Who Should Handle Lift Assists?

[Dinosaur 844]

Even if it means taking a rig (and a medic if in Northern Westchester) to a lift assist when they could be responding to a more serious calls (e.g. cardiac arrest or a MVA)? Taking 1 of the 3 medics to respond to a lift assisnt is a waste, IMO, unless there is a need for pain management. I've never been to a lift assist, so maybe I shouldn't be talking, but I'm just looking for clarification and opinions.

1. What is the call volume in the area you're referring to?
   
2. How many ambulances and crews are there in that area?
   
3. How many simultaneous calls are received in general?
   
4. How many of the simultaneous calls are received while a primary unit is on a lift assist?
   
5. How many of the simultaneous calls received while on a lift assist are a serious MVA or cardiac?
   

I'm willing to bet that there are no answers to these questions and because we can play "what if" forever, there's got to be some common sense involved here somewhere.

What happens when your lift-assist call is actually due to a stroke or heart attack but the information isn't properly reported to 911?

What happens when you're on a BLS accident call and an ALS medical emergency comes in?

A lift assist without any symptoms/complaint is a lift assist and strikes me as a BLS call. Why a medic is sent to that is beyond me but then again we still have agencies that are sending their medics on every call regardless of nature. But that's another thread.

Bottom line is we have to stop acting as if we can pick and choose what we respond to. Someone calls 911 and they get us whether its for a stubbed toe, smoke /CO alarm, burglar alarm or a cardiac arrest, structure fire, or robbery.

[ckroll 101]

Probably because so many agencies consider the 'youth corps' anyone under 50 and the combined age of a crew is regularly over 200.

[firedude 985]

1. What is the call volume in the area you're referring to?
   
2. How many ambulances and crews are there in that area?
   
3. How many simultaneous calls are received in general?
   
4. How many of the simultaneous calls are received while a primary unit is on a lift assist?
   
5. How many of the simultaneous calls received while on a lift assist are a serious MVA or cardiac?
   

The Area I was talking about was Northern Westchester, a majority is covered by a volunteer BLS ambulance and a paid medic in a fly car. A large portion is covered by the 45-Medics (Westchester EMS). This tread (45 Medics - Are 3 enough?) is filled with statistics about the 45-Medics. Some of the questions you have asked are answered there. Others are not available.

[wedgeclose 59]

In our district we are very busy. Often two rigs out on jobs with no backup in sight. I said that PD should first respond to a lift assist with no talk of injury. we have a very well trained PD who have been responding for many years along with ems to all calls. times change and the volumn of ems calls has exceeded coverage so all the more reason for pd to be dispatched first to non emergency lift assist requests. i never said they were nuisance calls. ive been on many lift assists both needing and not needing medical care and know the priorities. we do not have the luxury of having more than 2 ambulance crews available and mutual aid just strips neighboring towns who have trouble just getting a crew together for a daytime call. in urban sectors most lift assists are handled by fd because they have the units available in rural areas both ems and fire are volunteer so that is why pd should be first to go.

[Bnechis 3,961]

You're still tying up FD resources, so what's the difference if you're tying up FD or EMS?

We have 2.5 staffed ambulances and 8 staffed fire apparatus. It is often less of a problem for FD to be there and in most cases the call lasts less than 10 minutes.

In areas were EMS is provided by a commercial company or other fee for service group, is billing the patent for this type of call a consideration for a FD only response?

As Antiquefire points out, you cant bill for these (or risk losing your medicare payments). So thats not an issue.

EMS will not only evaluate for injuries, they also have more specialised patient transport equipment on the rig such as a scoop stretcher, stair chair, REEVES stretchers and all of that, and have more training in moving patients with the least possibility of further injuring them or the rescuers.....But again, its a simple fact of, after the patient is cleared medically by EMS and is given the ok to be moved, it all boils down to who has the strongest backs and who gets there the fastest, right?

Since all our firefighters are EMT's. We expect them to medically clear the person 1st, then pick them up. It is very rare that we need transport equipment and we have it or if really needed we can call for an ambulance. normally we only need it if they are injured and need to be transported to the hospital.

The only plus side of FD doing lift assists is that they get to see buildings without smoke in them. Someday they may be back...for a call involving smoke and that hot red orange stuff...

A very good point and we do take advantage of that.

Another advantage is many of our lifts require forcible entry, which EMS would need us for. Even better is in many multiple dwellings we have Knox Boxes....So the FD has the keys to get in. This is particularly true in all our highrise Sr. Citizen buildings.

Finally, we have a patient assist system that our crews can document the situation and is forwarded to the Office for the aging (and others). This has reduced repeat calls, gotten meals on wheels and home health care services, in some cases special medical equipment and sometimes placement in long term facilities.

I had one call for a person who was on the floor, he had a helth care aid, but was to big for them to lift him. We found no injuries, lifted him back into bed and noticed many cigarette burns in the bedding. I reported it, thru the system and they were able to get the health care service to keep the cigarettes away from the bedroom.

