Boston Fire Department Defends Using Trucks for Medical Calls

[x635 4,066]

Boston Department Defends Using Trucks for Medical Calls

Keith O"Brien Globe Staff - Maria Cramer and Donovan Slack of the Globe staff contributed to this report

The Boston Globe

1-25-09

The massive 42-foot ladder truck, with its 110-foot rear-mounted ladder and 500-gallon water tank, was designed for fighting raging fires and plucking people from burning buildings. But on its recent fatal run, Ladder 26 was on a more pedestrian duty: a medical call for a man having difficulty breathing.

FULL STORY: http://www.boston.com/news/local/massachus..._medical_calls/

[Guest]

This happens in dublin quite frequently, but thats because we only have a max 17 ambulances (12 fire brigade 5 health service) dedicated to ems calls (others tied up on patient transports etc) for a city of over 1.5million.

Each fire brigade truck will have minimum of 4 trained paramedics on board, maybe even an advanced paramedic, it works out will with pre determined attendences for RTA's, Cardiac Arrests, Possible spinal injurys etc including turnout of both truck and ambulance.

Sometimes when there just isnt an ambualnce available (happens quite often as they get tied up in a ED waiting for a bed for the pt so they can get their trolley back) a motor will be sent to assess and stabalise the pt until an ambulance arrives.

Granted its not an ideal situation, but politics has made it this way and rescources have to be managed as efficently as possible

[INIT915 1,119]

FULL STORY: http://www.boston.com/news/local/massachus..._medical_calls/

Very interesting to see then Gov. Mitt Romney's position.

[IzzyEng4 427]

What they fail to state in the article is how BFD responds to medicals and thier running rules. Ladder Companies and Engine Companies housed swap every other month as first out. So odd months (Jan, Mar, May, Jul, Sep, Nov) for example medicals are handled by the ladder company the other months the Engine company handles medicals. The last I knew prior to the crash this running rule had not changed.

[Bnechis 3,961]

since when does BFD's trucks carry 500 gal of water?

The article says that 15 years ago 50% of BFD's calls were EMS, but now its 37%.

NFPA also says (not in this article) that most FD's are running 65-85% EMS. If this is true, BFD is clearly not "over sending" FD apparatus.

Interesting that the Globe is trying to blame this tragic accident on FD EMS response. Maybe the way to stay safe is to never have FD's leave the station.

The real issue here is why did the breaks fail?

Why does BFD not have a preventative maintenance program?

Why did the Fire Commissioner tell the Globe that he did not know that they did not have a proper PM program, but 6 months earlier he told them they did not have personnel with the skills to do PM?

Loved the comment from the Nursing homes, In my experience the best medical care in most "skilled Nursing Facilities" comes from EMT's & Paramedics.

[INIT915 1,119]

What they fail to state in the article is how BFD responds to medicals and thier running rules. Ladder Companies and Engine Companies housed swap every other month as first out. So odd months (Jan, Mar, May, Jul, Sep, Nov) for example medicals are handled by the ladder company the other months the Engine company handles medicals. The last I knew prior to the crash this running rule had not changed.

It appears they did address this in the article:

Each firehouse alternates the vehicles it sends on medical calls, MacDonald said. One month, the fire engine will answer medical calls. The next month, the ladder truck will respond. The goal, he explained, is making sure firefighters assigned to each truck use the EMT training they have received.

[Guest alsfirefighter]

I love when those not in the service and have no clear nor precise background or information on the topic starts chiming in with stuff. Perhaps they need to be taught about tiered response.

One of my favorite arguments against bls response was the old "it puts too much wear and tear on the apparatus." Give me a break. But take it everywhere for parades...and nevermind the AFA that you went to 5 times in one day from the same place. But don't have a heart attack, stroke, SOB, or fall...we can't afford to put the mileage on the near half a million dollar engine that your hard earned money helped pay for.

I don't care if the response level was 99%. You still need to have safe staffing and appropriate response for the 1% and they are out there doing a needed job and one that was traditionally the FD role in many areas. I love the comments by some on the globe sight. As if you can't tell they don't like EMS. Nothing like keeping tradition from getting in the way.

[IzzyEng4 427]

It appears they did address this in the article:

Okay I did miss it then. Trying to read boston.com on the work computer isn;t that great. My bad on that one.

[Goose 188]

Honestly, i never felt that i needed to have a fire department respond with me. My partners and i are very capable of holding down calls ourselves. When i worked with an FD who ran medical calls i always let them go 10-8 once we got there.

