the problem around.
Faced with a shortage of funding and staff, the department’s options are limited. But by shuffling employees, further educating firefighters and equipping fire engines with paramedic equipment, the new program is proving to be a good option in a pinch.
Basically, department officials are spreading out their paramedics to be able to respond to more calls.
In 2006, paramedics in 10 areas around the county’s 30 fire stations were taking longer than the 6- to 8-minute standard set nationwide by the American Heart Association, Chief Tobia said. The trouble spots are spread throughout the county, from Lake Shore to Harwood and Deale.
Since the implementation of the pilot program in mid-2006, all but two of the 10 fire stations over the limit met the national standard last year, Chief Tobia said. Herald Harbor is still over the mark by 26 seconds, and the Annapolis Neck area is 36 seconds over the 8-minute standard.
That’s because the Annapolis Neck relies on the city’s Eastport Fire Department to handle medical emergencies, Chief Tobia said, adding precious seconds to their responses with the additional level of communication. County fire officials said they expect the response time to decrease “considerably” in that area with the introduction of the new Annapolis Neck Fire Station, slated to open off of Bay Ridge Avenue in April 2009.
A domino effect
Department officials said the problem was a “domino effect.” For example, if the paramedic unit in Avalon Shores in south county is at a medical call, a second emergency that requires paramedics must rely on a unit from Harwood to respond.
In the meantime, if a critical medical emergency happens in Harwood, an paramedic ambulance from Deale is called in to help.
“When something happens in Brooklyn, it can be felt in Harwood-Lothian,” Chief Tobia said.
Often, the two paramedics assigned to each ambulance aren’t both needed at the emergency. This commonly leaves the skills of one paramedic at each scene not being used to their fullest capacity, Chief Tobia said.
While ambulances are running from call to call, several of the county’s 30 fire engines are parked in the bay, waiting for a blaze or less-traumatic medical emergency to respond to.
That’s why when a frantic caller dials 911, a fire truck is often first to arrive at the scene. Plus, there are 10 more engines than ambulances in Anne Arundel.
“One of the most common questions we get is, ‘Why is a fire truck showing up to my house when I called for an ambulance?’ ” Chief Tobia said. “It’s because often, because of call volume, it’s likely an ambulance is already out on a call. We send as much help as quickly as we possibly can. A fire truck is usually what is closest and available.”
Generally, fire engines are only staffed with firefighters. All county firefighters have the 120 hours of training required to be certified emergency management technicians, or EMTs, meaning they have basic techniques, like cardiopulmonary resuscitation and using an automated external defibrillator.
But only a paramedic, who has 2,000 hours of advanced training, can provide care in certain life-threatening emergencies, such as giving a patient intravenous medications and applying a pacemaker, Chief Tobia said. And the paramedic response-time clock doesn’t stop ticking until they’ve arrived on the scene.
The county currently has 300 trained paramedics, who are split for shift work amongst 20 units. Until summer 2006, they were only assigned to the busy ambulances that drive from scene to scene. Some were working positions within the department that didn’t require their paramedic credentials.
The solution
To use each paramedic’s skills to their full capability, and get the needed help to a life-threatening situation quicker, the county Fire Department in June 2006 started the pilot program, modeled after other similar ones in departments across the country.
The department started with Harmans/Dorsey Fire Station on Dorsey Road in Glen Burnie. The idea was to equip the station’s fire engine with the $30,000 worth of tools needed for a paramedic to treat a critically ill or injured patient. Once the engine was updated, the department split that station’s two-person-per-shift paramedic unit - one paramedic would ride in an ambulance, and the other would ride aboard the fire engine.
If the station’s paramedic is on a medical call with the ambulance, and another call comes in, the fire engine - now staffed with a paramedic - could respond to the scene, and the clock stops. As a bonus, the paramedic on the fire engine can also take part in fighting flames on fire calls. This is something many firefighters miss doing after being trained as a paramedic, Chief Tobia said.
Giving paramedics the opportunity to occasionally fight fires is not only a good way to keep them satisfied with their job, but also is a good recruiting tool, said Capt. Rob Vaccaro, of Harmans/Dorsey Fire Station.
“It gives us the best of both worlds,” he said. “It’s a win-win situation for everyone.”
After seeing positive results, the department in July added equipment to the fire engine at Woodland Beach Fire Station.
The two stations were chosen because of their higher call volume and the distance of the next nearest fire station, Chief Tobia said.
And through a program with Anne Arundel Community College, the county Fire Department is continually training firefighters to become paramedics. It’s also moving staffers with paramedic credentials, but weren’t using them in their positions, to other stations where they can put their skills to use.
This allowed a paramedic ambulance to be put to use at Avalon Shores in 2006. And in July, a paramedic unit was placed at Herald Harbor Fire Station. Neither had its own paramedic ambulance running before the shifts.
“Before, it (a paramedic unit) always had to come from Waugh Chapel,” Chief Tobia said. “It was taking a paramedic unit out of service in their (Waugh Chapel’s) community.”
The tweaks prove to be working, Chief Tobia said. With more funding, shuffling of staff, and further training of county firefighters, the department hopes to expand the program to other stations - equipping fire engines with medical supplies and tools, and placing paramedics on more trucks.