EMS Study Tour Completes Circuit of Southwest U.S.
The "EMS Diversity in America" Study Tour traveled the Southwest U.S. Oct. 7-14 visiting private and public EMS services from Los Angeles, CA to Las Vegas, Nevada where participants spoke at EMS EXPO on Oct. 16, 2008.
The "EMS Diversity in America" Study Tour traveled the Southwest U.S. Oct. 7-14 visiting private and public EMS services from Los Angeles, CA to Las Vegas, Nevada where participants spoke at EMS EXPO on Oct. 16, 2008.
Final entries coming soon!
Day 5: Dispatches from Tucson, Arizona
Southwest Ambulance, a unit of Rural Metro Corporation, operates both ambulances and fire trucks in Pima County and other contracted areas in southern Arizona. Arizona has interesting laws governing EMS. Service areas, rates and some performance standards are regulated by the state of Arizona through its state lead EMS office. As such, ground ambulance services can only operate in a specific area by a process called certificate of necessity (CON). BLS and ALS services can have separate CONs in the same geographic service area.
Marco Rivera oversees both fire and EMS operations in the Tuscon/Southern Arizona area. With 567 employees, most of whom are with the EMS Operation, Southwest provides ALS services to several areas outside the city of Tucson and it handles all BLS transports within the city of Tucson. Tucson Fire Department transports all ALS patients within the city.
With all operations combined, Southwest does upward of 100,000 calls per year, a very busy operation. They also provide secondary PSAP services for their own fire and EMS operations as well as provide contract dispatching for several area jurisdictions. As with other Rural Metro PSAPs, they utilize National EMS Academy EMD and medic priority dispatch system (MPDS). They also operate their own fire training academy in Tucson.
Todd Pearson is the Deputy Chief for EMS operations with Tucson Fire Department (TFD). Tucson Fire runs about 76,000 calls per year including both fire and EMS responses. As with most other fire-based EMS operations in the US, 80% of those calls are EMS. They operate 17 paramedic-staffed trucks for transport of ALS patients only. Rural Metro transports all BLS patients under contract with TFD.
The Tour Group was both surprised and honored when Chief Pearson read a proclamation from the honorable Robert E. Walkup, Mayor of Tucson, proclaiming the date of our visit, October 11, 2008 "Emergency Medical Services Day in this community," and encouraged "all of our citizens to support the many public safety activities and efforts of Tucson's emergency services professionals." Tour group members acknowledged the honor and thanked Chief Pearson for his extraordinary efforts on behalf of the City of Tucson.
Tucson Fire is implementing a high tech program that places remotely operated video cameras both in the ambulance patient compartment and on the rear of the vehicle. These cameras transmit both patient management and scene information to the base hospital -- University Medical Center in Tucson. The base station docs can remotely operate the cameras and even zoom in on a shot or patient to see what is happening at the scene and in the ambulance. The doc can also appear on a screen in the patient compartment and provide advice to the paramedic treating the patient. This all operates on a city wide M.E.S.H. network.
Related Video: Tucson Telemedicine
Tucson Fire has a human services referral program by which paramedics can access a local web site at any of their fire stations and make an on line referral for social services needs for patients they see in the field, whether or not the patient is transported.
A truly landmark innovation involves putting "Alpha" trucks in all TFD fire stations. The PSAP uses the MPDS to dispatch them to low acuity 911 calls. Alpha trucks are pickups that can respond code 1 or 2 to a scene, assess a patient and then take the time at the scene to help that patient get help through a long laundry list of social service programs available in the city of Tucson.
According to Norma Battaglia, RN, of the TFD, the Alpha trucks are staffed by fire academy graduates that are basic EMTs. System stats show that the Alpha truck program has reduced repeat 911 abusers and, more importantly, reduced needless responses by ALS units, freeing them up for higher acuity calls. Placing these less costly units in their operation has allowed TFD to respond to higher numbers of calls each year without having to place more ambulances and paramedics in service to meet the demand.
Day 4: Travel day -- San Diego to Tucson.
