Re: EMS Assist/Standard of Care Issues

July 26, 2002

If you look at the provision of EMS across the US you will see a wide

range of variation. I do agree, however, that the medical standard of

care is a national standard. Just in the metroplex you will find

departments that send an engine and an ambulance lights and sirens to

EVERY call. (Personally I think it is a waste of resources and a huge

amount of risk for low priority calls). You will also find departments

which risk stratify their response and send additional resources based

on " risk " to the patient.

I would not say that there is a standard of care which says that every

75 yo male with chest pain and difficulty breathing should get an engine

and an ambulance. Two well trained paramedics should be able to handle

this call the majority of the time without any additional assistance.

With regard to NFPA 1710 and EMS this document has done the more than

any other document to set fire based EMS back 20 years. Many fire

chiefs have accepted the EMS recommendations without question. However,

if one reads the references on which the recommendations are based they

all relate to cardiac arrests. NFPA then generalized them to every

other possible type of patient situation. There is no published

literature which supports this.

If your ambulance crews want to choose what type of calls they would

like to have an engine on then it would probably fine as long as this

selection is based on data showing possible need. If you are using MPDS

it might be all DELTA calls. To go along with this you need to collect

data so that you can refine your system such that if on a certain type

of call an engine is not needed 95% of the time then maybe you should

not send one.

Stacey Wyrick, MD

EMS Assist/Standard of Care Issues

To all:

I would like to receive your input regarding EMS Assist calls made by

fire

departments and other groups. Currently, our department responds an

engine

with certain types of calls (chest pain, breathing difficulty for

example)

that were formulated using national standard criteria such as those used

by

EMD, for example.

There is a proposal to change this policy to allow the ambulance crew to

decide which calls (other than major calls) they will receive assistance

from an engine on.

I believe that besides patient care issues and crew safety there is a

standard of care issue involved. I do not know of any fire or EMS agency

in

the Dallas/Fort Worth area that does not receive some type of assistance

on

EMS calls. For those with a fire background, I believe NFPA 1710

addresses

this.

I am requesting input from you regarding your current practice at your

department or company. If you use a national standard, what did you

derive

this from?

I would like to forward these on to the administrative staff that will

be

making the final decision.

Thank you for your assistance.

Lt. Steve Lemming

EMS Training Officer

Azle Fire Department

July 26, 2002

WASTE OF RESOURCE?

I think that you need to do what you feel will BENEFIT your community. No

matter what ANYONE states on here, you have an obligation to provide the BEST

CARE possible to your taxpayers.

Outside of the metroplex [on Co.], about 95% of all EMS calls are

dispatched with the EMS unit. About 60-70% of those agencies are paid or

well-funded volunteer departments that send and engine company. We do have

some EMD certified dispatchers, but do not have a formal method of triaging

calls. The one exception is a city that does not send engine crew to nursing

home calls, but allow the EMS crew responding to request assistance if

needed. It is the RESPONSIBILITY of the responding EMS crew to cancel FRO if

they are not needed to provide QUALITY care.

It is good to allow us to give you some input, but I would look to those that

are in similar situations and apply their mistakes on your way to your

success. Not flaming, I would find it hard to take advice from someone that

is not in the field SHIFT, after SHIFT, after SHIFT [in today's EMS

environment] where ADEQUATE CARE is not acceptable, when people want

EXCEPTIONAL care.

Good luck,

J-B

July 26, 2002

RE: nursing homes, doctor's offices, clinics...

The HARSH reality of it is... despite having medical training, these folks

are very inexperienced and very ill-trained in emergency medicine. That is

what EMS is emergency medicine... we can play on all the symantics that we

want, but when it comes down to it... NONE of the nursing homes in our area

could handle a serious medical call... or a BASIC fall requiring c-spine

precautions. If you can PROPERLY put a nursing home patient in spinal motion

restriction [sMR] with only 2 EMTs... you are the man/woman!!!

