Sparks City Council Sparks City Council Consideration Consideration Should Paramedic-Level Service Be Should Paramedic-Level Service Be Implemented in the Sparks Fire Implemented in the Sparks Fire Department? Department?
Two-Tiered EMS System Two-Tiered EMS System • Designed in 1986 Designed in 1986 • First-Tier – First-Tier – Fire Departments: ire Departments: Fire strategically placed within 4 Fire strategically placed within 4 minute drive time minute drive time Provide rapid initial care Provide rapid initial care • Second-Tier – Second-Tier – REMSA Ambulances: EMSA Ambulances: Provide Paramedic-level service Provide Paramedic-level service Provide transport Provide transport
History of EMS In Sparks Fire Department History of EMS In Sparks Fire Department • 1986 – 1986 – First Responder irst Responder 45% EMS 45% EMS • 1996 – 1996 – Basic EMT-D (defibrillators) asic EMT-D (defibrillators) 60% EMS 60% EMS • 2000 – 2000 – Advanced EMT dvanced EMT 74% EMS 74% EMS • 2016 – 2016 – Paramedic? aramedic? 80% EMS 80% EMS *EMS is a Core Service of the Sparks Fire Department *EMS is a Core Service of the Sparks Fire Department
Is There A Need for SFD Paramedics? Is There A Need for SFD Paramedics? • Only if SFD arrives on scene first Only if SFD arrives on scene first • Only if SFD waits for REMSA to arrive Only if SFD waits for REMSA to arrive • Only if these EMS calls are classified as Only if these EMS calls are classified as urgent urgent
Does SFD Get to EMS Calls First? Does SFD Get to EMS Calls First? • From January 1, 2015 through March 31, 2016, there From January 1, 2015 through March 31, 2016, there were 11,091 EMS calls where both SFD and REMSA were 11,091 EMS calls where both SFD and REMSA responded responded • SFD arrived first 6,705 times SFD arrived first 6,705 times • 60.5% of the time SFD arrived first 60.5% of the time SFD arrived first
How Long Does How Long Does SFD Wait for REMSA SFD Wait for REMSA Wait Times for Fire Department Calls with Wait Times 0 to 5 Minutes 5410 Calls with Wait Times 5 to 10 Minutes 922 Calls with Wait Times More Than 10 Minutes 373 Total Calls where SFD Waited 6705 Average Wait Time 0:03:24 Maximum Wait Time 1:09:25 Median Wait Time 0:02:18 Count of Matched EMS Calls 11091 % of Time SFD First on Scene 60.5%
Average Wait Average Wait Times Times Percent of time Percent of time As EMS calls occur As EMS calls occur that SFD is first that SFD is first 4:47 4:47 further away from further away from on scene by on scene by the core of the City the core of the City district district wait times increase wait times increase 3:50 3:50
When SFD Arrives First Are Urgent EMS When SFD Arrives First Are Urgent EMS Emergencies Found? Emergencies Found? Urgent EMS Call Volume Provider Primary Assessment Number of EMS Incidents Airway obstruction 24 Allergic reaction 35 Altered level of consciousness 421 Cardiac arrest 74 Cardiac rhythm disturbance 51 Chest pain / discomfort 283 Diabetic symptoms (hypoglycemia) 114 Hyperthermia 6 Hypothermia 2 Hypovolemia / shock 16 Poisoning / drug ingestion 35 Pregnancy / OB delivery 16 Respiratory arrest 3 Respiratory distress 326 Seizure 189 Stroke / CVA 66 Syncope / fainting 184 Traumatic injury 897 Total 2742
Paramedic-Level EMS Service Paramedic-Level EMS Service Opportunity to Opportunity to Improve Patient Care Improve Patient Care • SFD is arriving at EMS calls first SFD is arriving at EMS calls first • SFD is waiting for REMSA to arrive SFD is waiting for REMSA to arrive • Over 40% of these EMS calls are classified as Over 40% of these EMS calls are classified as urgent urgent *These 2742 calls represent opportunities hese 2742 calls represent opportunities to improve patient care by providing to improve patient care by providing Paramedic-Level service immediately Paramedic-Level service immediately upon Fire’s arrival upon Fire’s arrival
Medically Speaking – Medically Speaking – Why Upgrade? hy Upgrade? Since the inception of our Advanced EMT service in 2000, Since the inception of our Advanced EMT service in 2000, medicine and associated technology has advanced: medicine and associated technology has advanced: • The Paramedic Scope of Practice has The Paramedic Scope of Practice has expanded expanded much more than the Advanced scope creating a much more than the Advanced scope creating a greater gap between service levels greater gap between service levels • Standards of Care regarding the elapsed time Standards of Care regarding the elapsed time between recognition and definitive care for particular between recognition and definitive care for particular medical emergencies now exists for medical systems medical emergencies now exists for medical systems