Most of the time they had no desire to be there or running EMS calls in general and we never needed any additional help anyway so back in service they went.

I guess it all depends on your system, but as apparent from this article, it often comes down to increasing run numbers to justify jobs, budgets, etc. There really is little mention to see if the patient benefits from a CFR response.

[wcr20 17]

This may be nit-picky, but does it bother anyone that the paper termed a chest pain call "more pedestrian duty"?

[DR104 141]

quote]

Honestly, i never felt that i needed to have a fire department respond with me. My partners and i are very capable of holding down calls ourselves. When i worked with an FD who ran medical calls i always let them go 10-8 once we got there.

Most of the time they had no desire to be there or running EMS calls in general and we never needed any additional help anyway so back in service they went.

You will one day!!!! I guess from your age 21-24 you have seen it all!!!! Never turn away help. I as a paid firefighter do have a great desire to help and be there!!!!!!!!!!!!

Edited January 25, 2009 by DR104

[Bnechis 3,961]

Honestly, i never felt that i needed to have a fire department respond with me. My partners and i are very capable of holding down calls ourselves. When i worked with an FD who ran medical calls i always let them go 10-8 once we got there.

Most of the time they had no desire to be there or running EMS calls in general and we never needed any additional help anyway so back in service they went.

We had to develop policies because too many EMS crews wanted "to be nice" to the fire crews and let them go even on calls where they were needed. While you may be "capable" that does not mean its the right thing to do. Having extra hands does cut time on the call. And didn't the patient pay for the hire level of service, that you feel is not needed because you are capable?

One of the reasons we had to develop policies was after pt's deteriorated after EMS got there but had yet to complete an assessment and didn't realize the pt was critical.

I guess it all depends on your system, but as apparent from this article, it often comes down to increasing run numbers to justify jobs, budgets, etc. There really is little mention to see if the patient benefits from a CFR response.

1) If you do the math, which the media never does, you'd see that BFD's numbers are up, subtract the number of EMS calls and they are still higher than they were before they did EMS.

2) In my depts case, 21 years ago we were doing 3,600 calls per year, now we are over 8,000 and we started doing EMS 30+ years ago. Our EMS % has been dropping while everything else has gone up.

3) we dont justify based on call volume (our City Manager could care less) we justify based on NFPA, ISO, ICMA standards which address the number of firefighters and the response time/distance to respond to those calls. If you reduce the fire response your rating goes up and your property owners will pay for the increased insurance 6-12 times more than the cost for the fire dept. In fact our total number of fire & hazard calls (not counting our EMS calls) is greater now than the total call volume with EMS was 20 years ago.

[Guest]

Hmm seems like a differnt set of cercs in the states. In dublin all fire fighters are paramedics and rotate their shifts between the ambualnce and the appliance. Thus ems calls are as big a part of their jobs as rescues and fires, so they're not disinterestd.

I've found from being in attence at incidents where a fire appliance responds with an ambualnce, its often there first and they guys are never disinterested, they do their job and unlike other mabulance crews are gratful of my assistance and assements and take full patient handover from me rather then just dismissing me like some have.

[Goose 188]

First of all i never made any generalization about any fire department or firefighter(s). I spoke directly of my experience and my experience alone. I never espoused that i "saw it all" all i said was that on the vast majority of calls my partners and i are capable of handling the call in a safe, timely and effective manor ourselves. That's my responsibility as a professional.

When i worked in areas where FD ran CFR (don't work in a system like that any more) 99.99% of the time i or my partner released the engine company almost immediately. From where i stand, there is no point in holding them up on a sick call but. Cardiac arrest or a very nasty job - that tended to be a different story but that wasn't an every day occurrence. Never once did a patient suffer because i or my partner released the fire crew from an EMS call. I'm sorry, I'm not just not going to keep them on an EMS call for vomiting and diarrhea.

Additionally, it's a mixed bag. Some guys don't mind running EMS and some guys hate it. Sometimes you get a good assessment sometimes you get nothing. Thats just the truth as i have experienced it. Bnechis and DR104, if your departments take an aggressive proactive approach to EMS then thats great. I'm sure patients benefit, but that isn't the case everywhere.

Edited January 25, 2009 by Goose

[ny10570 745]

Had the accident occurred after an AFA or building inspection would they be pushing to stop sending trucks out on those also? BS article from a paper that seems to have it out for the BFD. I appreciate the need for critical analysis of the dept, but this paper always seems to attack the dept.

[Bnechis 3,961]

Had the accident occurred after an AFA or building inspection would they be pushing to stop sending trucks out on those also?

