Since the inception of Oregon’s Marion County Fire District #1 (MCFD #1), much of its service area, once sparsely populated farmland, has been divided into dense housing complexes and businesses. An estimated 50,000 citizens now live within MCFD #1’s boundaries. With its rapid increase in population, the district has experienced challenges including rising call volume, increased numbers of paid personnel, the need for newer and larger equipment, and greater demands for training. It’s also seen an increase in pediatric emergencies.
MCFD #1 provides 24-hour paramedic advanced life support ambulance service to an area slightly larger than its fire-protection boundaries, as well as backup ALS service to surrounding areas. It currently fields three full-time ALS ambulances and two full-time ALS fire engines. Of its more than 6,000 calls a year, approximately 85% (5,100) involve medical emergencies, and roughly 10% of those are pediatric.
Among those pediatric patients are those with critical cardiovascular, pulmonary, immunodeficient and endocrine emergencies, many emergencies pertaining to chronic medical conditions, and some requiring pediatric ventilators. Recognition and management of pediatric emergencies is of paramount importance to MCFD #1’s providers. They now use PALS (Pediatric Advanced Life Support) kits designed to assist them with key interventions, such as timely and effective resuscitation.
“Pediatric patients are a low-frequency, high-risk group, thus demanding EMTs’ and paramedics’ expertise in the field,” says Marc Houston, DO, MCFD #1’s EMS physician advisor. “Time is of the essence: Pediatrics decompensate quicker than adults, and only 5%–12% of pediatric patients in cardiac arrest survive to hospital discharge.”
In 2008 Houston developed a multifocus strategic plan to enhance MCFD #1’s training and emergency medical delivery. Since then the district’s EMS Division has implemented intensive training schedules and demanding benchmarks. These include training and testing in 12-lead EKG interpretation, Advanced Cardiac Life Support (ACLS), Advanced Medical Life Support (AMLS), PreHospital Trauma Life Support (PHTLS) and, for those special patients, Pediatric Advanced Life Support. In addition we have rolled out surgical cricothyrotomy, intraosseous infusion (with the EZ-IO), continuous positive airway pressure (CPAP) and use of pneumatic ventilators. In 2011, with the support of Salem Health’s Department of Cardiology and Emergency Medicine, MCFD #1 successfully implemented the first prehospital cardiac cath lab activation program at Salem Health, in Oregon’s capital.
Later in 2011, MCFD #1 applied for a state grant aimed at providing transporting EMS services advanced equipment to support their work. It won that award in 2012. This was a reflection of professional staff vigorously pursuing avenues to fulfill the needs of its communities and enhance its care of pediatric patients. Like all fire and EMS systems in its region, MCFD #1 has to prioritize for effective operations within the constraints of its budget. Grants can supplement that.
The grant-writing process is a collaboration involving multiple stages. MCFD #1’s providers are highly educated, many achieving advanced fire and management degrees. They collectively addressed hard questions such as, “In today’s economy, how can we provide competitive service and enhance our EMS system?” As calculated as the grant-writing process is, it encompasses multiple drafts and revisions before an application is completed. The PALS kits we obtained as a result of our grant are a valuable addition to MCFD #1’s emergency medical inventory, and “were placed into service at no cost to taxpayers,” notes Battalion Chief Kyle McMann, of the district’s Finance Division.
As MCFD #1 providers respond to an increase in emergency requests, emergency kits have to become simpler and more standard. The PALS kits came with individual Unimed packs (minus pharmaceuticals) and coordinate with the Broselow system, which will replace the comparable pediatric life support equipment traditionally used in the district. Along with advanced training, more advanced supplies will help our providers deliver better care to both infants and children. We look forward to setting the regional standard of care for pediatric emergencies.
“This EMS grant was a great opportunity for MCFD #1 to obtain critical emergency equipment for pediatrics at no cost to its budget,” says firefighter/paramedic Jerrod Schuch. “It was a win-win scenario.”
For more see www.mcfd1.com.
Jerrod Schuch is a firefighter/paramedic for Marion County Fire District#1 in Salem, OR.
Patrick Wineman is battalion chief of the EMS Division, Marion County Fire District#1 in Salem, OR.