EMS Certification EMS Certification Levels Levels Advanced EMT: Advanced EMT: • Performs Basic and a Performs Basic and a limited set limited set of Advanced and of Advanced and pharmacological interventions: pharmacological interventions: Some advanced airway procedures Some advanced airway procedures I.V. access I.V. access 8 8 medications commo medications common to EMS to EMS
EMS Certification EMS Certification Levels Levels Paramedic: Paramedic: • Includes Basic and Advanced skills coupled with Includes Basic and Advanced skills coupled with invasive interventions and pharmacology: invasive interventions and pharmacology: Cardiac care including cardiac monitor and Cardiac care including cardiac monitor and defibrillator capabilities defibrillator capabilities Pharmacological Interventions including Pharmacological Interventions including advanced intravenous techniques and an advanced intravenous techniques and an expanded medication list expanded medication list Advanced airway techniques Advanced airway techniques
Paramedic Interventions Paramedic Interventions Cardiac: Cardiac: Airway / Medical: Airway / Medical: • 12-Lead EKG 12-Lead EKG • Endotracheal intubation Endotracheal intubation • End Tidal CO End Tidal CO 2 monitoring monitoring • Cricothyrotomy Cricothyrotomy • Manual Defibrillation Manual Defibrillation • Needle Thoracentesis Needle Thoracentesis • Synchronized Cardioversion Synchronized Cardioversion • Gastric tube placement Gastric tube placement • Transcutaneous pacing Transcutaneous pacing • CPAP administration CPAP administration • Vagal maneuvers Vagal maneuvers • Various routes of medicine Various routes of medicine • CPR feedback and data CPR feedback and data administration administration
Paramedic Medications Paramedic Medications • Adding similar medications as Adding similar medications as our regional partners our regional partners would quadruple our current medication list: would quadruple our current medication list: 13 additional cardiac emergency medications 13 additional cardiac emergency medications Multiple pain management medications Multiple pain management medications Medications for other serious emergencies including Medications for other serious emergencies including seizures, pregnancy problems, respiratory emergencies seizures, pregnancy problems, respiratory emergencies and altered level of consciousness and altered level of consciousness • Medications can be tailored to our Community needs Medications can be tailored to our Community needs
Standards of Standards of Care Care • STEMI – STEMI – recognition to notification to transport to ecognition to notification to transport to definitive care – definitive care – AHA recommends to strive to reduce HA recommends to strive to reduce this time as this time as much as much as possible possible • Protocols – Protocols – provides for most appropriate treatment rovides for most appropriate treatment • Strokes – Strokes – AHA promotes early recognition as HA promotes early recognition as possible possible • Airway Management - Airway Management - brain death can occur as rain death can occur as early early as 4 to 6 minutes without as 4 to 6 minutes without oxygen oxygen • Pain Management – Pain Management – good patient care and efficiency ood patient care and efficiency *Core Measures and Quality *Core Measures and Quality Assurance Criteria in high Assurance Criteria in high performing EMS Systems performing EMS Systems
Paramedic-Level EMS Service Paramedic-Level EMS Service Other Reasons for Implementation Other Reasons for Implementation • Enhanced Automatic Aid with TMFPD Enhanced Automatic Aid with TMFPD • Back-up plan for delivering Paramedic level care Back-up plan for delivering Paramedic level care • City of Sparks is City of Sparks is a a full-service city full-service city
Recommendation Recommendation • Statistical and medical reasons that numerous Statistical and medical reasons that numerous opportunities exist to improve patient care opportunities exist to improve patient care • Three other reasons to justify a Three other reasons to justify a Paramedic program Paramedic program • Fire Staff recommends implementation of Paramedics in Fire Staff recommends implementation of Paramedics in the fire department the fire department • Two plans proposed, either would be acceptable Two plans proposed, either would be acceptable
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