How about after a fire?.......Maybe its too dangerous to let them drive back from a fire/

BS article from a paper that seems to have it out for the BFD. I appreciate the need for critical analysis of the dept, but this paper always seems to attack the dept.

While the Globe has a reputation of attacking BFD and BFD has a reputation for being a very agressive fire dept. It also has a very poor record when it comes to many issues (maintenance, hiring, promotions, drinking &/or drugs onduty and DUI/DWI in dept vehicles to name the ones that have been out in the press).

The biggest question that has yet to be answered is why would the BFD and its union not insist on having a vehicle preventitive maintenance program? Why would they have no certified mechanics? Why did 50% of the rigs tested after this incident need to be placed out of service? And the emergency inspection program suspended because they had run out of spare rigs and it would have shut down companies?

The lawyers are circling for the kill on this one, and there are lots of potential targets.

[ny10570 745]

Now that would make for interesting reading. Wow, actual cause and effect. But without room for speculation and accusation its not juicy enough.

[Guest]

This may be nit-picky, but does it bother anyone that the paper termed a chest pain call "more pedestrian duty"?

I find that absolutely hysterical in an appalling way. It's sad that even under the circumstance of this papers less than p/c editorial about BFD they still manage to throw EMS even lower down the chain! It's OK the patient was just having a little attack of ye ole black lung, nothing to be concerned about... From my experience I can agree and yet agree to disagree on a lot said in regards to suppression doing EMS runs. For starters 60% of the time we beat them to the job. In NYC once EMS doubles up the CFR-D Engine is released, even if they're still en route. The other 40% of the time sure it's more than likely manageable by the EMS providers, and if the patient is critical enough you'll more than likely be calling for BLS on the back. However many times I've been more than appreciative of FD being there to help. Most guys in my area started in EMS and haven't forgotten their roots. Heck even if they don't carry my chair with me, at least they can take my lunchbox and tv down...

[FirNaTine 370]

First of all i never made any generalization about any fire department or firefighter(s). I spoke directly of my experience and my experience alone. I never espoused that i "saw it all" all i said was that on the vast majority of calls my partners and i are capable of handling the call in a safe, timely and effective manor ourselves. That's my responsibility as a professional.

When i worked in areas where FD ran CFR (don't work in a system like that any more) 99.99% of the time i or my partner released the engine company almost immediately. From where i stand, there is no point in holding them up on a sick call but. Cardiac arrest or a very nasty job - that tended to be a different story but that wasn't an every day occurrence. Never once did a patient suffer because i or my partner released the fire crew from an EMS call. I'm sorry, I'm not just not going to keep them on an EMS call for vomiting and diarrhea.

Additionally, it's a mixed bag. Some guys don't mind running EMS and some guys hate it. Sometimes you get a good assessment sometimes you get nothing. Thats just the truth as i have experienced it. Bnechis and DR104, if your departments take an aggressive proactive approach to EMS then thats great. I'm sure patients benefit, but that isn't the case everywhere.

Gotta agree with ya Goose on this one. Many guys can't stand EMS runs whose kidding who! Let's not justify our position cause call volume is down and somebody needs a hand wiping their @ss! Especially when their on a B/S call, you know the person that's been feeling sick for 5 days and decides to call you at 3:00am or has had a backache for a week. Let's not forget the "Jacobi & Meyers Whiplash" cases either. Ya know, the ones where motorists involved in an mva are all walking around prior to your arrival looking at their cracked tail light but suddenly want to be boarded after Emergency personnel arrive. I love being on these, especially when the rest of the companies get toned out for a "Job" in your first due area and your waiting 15 minutes for a bus so the Flu patient can get their taxi ride to the ER and don't have to wait outside in ERWaiting Room. I've actually heard of one Dept., from EMS personnel, where many of their guys don't even get out of their rig when an ambulance arrives first on scene. They go 10-8 immediately, so let's stop patting ourselves on the back. This is why so many of us fight for a position on the Truck Co. I guess one way to stop it though is to alternate companies on EMS runs every month, like BFD does. Sounds like a good practice. Why should guys get CFR/EMT pay and never have to step foot out the door on a call. Spread the wealth and keep members skills sharp, After all, aren't we all getting paid to do the same Job? Either that or maybe members should be rotated between apparatus. This would not only keep members sharp with their CFR/EMT skills but also all they've been taught about Firefighting. Yeah that would go over Big! Suddenly everybody would get amnesia about Pumping!