I personally DON'T want to take the time to TEACH someone SMR, when there is

an engine around the corner with EMTs/Paramedics that are TRAINED for this. I

can honestly say that I didn't get SMR in my CNA class nor the LPN class

(prior to leaving for EMT classes). If you are taxing beyond basic fire

service, you have an obligation to give the tax payer what they are being

charged for.

I am not saying that it is appropriate that nursing homes staffs, medical

office staff, and/or clinical staffs are not up to the challenge most of the

time, but that is the reality. It could be very different in Tyler, but

working in more than one service... I have found it is the same all places I

have been. What are we to expect from someone that makes about $6-9/hour in

some of the most awful conditions? When they are getting paid at our level

here, you can BET I will expect alot more.

Just a thought,

J-B

July 26, 2002

In the post prior...

I feel it is the responsiblity of the responding crew to cancel additional

resources when not needed. What you describe in your post (Mr. Tate)...

sounds like an issue that is OUTSIDE the relm of FROs... I find that to be a

COMMUNICATION issue. Despite having FROs on 3 different radio frequencies, we

can communicate with all our FROs. And they will tell you, I will cancel them

to any scene they are not needed on.

Common courtesy because I expected the same when I was a fireman... but I

have to admit... I LOVED running medical calls!!!

J-B

July 26, 2002

NOW, that is why I miss running calls with Phil!

If you get rid of the PSYCHs in your area Phil, I might come back. *lol*

July 26, 2002

Should FRO's be dispatched to Nursing Homes, Doctor's

Offices, or other facilities that should have adequate

nursing / medical care on site? I don't think MPDS

makes provision for these calls. We constantly get

sent on calls with EMS and when we arrive the medics

ask why we're there, or waive us off before we even

get out off the engine. We even get sent to free

standing ER's, ICU's, etc for some EMS calls. Should

some common sense be used when sending units to these

facilities?

E. Tate, LP

Tyler, Texas

--- Stacey Wyrick & lt;jwyrick@... & gt;

wrote:

& gt; If you look at the provision of EMS across the US

& gt; you will see a wide

& gt; range of variation. I do agree, however, that

the

& gt; medical standard of

& gt; care is a national standard. Just in the

metroplex

& gt; you will find

& gt; departments that send an engine and an ambulance

& gt; lights and sirens to

& gt; EVERY call. (Personally I think it is a waste of

& gt; resources and a huge

& gt; amount of risk for low priority calls). You will

& gt; also find departments

& gt; which risk stratify their response and send

& gt; additional resources based

& gt; on & #34;risk & #34; to the patient.

& gt; I would not say that there is a standard of care

& gt; which says that every

& gt; 75 yo male with chest pain and difficulty

breathing

& gt; should get an engine

& gt; and an ambulance. Two well trained paramedics

& gt; should be able to handle

& gt; this call the majority of the time without any

& gt; additional assistance.

& gt;

& gt; With regard to NFPA 1710 and EMS this document

has

& gt; done the more than

& gt; any other document to set fire based EMS back 20

& gt; years. Many fire

& gt; chiefs have accepted the EMS recommendations

without

& gt; question. However,

& gt; if one reads the references on which the

& gt; recommendations are based they

& gt; all relate to cardiac arrests. NFPA then

& gt; generalized them to every

& gt; other possible type of patient situation. There

is

& gt; no published

& gt; literature which supports this.

& gt;

& gt; If your ambulance crews want to choose what type

of

& gt; calls they would

& gt; like to have an engine on then it would probably

& gt; fine as long as this

& gt; selection is based on data showing possible need.

& gt; If you are using MPDS

& gt; it might be all DELTA calls. To go along with

this

& gt; you need to collect

& gt; data so that you can refine your system such that

if

& gt; on a certain type

& gt; of call an engine is not needed 95% of the time

then

& gt; maybe you should

& gt; not send one.

