Week 2 of the Orleans Citizens Fire Academy focused on emergency medical services (EMS).
Deputy Fire Chief George E. Deering, IV began the session with an overview of EMS at the Orleans Fire Department. The Orleans Fire-Rescue Department responds to some 3,000 calls a year, 80% of which are medical.
Orleans is fortunate to have three state-of-the-art ambulances, equipped as well as many emergency rooms were not that long ago. The ambulances and equipment offer redundancy, uniformity and are each staffed with three personnel.
Deputy Deering spoke briefly about the difference in training between an "EMT" and a "Paramedic". EMT personnel undergo approximately 120 hours of initial training. Paramedics, on the other hand, undergo 1,800 hours of initial training to qualify. Both classifications carry requirements for continuing education and periodic re-certification.
Working on an ambulance is a unique medical environment. One must work in a cramped space and be able to perform all tasks while traveling at speeds of 70 miles per hour.
Ambulance service is much different today than it was just a few years ago. Today's ambulances and their personnel are capable of providing advanced life support and nearly all the services you would find in a hospital emergency room. Paramedics and EMT's carry hundreds of tools with them to confront nearly an emergent medical situation. Far from yesterday's "scoop and run", today's EMT's and Paramedics are trained to stabilize a patient and make critical interventions that can save the patient's life long before they reach the hospital.
The Orleans Fire Department receives approximately $600,000 a year in ambulance billing income. This is collected from patients' insurance companies at negotiated rates. Billing is handled through an outside billing service. $100,000 a year of ambulance revenue is set aside in an ambulance replacement fund. Ambulances cost $300,000 and are replaced every three years. The Town of Orleans has three ambulances that are replaced on a staggered basis.
A tour of the ambulance bay is quite an experience. When we arrived in the bay, the firefighters had set up tables with all of the contents of an ambulance laid out. From med bags, to cardiac monitors, to defibrillators, to advanced equipment - it was all there. In addition to the contents of the medication bags, each ambulance is fully stocked with medications and supplies.
Here you'll find an IV or airway for every size adult and child - and advanced video technology to help insert the airway. They have advanced automatic stretcher lifting and loading devices to help ensure patient safety and avoid firefighter back injuries. There is a "stair chair" that will carry a patient over a stairway to reach the ambulance. The ambulance carries medications for every conceivable emergency - from EPI pens for allergic reactions, to Narcan for overdoses, to advanced painkillers and intervention drugs for patients suffering heart attacks. Monitoring devices vary from a simple finger monitor up to a full EKG setup.
One of the most impressive devices in the ambulance is the LUCAS chest compression system. This device automatically delivers CPR chest compressions to a patient whose heart cannot beat on its own. Paramedics told the group that the LUCAS device delivers exactly the right compression every single time - and it doesn't get fatigued. Better still, the LUCAS can keep performing CPR while the patient is being moved, carried up or down stairs and more. In some cases, paramedics say that the hospital asks to continue using the LUCAS device until the patient is stabilized in the emergency room.
All of the medications and devices in the kits are specified in a protocol guide that was shared with the class. It lists every single item - consumable and non-consumable - that is carried in the ambulance. The Orleans Fire-Rescue Department replenishes its consumable supplies at Cape Cod Hospital each time they deliver a patient. Less-frequently-used medications are constantly inventoried to monitor expiration dates.
Deputy Deering stressed that all emergency medical equipment is constantly tested and re-tested. "Every single item needs to work every single time," he reminded us. Many of the medical devices have redundant systems that include replacement batteries and the ability to plug into an AC outlet either on the ground or in the ambulance.
Every medical bag is configured exactly the same and the ambulances are stocked and configured identically. Paramedics and EMT's need to know where everything is in each bag and in every cabinet. Color coding is used extensively along with bold labels in large block letters.
This session offered an abundance of information. The paramedics and EMT's on duty explained the equipment and supplies with great enthusiasm for their work, often relating a story about how a specific item helped save a life on one of their calls.
It is a long drive to Cape Cod Hospital in the best of traffic and often a nightmare during peak summer traffic. Today's ambulances and the highly trained professionals that operate them are capable of providing advanced life support that starts the moment the rescuers arrive at the patient's side. By being in constant communication with the emergency room staff, the ambulance staff can conduct interventions and prepare the patient for their arrival at the hospital. In many cases today, a patient suffering a cardiac event can be taken directly from the ambulance to the cardiac cath lab when they arrive at Cape Cod Hospital. Within a few minutes of arriving at the hospital that cardiac patient can be well on the road to recovery.
Deputy Deering and all the other staff stressed "If you you think you need 911, you should call 911." Making that quick decision can quite possibly save your life.
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