Edited January 30, 2009 by FirNaTine

[Bnechis 3,961]

Gotta agree with ya Goose on this one. Many guys can't stand EMS runs whose kidding who! Let's not justify our position cause call volume is down and somebody needs a hand wiping their @ss!

In many parts of the country the job is EMS with an occassional fire...dont like it...leave. In right to work states they will show you the door. Do we have members who do not like EMS calls...sure, we also have guys that dont like packing hose or mopping floors...get over it. We have been doing EMS as a regular part of our job for 31 years now. Only 5 of our members came on before that (& they are chiefs who don't respond on EMS calls anymore, but they are all EMT's and have been there). To everyone else... we were doing it before you took the job, so if you really dont want to do 60% of your job, I'm sure we can find someone else who does. We've been doing it since long before the calls went down, so I guess we are not justifying anything, just doing the right thing. What about MVFD, during the "busy years" they were EMT's & ran 2 ambulances, they no longer do either, & they have the same numbers, I wonder, do you think they would get more respect/help from the community if they did EMS?

Especially when their on a B/S call, you know the person that's been feeling sick for 5 days and decides to call you at 3:00am or has had a backache for a week. Let's not forget the "Jacobi & Meyers Whiplash" cases either. Ya know, the ones where motorists involved in an mva are all walking around prior to your arrival looking at their cracked tail light but suddenly want to be boarded after Emergency personnel arrive.

THis is not just an FD issue. Why does the ambulance my taxes pay for need to be tied up on these calls?

I love being on these, especially when the rest of the companies get toned out for a "Job" in your first due area and your waiting 15 minutes for a bus so the Flu patient can get their taxi ride to the ER and don't have to wait outside in ERWaiting Room. I've actually heard of one Dept., from EMS personnel, where many of their guys don't even get out of their rig when an ambulance arrives first on scene. They go 10-8 immediately, so let's stop patting ourselves on the back.

Again this is a system wide problem, that no one has been able to solve, not just an FD issue. If the crews are not doing there job, then the leadership needs to deal with that. Someday it will bite them on the butt.

This is why so many of us fight for a position on the Truck Co. I guess one way to stop it though is to alternate companies on EMS runs every month, like BFD does. Sounds like a good practice. Why should guys get CFR/EMT pay and never have to step foot out the door on a call. Spread the wealth and keep members skills sharp, After all, aren't we all getting paid to do the same Job?

Makes sense, I like the idea.

[FirNaTine 370]

Talking to guys in FDMV they never ran 2 ambulances. Only one BLS bus and only a handful of guys volunteered to do it without any stipend. Most guys in FDMV during the busy yrs were not CFR's or EMT's. It wasn't required as part of their Job title like in other Depts. Your right about one thing though Bnechis, City Administrators don't care about "call volume" and "productivity". Many Depts are doing more calls now with the addition of EMS and are doing it with less manpower and equipment. Our response numbers have gone up but not our manpower or apparatus needs to meet these increases. Once again we're doing more with less. Then again, there's many a FF. who'd rather be administering O2 or applying bandaids then making a hallway or searching the floor above. I've got no problem assisting an ambulance with a Code or stabilizing a patient who was seriously injured until EMS arrives. If it's a serious injury or medical condition requiring immediate treatment then so be it. Everyone should give 100%. I got a problem though with tying up a 1/2 a million dollar piece of apparatus that's short manned to begin with for somebody who has a fever and runny nose. I personally believe all calls should be triaged with regards to an FD response. This isn't only me saying this but many a taxpaying citizen also. I've heard this issue brought up many times at City Council meetings buy residents of a Municipality. On another note, how many Engines are allowed to be out on EMS calls simultaneously before your Dept. denies a response? What's NRFD's protocol?

[NWFDMedic 58]

I don't know how it works down in Westchester, but I've never had a career/combo department up here that responds to EMS ever have a complaint about being there. Also, in the vast majority of cases, if they are there before us, they have an excellent assessment in progress. Maybe I should be giving more credit to the guys and gals in Kingston, Poughkeepsie, Arlington, and Beacon because they do an excellent job and are always willing to help. I'll grant you that they'd rather be on a nozzle or cutting a roof and I've had officers come up to me and ask "hey, we have a job, do you have this" and I'll say "absolutely". I know the feeling, because I've been in the same position when the EMS system is hitting the fan and I'm on standby at the remnants of a small fire. I have to kindly ask the OIC whether he can manage if we cleared and they usually understand as well.