& gt;

& gt; Stacey Wyrick, MD

& gt;

& gt; EMS Assist/Standard of Care

& gt; Issues

& gt;

& gt; To all:

& gt;

& gt; I would like to receive your input regarding EMS

& gt; Assist calls made by

& gt; fire

& gt; departments and other groups. Currently, our

& gt; department responds an

& gt; engine

& gt; with certain types of calls (chest pain,

breathing

& gt; difficulty for

& gt; example)

& gt; that were formulated using national standard

& gt; criteria such as those used

& gt; by

& gt; EMD, for example.

& gt;

& gt; There is a proposal to change this policy to

allow

& gt; the ambulance crew to

& gt; decide which calls (other than major calls) they

& gt; will receive assistance

& gt; from an engine on.

& gt;

& gt; I believe that besides patient care issues and

crew

& gt; safety there is a

& gt; standard of care issue involved. I do not know of

& gt; any fire or EMS agency

& gt; in

& gt; the Dallas/Fort Worth area that does not receive

& gt; some type of assistance

& gt; on

& gt; EMS calls. For those with a fire background, I

& gt; believe NFPA 1710

& gt; addresses

& gt; this.

& gt;

& gt; I am requesting input from you regarding your

& gt; current practice at your

& gt; department or company. If you use a national

& gt; standard, what did you

& gt; derive

& gt; this from?

& gt;

& gt; I would like to forward these on to the

& gt; administrative staff that will

& gt; be

& gt; making the final decision.

& gt;

& gt; Thank you for your assistance.

& gt;

& gt; Lt. Steve Lemming

& gt; EMS Training Officer

& gt; Azle Fire Department

& gt;

July 26, 2002

In most places, the FRO is dispatched because

they are generally significantly closer to the

patient than the EMS unit, and thus can provide

care quicker.

Even in places where the EMS unit is collocated

with the FD, the dispatcher for one agency may

not know where the units for the other agency are

located. Also, just becaue an ambulance is

" available for call " doesn't mean it's in the

station; they may be across their district

getting supper, and very few agencies have the

technological equipment to know the exact

location of their units.

Consequently, if one district (sector, region,

etc.) gets a BRT (Big Red Truck) because the EMS

unit is not statined nearby, the other districts

have to get BRTs on their calls, also. This

precludes the " they get better service than we do

because they get BRTs and we don't " argument.

Whether the BRT actually improves the patient's

condition is completely irrelevant to the person

writing the complaint.

Having been an " On-Air Personality " (Dispatcher),

I can tell you that many triage decisions are

based on ***how*** the caller gives the

information, rather than ***what*** the caller

says. In other words, all chest pain calls are

not the same.

Until somebody arrives at the patient's location

and is able to provide hands on/eyes on

assessment of the patient, I think it will be in

the patinet's best interests (and

therefore...your legal department's best

interests) to err on the side of patient safety

and send too much help than not enough.

Also, I have learned that quick BLS can decrease

the need for ALS in a few minutes, especially now

that albuterol, nitro, oral glucose, etc are

available at the BLS level.

I may be mistaken, and forgive me if I am, but be

sure this doesn't involve a " we don't want to run

no ambulance driver calls " attitude from the FD

and a " they aren't worth diddly when they get

there anyway " attitude from the EMS crews. Huge

training and attitude issues. Be sure this isn't

the reason you're thinking of changing your

responses before you jump off the cliff.

Does this rambling help you at all?

stay safe - pr

__________________________________________________

July 26, 2002

--- " E. Tate " wrote:

> Should FRO's be dispatched to Nursing Homes,

> Doctor's

> Offices, or other facilities that should have

> adequate

> nursing / medical care on site?

That depends on the nature of the emergency.

What if the patient needs ventilation, CPR,

restraint, etc.? Are your EMS units staffed to

handle ***any*** transport contingency, such as

CPR, without FD assistance? Do you think it

would be appropriate to take two people from the

nursing home, doctor's office, etc., to the

hospital to do compressions, ventilations, etc.?

