Loading...
ADDITION Staff Report EMT vs EMR Staff Report Date of Meeting: March, 3rd 2021 To: City Council From: Mike Hinz, Fire Chief Re: EMT Certification Requirement We have had this discussion with the city council multiple times over the years. The last time it was looked at was when Lakeview Ambulance moved to having an ambulance staffed in the fire station in 2014. We have also had this discussion with our Fire department officers recently, and have researched a few different options for reducing the requirement of EMT. The research has consistently suggested the continuation of EMT services. My staff and I feel that any reduction in the EMT requirement, even in part, would eventually leave the department with a limited number of EMT’s on staff to provide advanced care that requires at least 2 EMT’s to be on the call. One of the items that always comes up during this discussion is the additional cost of EMT training over the cost of EMR training. In 2019 the Minnesota Board of Firefighter Training and Education has determined that EMT training is a cost of firefighting and is now allowing fire departments to apply for reimbursement for the EMT training. In 2019 we received $9,600 reimbursement for the EMT training when we hosted it for 5 of our members. As a rural community, the state requirement for an ALS ambulance is 30 minutes. Currently MHealth has an average response time between the dates of 6/1/2020-12/31/2020 of 13 minutes and 58 seconds for emergent calls and 14 minutes & 47 seconds for non-emergent calls. The Scandia Fire Department’s average response time in the City of Scandia is 12 minute & 30 seconds. That means on average we are on scene for 1 minute & 28 seconds before the ambulance arrives emergent, and 2 minutes 17 seconds if they are responding non-emergent. This is MHealth’s average not including when they call a mutual aid ambulance for our area. Every year we end up having 3-4 calls that we end up waiting on-scene for 10 minutes or more before an ambulance arrives due to traffic or the need for the responding service needing to use mutual aid for coverage. As you can see in the charts below, the majority of the calls that we respond to are of a medical nature. 57% are medical and the remaining 43% is made up of 8 different types of calls. I just want to remind you that if someone calls 911 for help, they expect the fire department will come and take care of the problem. Also, if dispatch is not sure what the problem is, they will dispatch fire to figure it out and solve the problem. With the type of community we are, I do not see the percentage of medical calls decreasing. However, I do believe we will see it increase over time. Let me start with some of the capabilities that we would lose if we changed our requirement from EMT to EMR. Some of these changes would not be seen immediately as we would still have EMT staff for a while, but if it is not a requirement of the employee, no one would continue to earn their EMT certification on their own. Here are the meds that we would eventually lose since they require at least 2 EMT or higher members to administer: *Albuterol – This is to assist with breathing difficulty from things like COPD, Asthma & Bronchitis. *Aspirin – Given as early as possible during suspected heart attack *Glucagon – This is used to increase blood sugar in a diabetic patient *Nitroglycerine – Used to treat heart attack patients, it is a vasodilator *Epinephrine – This is given when a patient is suffering an allergic reaction to something. We would also not be able to use our advanced airway (I-Gel) during CPR operations Some of these medications that are allowed to administer at EMT level are very time sensitive. One example is Epinephrine, when someone is having a severe allergic reaction seconds do matter. This drug can make a life-or-death difference when administered early. It may be the difference between the patient beginning to recover when the ambulance arrives or the patient being unconscious and not breathing when medics arrive. The ability to use an advanced airway is also a critical part of the CPR process. We have added the use of the I-Gel advanced airway and the use of the Lucas automatic compression device to try to improve the outcome of cardiac arrest incidents. Albuterol is another one of those medications that may make the difference between a patient being conscious or unconscious. This is also a medication that the patient wants if they are experiencing difficulty breathing. If you have ever not been able to breathe, it is one of the scariest moments you will experience and Albuterol in most cases will help these patients feel that they can breathe again in a matter of minutes. Being an EMT gives our department that extra level of training that continues to make a substantial difference to those who are served by our agency. EMT training provides our membership, especially our newer members, critical skills and confidence to perform when they are under the stress of the emergency situation that they otherwise would have no experience with.. Having members that are EMT vs EMR also allows the ambulance crew to concentrate on their paramedic level interventions, knowing they can tell members what they need and it will get done. We have had all ambulance services that work in our area (Lakeview, MHealth, North & Lakes area) tell our staff that they like responding to our area, because they know the patient will be ready for their advanced care as soon as they arrive. If they need a rider to assist from one of our members during the transport, we always have ready and willing staff with the knowhow to assist with patient care. In closing, I would just like to say that if you asked our membership if the skills they have received as part of the EMT training has given them the confidence to do the job, or saved someone they worked on, I am confident that most would agree with that statement. Also, I think that the residents and visitors to the City Scandia expect this level of care and service from our department when they call for help. I feel that reducing the care we provide would be a disservice to our residents and community. 0 5 10 15 20 25 30 35 January February March April May June July August September October November December Total calls vs Medical Calls Medical Calls All calls 7% 0% 57% 7% 3% 19% 4% 1% 2%Call types Fires Explosion Medical Hazard condition Service Good Intens False alarm Weather Special