Like EMS agencies across the country, Tualatin Valley (OR) Fire and Rescue has been aware for some time how many of their calls were for non-life-threatening situations that didn't require an engine, four paramedics and a full toolbox to get the right resource to the right person.
In early May, they took a step that they're confident will solve that dilemma and be much more cost-effective in the long run by purchasing four Toyota FJ Cruisers that will be staffed with one paramedic and respond to certain call types.
"We looked at three year's worth of data with the goal of targeting call types, both EMS and fire, that could have been satisfied by a single paramedic response and came up with a call set that we felt comfortable we could send one car to," says EMS Chief Mark Stevens. "We took that information and applied it to our Emergency Medical Dispatch card system as Code 1 types, like abdominal pains or even a commercial alarm with no fire, and we then send the non-emergent car with a paramedic/firefighter. They carry ALS equipment, so if they get there and find something more serious, they have the equipment to start treating and upgrade the response if need be."
In the first four days in service, according to the agency, the cars were deployed to 41 incidents that included 15 false fire alarms, 9 non-injury motor vehicle crashes, and several smoke investigations, lock-outs, falls, sick persons and smoke detector problems. During that same time period, TVF&R's engines, trucks and medic units responded to 256 calls including 56 cardiac and breathing problems, 22 strokes and seizures, 10 fires, 35 unconscious/unresponsive persons and 10 MVA crashes with injuries.
"Before we started the program, we looked at data to see where and when the non-emergency, Code 1-type calls were coming from and noted that most of them are from assisted living and chronically ill-care facilities, so we've developed our schedules around that," says Stevens. "We're working 10-hour days, 40-hour weeks, Tuesday through Friday from 7 a.m. to 5 p.m. When the cars are off-duty, callers will get the nearest engine or medic unit."
Although it sounds like an expensive undertaking, it was far cheaper than buying a new fire engine, says Stevens. The vehicles are all 2007 or 2008 models and were purchased from local dealerships via a public bid process with funds from a capital improvement bond approved by almost 70% of voters in 2006.
"The FJs were low-mileage vehicles and met our criteria," says Stevens. "Everyone thought they should be red because they're fire vehicles, but they don't come in that color. We got four black ones and decaled them, which was much cheaper than painting. With this purchase, we have been able to retire one peak-activity engine and changed the hours from 24 to 12 on three ambulance medic units to free up paramedics, so there's no extra personnel cost."
Thanks to good media coverage, the community is aware and excited about the new response vehicles.
"We used to get asked why there was a big truck in front of someone's house for a general sick condition," says Stevens. "It's easy to explain for a life-threatening condition, but if it's a non-life-threat, it's an expensive piece of equipment to roll if you don't have to."
As the program develops, TVF&R sees many possibilities for expanding the cars' use.
"We're looking especially at some mental health patients and frequent callers and thinking we might pair the paramedics with a crisis team member," Stevens explains. "We had a call last week where one car was on scene for more than an hour with a crisis team member trying to meet the patient's needs and getting him to the right place the first time," he says. "Before now, that call would have meant a four-person fire truck with at least one paramedic and an ambulance out of service for that time. Here, we had one paramedic with a car out of service for one patient, so it was more cost-effective and it met the patient's needs better. If the dispatch cards call for an ambulance, we still send an ambulance the same as always. We're just changing the first response to the call."