I doubt it. That's a big reason the FD needs to

go on these calls. You can always cancel them if

you don't need them, but it's a long 5 minutes to

wait if you need them and they're not there.

stay safe - pr

__________________________________________________

July 26, 2002

Steve,

I would SUGGEST that IF you DO not have EMD trained DISPATCHERS that YOU

seriously CONSIDER not CHANGING any DISPATCH protocols. THE key TO

successfully PREPARING for ANY official INQUIRY (legal action) into YOUR

dispatch PROCEDURES is PROTOCOL and consistency.

THAT is ONE reason WHY EMD works and WORKS well. IT is a STANDARDIZED set of

QUESTIONS that EMD trained DISPATCHERS ask on EVERY call for EMS services.

THE response IS then determined BY the ANSWERS to THESE questions AND is

RESPONDED to the SAME every time....NO matter WHAT. Then, WHEN (not if)

something GOES wrong WITH the PATIENT and questions ARE asked YOU are

supported LEGALLY by a NATIONALLY accepted and researched DISPATCH protocol.

NOT what somebody thought about CHEST pain or HOW serious IT sounded OVER the

PHONE.....

For EXAMPLE, I was trained in EMD by NAEMD and worked IN a COMMUNICATIONS

center that ANSWERED and DISPATCHED over 150,000 requests for EMS services

ANNUALLY. We DID EMD on EACH and EVERY call and ON each and EVERY call THAT

was a DELTA, the FD and EMS went emergency and on EACH and EVERY call that

WAS an ALPHA, EMS went non-emergency and FD did NOT go.

<<<I'll stop the crazy every other word capitalizing....it just seemed to BE

the way to answer POSTS on this THREAD>>>

For example, any patient with rectal bleeding is a Delta response with all

agencies going emergency. Is this needed on all patients that say they are

bleeding from the rectum? NO, but it is necessary because of the research

and protocols state that patients that are truly bleeding are having a

medical emergency and it is worth erring on the side of caution. (Although

one night at about 0330 when I sent an FD engine and ambulance to the nursing

home for a rectal bleed that turned out to be 2 bloody spots on toilet

tissue, I got an angry phone call from an irate non-EMD trained firefighter

who wanted to know if I sent ALL rectal bleeds emergency regardless of their

severity....I told him that I did with the lone exception that if he had a

nose bleed I would consider that a rectal bleed but probably would not send

it emergency...for some reason he hung up??!??)

Anyway, after all this rambling, if you use protocol, base it upon data and

follow it. If you do not, send FD on everything or on nothing....any attempt

to guess or estimate what they are needed on will only set you up for

potential liability that you really do not need to expose yourself to. Try

visiting the NAEMD website (www.naemd.org) and see what they have to

say....they are the experts after all.

My thoughts,

Dudley

July 26, 2002

Phil: You (and all others) have made some very good points. I generally

agree with all of the points presented so far. The main problem is that

dispatch is not able to ask the right questions to narrow down the call (no

EMD). It is timely to see that today the state has released and RFP for a

regional or state Emergency Medical Dispatch resource center for those can

not provide it currently.

I am not sure where this question of changing the response began since we

have been providing call specific first response for two years now. Sure, we

have some that would rather eat twinkies and play nintendo, but fortunately

they are few. Most are aggressive, intelligent people who don't mind running

calls. I feel that we have the duty to provide the same level of care 24/7,

365 in all areas of our jurisdiction city/county without fail. It is simply

the right thing to do. Even FDNY now first responds on EMS calls, which for

many years they didn't. Since we all receive our paychecks from the same

place and dress alike, there are few " them vs. us " squabbles.

Thanks again for all the great posts and information. Hopefully it will help

convince those making the decision of the old agae " If it ain't broke don't

fix it " !

Be safe out there and keep the posts coming!

Steve

Re: EMS Assist/Standard of Care Issues

In most places, the FRO is dispatched because

they are generally significantly closer to the

patient than the EMS unit, and thus can provide

care quicker.