The fall was incidental, but the other was going to create a big issue.

[JJB531 652]

I completely agree with you BNechis about apparatus and staffing levels... But that's New Rochelle and while it may not be an issue there, what about other jurisdictions that struggle to send a fully staffed engine out on calls? I guess whether to send FD or EMS really depends on the dynamics of the individual system to decide what works best.

[Goose 188]

I don't personally care who does the lift assist. I have done lift assists as both an EMS and FD provider. What I am curious about is why EMS agencies request FD's for lifting assistance without first retoning their own agency/department. Why? Is it possible that agencies do not have 1 or 2 extra hands not already on the call?

Is that a serious question? I'm not joking and its with the utmost respect. You / I cannot even be sure a bus will respond in a timely fashion, if at all, to an aided case in the vast majority of this county. It just seems, at least to me, that the FDs (volunteer, not career) have a more robust and active membership. That said, if the job is only a lift assist and there isn't another medic to give me a hand, ill call for some manpower. It doesn't happen often, but when it has, at least with me, i've always gotten more people than i've needed and they've have been more than willing to help.

The way i look at it is we are all here to assist the public - as a team and within our own subset of specialties. At times we all need the assistance of each other to get our individual jobs done. A lift assist can be one of those instances.

Edited May 11, 2012 by Goose

[antiquefirelt 994]

I completely agree with you BNechis about apparatus and staffing levels... But that's New Rochelle and while it may not be an issue there, what about other jurisdictions that struggle to send a fully staffed engine out on calls? I guess whether to send FD or EMS really depends on the dynamics of the individual system to decide what works best.

The key is, as others and BNECHIS has noted above, having a trained EMS provider to clear the patient before anything is done. This is why I believe that only those with an EMS responsibility should be the primary responders on these calls. The FD is absolutely the right place to call if they have trained personnel with the ability to properly (legally) evaluate and determine the patients' medical/injury status. In some places this might be the PD as they may have an EMS responsibility.

[JJB531 652]

Antique I agree with you 100%. If you look back that's been my position from the beginning of the thread. Unless your FF's run BLSFR at the EMT level, it should undoubtedl (IMHO) be an EMS function. If the FF's are EMT's and run enough jobs to be comfortable and competent with their skills, then I could see it being an FD function.

[antiquefirelt 994]

The key is, as others and BNECHIS has noted above, having a trained EMS provider to clear the patient before anything is done. This is why I believe that only those with an EMS responsibility should be the primary responders on these calls. The FD is absolutely the right place to call if they have trained personnel with the ability to properly (legally) evaluate and determine the patients' medical/injury status. In some places this might be the PD as they may have an EMS responsibility.

Got it, I just wanted to chime in for those who are quick to grab on to the notion that it's up to each "individual system to decide what works best". It seems nowadays people are quick to point out how different their situation is and why they need their own special set of rules. Edited May 11, 2012 by antiquefirelt

[Bnechis 3,961]

I completely agree with you BNechis about apparatus and staffing levels... But that's New Rochelle and while it may not be an issue there, what about other jurisdictions that struggle to send a fully staffed engine out on calls?

I find most communities that can not get an engine out have even more trouble getting and ambulance out. Often these same communities only get a trooper or a sheriff and they cover huge area so it may take lots of time and they may only get 1 officer.

This should be a big question for everyone...What level of service is being provided in your community or more importantly in the community where your parents live? Sometimes you get what you pay for and sometimes you do not.

[efdcapt115 1,511]

I find most communities that can not get an engine out have even more trouble getting and ambulance out. Often these same communities only get a trooper or a sheriff and they cover huge area so it may take lots of time and they may only get 1 officer.

This should be a big question for everyone...What level of service is being provided in your community or more importantly in the community where your parents live? Sometimes you get what you pay for and sometimes you do not.

There's a lot of fingers crossed in a lot of places, and people praying their fragile bubble doesn't burst. There's also a ton of ignorance on the part of the public in areas where emergency coverage is questionable at best. It'll never happen to them; until it does.

[firemoose827 324]

We have 2.5 staffed ambulances and 8 staffed fire apparatus. It is often less of a problem for FD to be there and in most cases the call lasts less than 10 minutes.

As Antiquefire points out, you cant bill for these (or risk losing your medicare payments). So thats not an issue.

Since all our firefighters are EMT's. We expect them to medically clear the person 1st, then pick them up. It is very rare that we need transport equipment and we have it or if really needed we can call for an ambulance. normally we only need it if they are injured and need to be transported to the hospital.

A very good point and we do take advantage of that.

Another advantage is many of our lifts require forcible entry, which EMS would need us for. Even better is in many multiple dwellings we have Knox Boxes....So the FD has the keys to get in. This is particularly true in all our highrise Sr. Citizen buildings.

Finally, we have a patient assist system that our crews can document the situation and is forwarded to the Office for the aging (and others). This has reduced repeat calls, gotten meals on wheels and home health care services, in some cases special medical equipment and sometimes placement in long term facilities.