Day 3: Dispatches from San Diego
San Diego Medical Services Enterprize is a unique partnership between the City of San Diego and Rural Metro San Diego. Asst. Fire Chief Rod Ballard cites the organization's mission: "In partnership with the community, we shall provide innovative and quality medical care." On close inspection there is indeed evidence of both innovation and quality. It seems counter-intuitive that fire department employees and Rural Metro employees could work side by side, on equal status without rancor or major turf issues but that is what happens every day as the "Enterprise" responds to upwards of a 100,000 calls for service per year. Chief Ballard is Vice Presient of the company and works closely with CEO Philip Forgione, a Rural Metro employee.
The San Diego Medical Services Enterprise also takes a lead role in a Program called Project Heartbeat. Project Heartbeat is a public access defibrillator/CPR training program that has place over 4,000 AEDs in and around the City of San Diego and provides training in CPR and AED use to the citizens of San Diego. Since its inception in 2001 the program boasts 51 saves of cardiac arrest victims.
Todd Stout, CEO of First Watch explained how his company can provide monitoring, surveillance and reporting for public health and public safety as well as operatational and performance monitoring for fire, EMS and police organizations.
Captain Pringle, SDFD, teaches documentation at the San Diego Fire Academy and oversees the Tap Chart electronic documentation system used by its medics. Tap Chart is a home grown Palm based program that has been in use for 8 years. The system is very user friendly, is well like by San Diego paramedics and has won several awards since its inception. The San Diego Tap Chart system will soon be integrated with Image Trend's E-PCR and data system which will give the San Diego Medical Enterprise a user friendly and robust data system.
Tom Anglim supervises the SD Fire/EMS Communications center. The Center is recognized as a "Center of Excellence" by the National Academy of Emergency Medical Dispatch. It has 14 work stations and dispatches 75 engines, 42 ALS ambulances as well as BLS ambulances. All vehicles in the fleet are equipped with mobile data terminals with AVL/GPS and mapping capability.
San Diego Fire boasts 2 state of the art fire/rescue helicopters. The air unit consists of Bell 212 and 412 airships equipped with medium duty winches, FLIR, night vision goggles and 350 gal. water tanks. The hydraulic suction on the 412 can fill its tank in 17 seconds. Each aircraft is staffed with a pilot, paramedic and flight engineer.
Image Trend's Dave Zaiman hosted the World EMS Study Tour, representatives from San Diego Medical Services Enterprise and Jon Becknell and Lauren Simon from EMS Best Practices with a champagne reception and dinner aboard the motor yacht Renown Hornblower, the evening of Thursday, October 9, 2008. The time aboard the yacht provided a great opportunity for networking between study tour members and folks from the San Diego EMS and fire community.
Day 2: Dispatches from Los Angeles
Los Angeles City Fire Battalion Chief Tim Ernst points to steady improvements that have been made over the last 8-10 years that have improved response times and patient care for the 850 responses each day by EMS units with the LA City Fire Department.. He touts a proud tradition in his fire service that runs 130 ambulances and transports 500 patients each day. He also admits that the same tradition sometimes stands in the way of more rapid improvements he would like to see in his fire-based EMS organization.
LA City Fire does provide pre-arrival instructions and Emergency Medical Dispatch protocols in its modern communications center; Nurse trainers that work hard to provide CME for his fire medics; 12 lead EKG on his 124 ALS units; a small but growing bike medic program; and a move toward electronic patient care records. His earthquake-proof dispatch center boasts 14 stations for call takers and dispatchers. Each station has 3-7 computer monitors that display ANI, ALI and detailed information on dispatch needs dependent on building size, use and location.
A few weeks ago, Chief Ernst found himself acting as rescue command for the Metroliner vs freight train collision that resulted in 25 deaths and 135 injured passengers. He and Chief Keith Douglass debriefed the study tour group with a review of access challenges, heavy rescue challenges, field triage and transport operations and multiple agency response including LA County Fire, LAPD, LA County Sheriff, multiple other areas' fire and EMS agencies, along with NTSB and FBI investigators.