Even in places where the EMS unit is collocated

with the FD, the dispatcher for one agency may

not know where the units for the other agency are

located. Also, just becaue an ambulance is

" available for call " doesn't mean it's in the

station; they may be across their district

getting supper, and very few agencies have the

technological equipment to know the exact

location of their units.

Consequently, if one district (sector, region,

etc.) gets a BRT (Big Red Truck) because the EMS

unit is not statined nearby, the other districts

have to get BRTs on their calls, also. This

precludes the " they get better service than we do

because they get BRTs and we don't " argument.

Whether the BRT actually improves the patient's

condition is completely irrelevant to the person

writing the complaint.

Having been an " On-Air Personality " (Dispatcher),

I can tell you that many triage decisions are

based on ***how*** the caller gives the

information, rather than ***what*** the caller

says. In other words, all chest pain calls are

not the same.

Until somebody arrives at the patient's location

and is able to provide hands on/eyes on

assessment of the patient, I think it will be in

the patinet's best interests (and

therefore...your legal department's best

interests) to err on the side of patient safety

and send too much help than not enough.

Also, I have learned that quick BLS can decrease

the need for ALS in a few minutes, especially now

that albuterol, nitro, oral glucose, etc are

available at the BLS level.

I may be mistaken, and forgive me if I am, but be

sure this doesn't involve a " we don't want to run

no ambulance driver calls " attitude from the FD

and a " they aren't worth diddly when they get

there anyway " attitude from the EMS crews. Huge

training and attitude issues. Be sure this isn't

the reason you're thinking of changing your

responses before you jump off the cliff.

Does this rambling help you at all?

stay safe - pr

__________________________________________________

July 26, 2002

Sorry, I guess I didn't quite get my point across.

I'm not talking about calls where FD is needed; I.e.

cardiac arrest, difficulty breathing, falls, etc. I

am speaking about calls for routine transport calls.

We get sent on calls that come across to the engine as

some kind of emergency call. Upon our arrivial we

find Mr. in his room with C/O no BM X4 days.

EMS rolls up 5 minutes later non-emergency and wants

to know why we're there on a bowel obstruction.

I've worked in dispatch, on the truck, and now on a

truck company (Quint) in south Tyler. I believe it's

time for the dispatchers to wake up and smell the

coffee. Why are we running 5 firefighters and a

$500,000+ truck company-hot-across town for bowel

obstructions, " I don't feel wells " , and the like?

Miscommunication? Failure to follow MPDS? Random

sequencing?

We've had EMS units sitting at the station with us,

and they'll get a call for something serious in our

district. So we'll go ahead and roll with them.

Suprisingly, we never get dispatched on the call. We

even get sent on lifting assistance calls and aren't

given any information about the patient's condition.

Assumptions are a bad thing, but when you get,

" Attention Ladder 2, Assist EMS with lifting

assistance, 123 Main, unit responding acknowledge " , we

don't run hot. In our truck the difference between

hot and cold is minimal, but we've arrived on one

occasion and the " lifting assistance " is actually a

code.

Our county is in the midst of building a new County

Wide 911 Dispatch Center. The only exception is the

private EMS service here will not be participating.

However, we on the streets feel this new center is a

very good thing. Other changes are being made like

our chief encouraging EMS to get on our channel if

needed and give us information. Something we often

hear from the crews is that they never know if we are

coming or not. Seems easy enough to fix to me, " EMS

350, Be enroute to 123 Main for a difficulty

breathing, Fire is also enroute " . Where is the

breakdown? I don't know. Hopefully someday we'll

get something like " Attention Ladder 2, Assist EMS

Unit 350 with lifting assistance, 123 Main, unit

responding acknowledge " . Then if there is a questoin

we can flip over the the EMS channel and asks them.

Time will tell.

