Decreased Quality of Care

Staffing “firefighter medics” on fire engines will not improve patient outcomes.

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Staffing “firefighter medics” on fire engines may result in a small reduction in ALS response times—primarily owing to the fact that there are more fire engines than ambulances and ambulances are committed to EMS calls for a longer period of time than fire engines. Small reductions in ALS response times, however, have never been shown to improve patient outcomes.[i],[ii],[iii]

Current response times in the City of Alexandria already strike an appropriate balance between the costs and benefits of ALS response.

Current response times in the City of Alexandria already strike an appropriate balance between the costs and benefits of ALS response.[iv] Reducing ALS response times to a level that would further improve existing patient outcomes is cost-prohibitive (requiring response times of less than 5 minutes for all patients having a medical emergency and less than 4 minutes for all patients in cardiac arrest).[v],[vi]

“Firefighter medics” will not improve the EMS care already provided on the scene by traditional firefighters.

Even for patients requiring ALS care, traditional BLS firefighters are able to perform the most time-critical, lifesaving interventions until medics arrive on the scene.[vii],[viii] In addition, it has been shown that when firefighters with advanced EMS training (such as “firefighter medics”) arrive on the scene before an ambulance staffed by medics, they perform ALS interventions on only a very small fraction (less than 8%) of the patients they encounter, with no proven benefit to patients.[ix]

Increasing the number of medics in the fire department will only reduce each individual medic’s exposure to truly critical patients, resulting in decreased skill proficiency and worse patient outcomes.

Increasing the number of paramedics in the fire department will only dilute the quality of EMS care.

In order to create a cadre of “firefighter medics”, the Fire Chief has sought to hire additional firefighters who already have paramedic training; he is also paying for existing firefighters to obtain paramedic training.[x] Increasing the number of medics in the fire department, however, will only reduce each individual medic’s exposure to truly critical patients, resulting in decreased skill proficiency and worse patient outcomes.[xi],[xii],[xiii]

[i] Blackwell, T.H. (July 2011). EMS response time standards. In J.M. Goodloe and S.H. Thomas (Eds.), Emergency medical services evidence-based system design white paper for EMSA; see also Bailey, E.D. & Sweeney, T. (2003). Considerations in establishing emergency medical services response time goals. Prehospital Emergency Care, 7(3), 397-399.

[ii] Pons, P. T., & Markovchick, V. J. (2002). Eight minutes or less: does the ambulance response time guideline impact trauma patient outcome? The Journal of Emergency Medicine, 23(1), 43-48.

[iii] Blackwell, T. H., et al. (2009). Lack of association between prehospital response times and patient outcomes. Prehospital Emergency Care, 13(4), 444-450.

[iv] Confusingly, the fire department currently only reports “travel time” to the Alexandria EMS Council. This is despite the fact that NFPA Standard 1710 defines “response time” to include not only travel time but also “alarm handling time” (the time it takes to dispatch a call) and “turnout time” (the time between when a call is dispatched and when responding apparatus begin travel to the scene).

[v] Blackwell, T. H., & Kaufman, J. S. (2002). Response time effectiveness: comparison of response time and survival in an urban emergency medical services system. Academic Emergency Medicine, 9(4), 288-295.

[vi] Pons, P. T., et al. (2005). Paramedic response time: does it affect patient survival? Academic Emergency Medicine, 12(7), 594-600.

[vii] Blackwell, T.H. (July 2011). EMS response time standards. In J.M. Goodloe and S.H. Thomas (Eds.), Emergency medical services evidence-based system design white paper for EMSA.

[viii] Myers, J.B., et al. (2008). Evidence-based performance measures for emergency medical services systems: A model for expanded EMS benchmarking. Prehospital Emergency Care, 12(2), 141-151.

[ix] Boland, L., et al. (2015). Advanced clinical interventions performed by emergency medical responder firefighters prior to ambulance arrival. Prehospital Emergency Care, 19(1), 96-102.

[x] Alexandria Fire Department. (Mar. 25, 2015). Information Bulletin 15-022: ALS Class for interested Firefighters.

[xi] Myers, J.B., et al. (2008). Evidence-based performance measures for emergency medical services systems: A model for expanded EMS benchmarking. Prehospital Emergency Care, 12(2), 141-151.

[xii] Eckstein, M. (July 2011). Basic and advanced life support considerations (BLS vs ALS – What does it mean for system design?). In J.M. Goodloe and S.H. Thomas (Eds.), Emergency medical services evidence-based system design white paper for EMSA.

[xiii] Pouliot, R.C. (2010). Failed prehospital tracheal intubation: A matter of skill dilution? [Letter to the editor]. Anesthesia & Analgesia, 110(5), 1507-1508.

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