I had one call for a person who was on the floor, he had a helth care aid, but was to big for them to lift him. We found no injuries, lifted him back into bed and noticed many cigarette burns in the bedding. I reported it, thru the system and they were able to get the health care service to keep the cigarettes away from the bedroom.

The fall was incidental, but the other was going to create a big issue.

Agreed that not all situations will call for the equipment to assist with the lift and movement of the patient, but I am sure a respected officer like you knows the emergency scene is a constantly dynamic thing, always changing and new techniques are being created everyday to do the routine things. A simple thing like a scoop stretcher can be invaluable for the 300 pound man lying on the bathroom floor with little room to maneuver, allowing the crew to get the scoop under him and use the handles to lift him up and then carry him back to bed, as opposed to trying to lift him with other means.

But then again a simple thing like a blanket can help out with a large person as well, depending on the situation at hand. I feel (In my area) that with all three agencies responding to some of the calls we have, you get that mixed variety of experience and styles and tools and techniques that can easily be used in most situations.

In my old department, we had the village PD respond with us to all calls in the village, fire or EMS, so they can secure a scene, offer assistance with patients, control any crowds, or be an extra pair of hands. But most of the EMS crews were smaller, older people who couldnt lift, and with only one, possibly two village PD officers you would still need the extra help from FD for lift assists.

The FD that covers my grandparents house are excellent, my grandparents are always falling and require help back up into their chairs, so their chief responds to the scene with the EMS crew and helps them lift, every time they get called there, and being that I live 20 minutes away from them that makes me feel good to know they do things like that. I guess that should be what matters though, and not who is helping or how they are doing it.

Ironically, my FD had a lift assist last night with our EMS crew at 3AM, my back is sore today, but we had a large crew show up to help, had to turn a few away at the door.

[PFDRes47cue 653]

Is that a serious question? I'm not joking and its with the utmost respect. You / I cannot even be sure a bus will respond in a timely fashion, if at all, to an aided case in the vast majority of this county. It just seems, at least to me, that the FDs (volunteer, not career) have a more robust and active membership. That said, if the job is only a lift assist and there isn't another medic to give me a hand, ill call for some manpower. It doesn't happen often, but when it has, at least with me, i've always gotten more people than i've needed and they've have been more than willing to help.

The way i look at it is we are all here to assist the public - as a team and within our own subset of specialties. At times we all need the assistance of each other to get our individual jobs done. A lift assist can be one of those instances.

No disrespect taken. I completely agree with you that we are all fighting for the same cause and helping each other out is a must. It just seems that in other counties in the state, I hear EMS agencies re-tone for their own man power to go to the scene for lifting assistance. If this is not filled then an fd is requested for lifting assistance. I understand doing whatever it takes to get the patient the care they need just seems that rather than just skipping over your remaining membership that could help assist and calling for another agency/department might be unnecessary. If you can not fill the need then of course call an outside agency.

[PFDRes47cue 653]

for the more urban enviorments....with FD as a first responder to calls....can they pick up the pt and place them back in bed or chair or where ever they want and cancel EMS??

I say this because waterbury FD responds to all medical calls if available as the first responder except psychs and all 911s at skilled nursing (except codes). If its a "help me i cant get up" and put me in bed where as farmington FD they can cancel and obtain a refusal

It is not an urban example but up here in St. Lawrence County often times for EMS runs, the rescue squad and FD first responders are dispatched. If the first responders get on scene first and their is no need for rescue, they can cancel the squad.

[JJB531 652]

I find most communities that can not get an engine out have even more trouble getting and ambulance out. Often these same communities only get a trooper or a sheriff and they cover huge area so it may take lots of time and they may only get 1 officer.

This should be a big question for everyone...What level of service is being provided in your community or more importantly in the community where your parents live? Sometimes you get what you pay for and sometimes you do not.

I'm only going to half agree with you because the number of agencies that have gone to paid BLS personnel (ether hired within or contracted out) has increased rather significantly. As of recent you have Briarcliff, Croton, Dobbs Ferry, Eastchester, Harrison, Hawthorne, Mohegan, Ossining, Peekskill, Port Chester/Rye, Somers, Tarrytown, Valhalla (and maybe a few others that I'm missing) who have all started to utilize paid in-house staff. As more and more agencies follow this model of EMS as it becomes necessary or the realization finally sets in that their current system is broken and needs to be fixed, the better probability you have of handling the job in a more expeditious manner with an in-house EMS crew then trying to roster an Engine.

The question posed is a great one, and definitely one we should all be thinking about.

[grumpyff 1,159]

Article in todays NY Post http://m.nypost.com/p/news/local/queens/let_ma_die_lawsuit_5mVyIjEw1NwDKJmXJTaqlL

When asked if she needed an ambulance she said no. She may not have known she had a head injury. I would have to say send EMS, even to just give a basic assesment. If your FD does a first responder program, they can respond as well, possibly cancelling the bus if not needed.

Edited May 14, 2012 by grumpyff