Now here's something else to lay out there. What about

being sent to a free standing " ER " . Both of our local

hospitals have these in our district and we get sent

to them on calls for things like chest pain with

difficulty breathing. Is it just me, or shouldn't an

" ER " be able to handle this until EMS arrives? Then

there are those times we are dispatched to the main

hospital campus for some kind of medical emergency. I

understand the " way out in the back 40 " they have a

construction worker that's impaled on rebar, but

cardiac arrest in a private room? Where is the

hospital staff? What about calls to dialysis centers

or personal physicians offices?

Forgive me, I'm in the middle of my last move for a

long time, and had a very bad shift Wednesday where we

were sent on 3 to 4 calls that IMHO, we should have

never been sent on in the first place. Maybe my shift

tomorrow will be better than the last.

Stepping down from my soapbox,

E. Tate, LP

--- CenTexMedic1970@... wrote:

> RE: nursing homes, doctor's offices, clinics...

>

> The HARSH reality of it is... despite having medical

> training, these folks

> are very inexperienced and very ill-trained in

> emergency medicine. That is

> what EMS is emergency medicine... we can play on all

> the symantics that we

> want, but when it comes down to it... NONE of the

> nursing homes in our area

> could handle a serious medical call... or a BASIC

> fall requiring c-spine

> precautions. If you can PROPERLY put a nursing home

> patient in spinal motion

> restriction [sMR] with only 2 EMTs... you are the

> man/woman!!!

>

> I personally DON'T want to take the time to TEACH

> someone SMR, when there is

> an engine around the corner with EMTs/Paramedics

> that are TRAINED for this. I

> can honestly say that I didn't get SMR in my CNA

> class nor the LPN class

> (prior to leaving for EMT classes). If you are

> taxing beyond basic fire

> service, you have an obligation to give the tax

> payer what they are being

> charged for.

>

> I am not saying that it is appropriate that nursing

> homes staffs, medical

> office staff, and/or clinical staffs are not up to

> the challenge most of the

> time, but that is the reality. It could be very

> different in Tyler, but

> working in more than one service... I have found it

> is the same all places I

> have been. What are we to expect from someone that

> makes about $6-9/hour in

> some of the most awful conditions? When they are

> getting paid at our level

> here, you can BET I will expect alot more.

>

> Just a thought,

> J-B

>

> [Non-text portions of this message have been

> removed]

>

=====

" It's been said that a firefighter's first act of bravery is taking the oath to

serve. And all of them serve, knowing that one day they may not come home. "

- President Bush

October 7, 2001

__________________________________________________

July 26, 2002

God Bless ALL the help I get on scene....when all the bickering is done...I

love hearing the BRT right behind me and the love hearing the white box show

up too.

I think Phil and Junior have said it all...btw, Waco looked lovely

tonight...arggghhh

RE: EMS Assist/Standard of Care Issues

>

> --- " E. Tate " wrote:

> > Should FRO's be dispatched to Nursing Homes,

> > Doctor's

> > Offices, or other facilities that should have

> > adequate

> > nursing / medical care on site?

>

> That depends on the nature of the emergency.

> What if the patient needs ventilation, CPR,

> restraint, etc.? Are your EMS units staffed to

> handle ***any*** transport contingency, such as

> CPR, without FD assistance? Do you think it

> would be appropriate to take two people from the

> nursing home, doctor's office, etc., to the

> hospital to do compressions, ventilations, etc.?

> I doubt it. That's a big reason the FD needs to

> go on these calls. You can always cancel them if

> you don't need them, but it's a long 5 minutes to

> wait if you need them and they're not there.

>

> stay safe - pr

>

> __________________________________________________

>

July 27, 2002

asst calls should be used for crowed residences and large patients that require

more than two medics or for full arrests or any medical call that needs man

power ast..

Silsbee EMS

114 hwy 96 south

Silsbee, Tx 77656

EMS Assist/Standard of Care Issues

To all:

I would like to receive your input regarding EMS Assist calls made by

fire

departments and other groups. Currently, our department responds an

engine

with certain types of calls (chest pain, breathing difficulty for

example)

that were formulated using national standard criteria such as those used

by

EMD, for example.