I'm sure that the vast majority of calls that they are sent on could be handled by the EMS crew alone, just as the vast majority of room and contents fires can be handled by a single engine company. The reason we send more help is because of that minority of calls that may require it and the fact that those minority of calls, whatever the percentage, put life in danger. And when life isn't in danger, I definitely appreciate the extra hands when the last 3 calls I did were 300 lb. 3rd floor carry-downs alone.

[Bnechis 3,961]

On another note, how many Engines are allowed to be out on EMS calls simultaneously before your Dept. denies a response? What's NRFD's protocol?

How many engines are allowed on simultanious AFA, or CO calls or any other call?

If 4 of 5 engines are already out on EMS calls (even if they are BS calls) and a call comes in for chest pain (particularly with an EMS delay) do you not send an engine because there may be a fire call?

If the patient feels they did not get the service they are entitled too, how do you explain to a jury that we did not service them because someone else might call?

[SRS131EMTFF 471]

How many engines are allowed on simultanious AFA, or CO calls or any other call?

If 4 of 5 engines are already out on EMS calls (even if they are BS calls) and a call comes in for chest pain (particularly with an EMS delay) do you not send an engine because there may be a fire call?

If the patient feels they did not get the service they are entitled too, how do you explain to a jury that we did not service them because someone else might call?

Yes but can't you also be the target of similar liability if you are already out on the a medical call and another call comes in and there is no one able to make the save? Is there not an obligation for the fire department to provide its tax payers with fire-rescue services, which may or may not include first response.

[Guest]

So normally we complain about how certain depts and personnel pick and choose calls, and now some people are advocating it?

Edited January 30, 2009 by Slayer61

[Bnechis 3,961]

Yes but can't you also be the target of similar liability if you are already out on the a medical call and another call comes in and there is no one able to make the save? Is there not an obligation for the fire department to provide its tax payers with fire-rescue services, which may or may not include first response.

Generally liability includes a duty to act, once you set the standard of what that duty is (what you respond to), if you have resources available and you fail to use them, then you have failed to act. If you run out of resources you have limited liability because its not that you failed to act, you have delayed acting.

Since state law clearly does not allow you to abandon a patient, even if BS. Your hands are tied. The best solution is to do a better job of triaging the calls.

[SRS131EMTFF 471]

Ok, now I understand. Thank you for the clarification.

[FirNaTine 370]

The best solution is to do a better job of triaging the calls.

My point exactly. I was under the impression though that many Depts. including yours, will only dispatch a certain number of Eng.Cos. on EMS calls. I believe I was once told no more then 3 out of the 5 are allowed to be out on EMS runs at one time. Just curious, cause many yrs. back I was conversing with an ER nurse, who was absolutely infuriated and was reaming me a new one because she had a fire in her house that got away because the 1st and 2nd due Engine Cos were on EMS runs and it took longer for the 3rd due Eng. Co. to arrive. She basically told me to worry about putting out fires and not her Job. She calmed down though after I bought her a drink!

[Bnechis 3,961]

My point exactly. I was under the impression though that many Depts. including yours, will only dispatch a certain number of Eng.Cos. on EMS calls. I believe I was once told no more then 3 out of the 5 are allowed to be out on EMS runs at one time. Just curious, cause many yrs. back I was conversing with an ER nurse, who was absolutely infuriated and was reaming me a new one because she had a fire in her house that got away because the 1st and 2nd due Engine Cos were on EMS runs and it took longer for the 3rd due Eng. Co. to arrive. She basically told me to worry about putting out fires and not her Job. She calmed down though after I bought her a drink!

We dont have any policy like that.

A lot of ER RN's there use to complain when EMS didn't start IV's on BLS Pt's or didn't get bloods (cause they would have to do it), so they dont want FF's doing "their job" but they also want EMS doing it....cant have your cake and eat it too.

[FirNaTine 370]

We dont have any policy like that.

A lot of ER RN's there use to complain when EMS didn't start IV's on BLS Pt's or didn't get bloods (cause they would have to do it), so they dont want FF's doing "their job" but they also want EMS doing it....cant have your cake and eat it too.

I hear ya Bnechis, but are you telling me that your Dept. will send all 5 Eng.Cos. out on EMS calls leaving the rest of the City without any water supply? Don't we have an obligation to provide Fire Protection? If the City doesn't want to pay for EMS that isn't our fault. If I was a taxpayer and the 1st due Eng.Co. was out on a sprained ankle, I'd be pretty pissed off if I had a true Emergency. There comes a time where calls have to be triaged like we both agreed upon.