Lessons learned from a previous Metroliner collision and from after action reports on this incident will assist them in improving response and rescue operations in the future. In spite of the phenomenal challenges to this rescue operation, they were able to triage and transport all seriously injured patients in less than 3 hours.
The group also toured LA City Fire Boat No. 2, which is the largest, most powerful fire boat in the world. The department shows great pride in the craft, protector of all things floating and on the LA waterfront, home to thousands of shipping containers and oil and fuel storage tanks. The fire boat boasts the newest technology afloat. Its front water cannon can project 11,000 (that's thousand) GPM of water, or water/foam combo, hundreds of feet.
At the UCLA Center for Prehospital Care in Inglewood, tour participants met with Dr. Baxter Larmon, Director, for a free ranging discussion on EMS, prehospital care issues and education. Dr. Larmon is well known in the EMS field as thought leader, teacher and researcher. He also provided an overview of the center and their various activities. The Center's paramedic training program provided a setting for our discussions.
After leaving Inglewood, the bus traveled to San Diego at the end of the day. Each member of the tour group took the bus' microphone and shared their reflections on EMS in Los Angeles City and County with perceived strengths and challenges of each system.
Day 1: Dispatch from the Los Angeles County Fire Museum
Study tour participants received a warm welcome Tuesday, Oct. 7 at the L.A. County Fire Museum as they kicked off their tour of EMS systems of the Southwest U.S.
Joe Woyjeck and Paul Oyler, both L.A. County fire captains, dedicate their spare time to the loving care of Squad 51 and Engine 51 (of TV series "Emergency!") and dozens of other pieces of fire apparatus owned by the L.A. County Fire Museum. On Tuesday they also welcomed study tour participants with a reception held in their honor at the Museum.
Along with Director of Marketing Nancy McFarland, Captains Woyjeck and Oyler organized the reception and provided snacks, beverages and dinner for the study tour group and for several L.A. County engine companies and rescue squads that stopped in to meet the Study 'tourists" and to educate them on how EMS is done in L.A. County.
Squad 98 gave us a tour of their rescue truck and joined in on the conversation along with fire/medics from squad 45. Engine 23 and Jesse Lichtenfeld, Justin Reyes and Derek Gray, all cadets from the Riverside Community College paramedic academy presented information on the academy, which conducts 13-month paramedic training for many future L.A. County fire medics. Lichtenfeld, Reyes, and Gray are president, vice president and PIO respectively of their academy class. These cadets show the promise of a bright future for the EMS profession in the U.S.
Kathy Chidester, Director of EMS for L.A. County and Chief Ed Gandara informed tour participants about the history of EMS in L.A. County and highlighted major milestones and accomplishments of the largest county-based EMS system in the country.
The L.A. County Fire Department collaborates with approximately 60 cities within the county for provision of fire and EMS services. L.A. County Fire staffs both EMTs and paramedics for medical responses but contracts with private ambulance services in each community they serve for transportation of patients to area hospitals.
View more about the L.A. County Fire Museum, as well as the Tour scedule, at http://worldemstour.ncemsi.org.
The "EMS Diversity in America" Study Tour, which embarked on Oct. 7, from Los Angeles, CA will tour private and public EMS and ambulance services in Los Angeles, San Diego, Tucson, Grand Canyon and Tuba City. The travel itinerary will include additional stops along the way and also take in some of the region's more popular sightseeing locations. The tour will end in Las Vegas where tour organizers and participants will be speaking with attendees at EMS EXPO on Oct. 16, 2008, regarding their learning's and experiences on the tour.
By participating, EMS professionals will earn 30 CEU's accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS). Each tour participant will also receive a complimentary 3-day Conference Program pass, valued at $355, to EMS EXPO, Oct. 15-17. In addition, sponsorship support has underwritten some of the tour costs.
The mission of the North Central EMS Institute is to provide leadership in EMS through educating, standard setting and benchmarking. To learn more about the tour visit www.worldemstour.ncemsi.org or www.emsexpo2008.com.