There is a proposal to change this policy to allow the ambulance crew to

decide which calls (other than major calls) they will receive assistance

from an engine on.

I believe that besides patient care issues and crew safety there is a

standard of care issue involved. I do not know of any fire or EMS agency

in

the Dallas/Fort Worth area that does not receive some type of assistance

on

EMS calls. For those with a fire background, I believe NFPA 1710

addresses

this.

I am requesting input from you regarding your current practice at your

department or company. If you use a national standard, what did you

derive

this from?

I would like to forward these on to the administrative staff that will

be

making the final decision.

Thank you for your assistance.

Lt. Steve Lemming

EMS Training Officer

Azle Fire Department

July 27, 2002

THESE ARE ONLY MINIMUM CARE LEVELS NOT A LIMIT IN MY OPINION.

Silsbee EMS

114 hwy 96 south

Silsbee, Tx 77656

Re: EMS Assist/Standard of Care Issues

WASTE OF RESOURCE?

I think that you need to do what you feel will BENEFIT your community. No

matter what ANYONE states on here, you have an obligation to provide the BEST

CARE possible to your taxpayers.

Outside of the metroplex [on Co.], about 95% of all EMS calls are

dispatched with the EMS unit. About 60-70% of those agencies are paid or

well-funded volunteer departments that send and engine company. We do have

some EMD certified dispatchers, but do not have a formal method of triaging

calls. The one exception is a city that does not send engine crew to nursing

home calls, but allow the EMS crew responding to request assistance if

needed. It is the RESPONSIBILITY of the responding EMS crew to cancel FRO if

they are not needed to provide QUALITY care.

It is good to allow us to give you some input, but I would look to those that

are in similar situations and apply their mistakes on your way to your

success. Not flaming, I would find it hard to take advice from someone that

is not in the field SHIFT, after SHIFT, after SHIFT [in today's EMS

environment] where ADEQUATE CARE is not acceptable, when people want

EXCEPTIONAL care.

Good luck,

J-B

July 27, 2002

I agree use some common since thought processes.

Silsbee EMS

114 hwy 96 south

Silsbee, Tx 77656

EMS Assist/Standard of Care

& gt; Issues

& gt;

& gt; To all:

& gt;

& gt; I would like to receive your input regarding EMS

& gt; Assist calls made by

& gt; fire

& gt; departments and other groups. Currently, our

& gt; department responds an

& gt; engine

& gt; with certain types of calls (chest pain,

breathing

& gt; difficulty for

& gt; example)

& gt; that were formulated using national standard

& gt; criteria such as those used

& gt; by

& gt; EMD, for example.

& gt;

& gt; There is a proposal to change this policy to

allow

& gt; the ambulance crew to

& gt; decide which calls (other than major calls) they

& gt; will receive assistance

& gt; from an engine on.

& gt;

& gt; I believe that besides patient care issues and

crew

& gt; safety there is a

& gt; standard of care issue involved. I do not know of

& gt; any fire or EMS agency

& gt; in

& gt; the Dallas/Fort Worth area that does not receive

& gt; some type of assistance

& gt; on

& gt; EMS calls. For those with a fire background, I

& gt; believe NFPA 1710

& gt; addresses

& gt; this.

& gt;

& gt; I am requesting input from you regarding your

& gt; current practice at your

& gt; department or company. If you use a national

& gt; standard, what did you

& gt; derive

& gt; this from?

& gt;

& gt; I would like to forward these on to the

& gt; administrative staff that will

& gt; be

& gt; making the final decision.

& gt;

& gt; Thank you for your assistance.

& gt;

& gt; Lt. Steve Lemming

& gt; EMS Training Officer

& gt; Azle Fire Department

& gt;

July 27, 2002

Consider if you are a private service and you abuse fire service ast. you might

end up not receiving the ast. services when actually needed. buy a Fire chief

who doesn't under stand you needs.