Michigan County's Medical Protocols Rankle Fire Chiefs

Area fire chiefs say new protocols mandated by the county medical control authority could compromise patient care and will tax already budget-strapped departments.

"Do we take a chance and treat the person or take a chance and get suspended," asked Gaines Township Fire Chief Bill Miller, a critic of the county regulations. "It's all because they're trying to protect themselves. The liability is ours, not theirs."

Ten of the 19 fire departments in the county are first responders, meaning they are the first to be dispatched to a medical call. In rural areas, they often arrive before ambulances and paramedics.

"Fire medical first responders have a very narrow purpose and value," said Bruce Trevithick, executive director of the medical control authority, which regulates emergency medical services in the county. "They're there to provide care before an ambulance gets there. They're primarily used in rural areas where response times are longer."

Fire chiefs say recent changes to the county protocols could compromise their care to patients by requiring that anyone assisting on a medical call be a medical first responder. Miller said although 25 of the 30 volunteer firefighters in the township are licensed first responders, it's often necessary to have a firefighter who isn't licensed assist one who is, such as grabbing bandages or helping to carry a backboard.

"The bottom line is they came out with this protocol, and we are not providing a service to our community. I can get anyone to help to assist, but I have trained personnel I can't use," said Miller, adding that there is a good Samaritan law that allows bystanders to help emergency personnel.

Trevithick said the protocols are regularly tweaked by a five-person group and are designed to protect patients and area agencies.

"What happens if you slip and fall with the patient and you're now unprotected," Trevithick said of prohibiting nonlicensed medical first responders from assisting with patient care.

Trevithick said the county is enforcing state regulations, and argued that there is no room for interpretation. Miller doesn't agree.

"They're taking the law and directing it to the system," Miller said. "They're not looking at the spirit of the law."

Robin Shivley, manager of the EMS/trauma section for the state, said the state protocols are only a guide. Many counties adopt the state protocols, others craft their own. She said as of last week, Genesee County had not adopted the state protocols. She said Genesee County regularly submits their own protocols for approval from the state; however, she could not say when they last did.

Shivley said state protocols require that licensed medical first responder agencies dispatch around-the-clock, and that at least one person with medical first responder training be dispatched. She said the state doesn't prohibit nonmedical first responders from assisting first responders with patient care.

"That doesn't mean they can't assist in patient care, like assisting with backboards," she said.

Mundy Township Fire Chief Toney Romans said the protocols are costing budget-strapped departments more money. The county is requiring special identification badges for first responders - Shivley said it's their right to do so - and for personnel to take a test on the county protocols.

"How do you get 35 people through a protocol test when you're having to go down to the court and take off work," said Romans, adding that the department would have to pay firefighters for their time to take the test.

Miller said in Gaines Township the fire department operates on an annual budget of $132,000. He said even if the badges indentifying personnel as medical first responders cost about $5 apiece, it's money his department can't afford. He said the department responds to 300 calls a year, half of which are medical calls.