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Letters to the editor

editor@vaildaily.com

Why merger is inadvisable-

More and more discussions are taking place in the upper valley concerning the possible merging of emergency medical services (EMS) with the fire departments and of the building of a West Vail Fire Department station.

These discussions are seen in newspaper articles, letters to the editor and also governmental and popular opinion discussion groups.



One of the key catch phrases I always hear is “response times. In the former Minturn Fire Chief J. Brian Wilson’s letter to the editor, he asked, “Why does fire even respond to EMS calls in the valley now? Answer: Because they can get there faster in the majority of cases due to being more strategically located.”

Everyone interested in this debate should ask the questions: How important are response times? Are they very important? Are they not important at all? Does the answer lie somewhere in between?



In this world in which we now live, speed means everything to a majority of people: fast food, fast airplane travel, fast gratification. Even the fictitious medical shows we watch on television have medical personnel shouting, “Let’s go, people: NOW, NOW, NOW!” as they either save or lose a life between commercials. (In real medical situations this very rarely happens).

In the same way even emergency medical services and fire departments have perpetuated this stereotype by the running of lights and sirens to all 911 calls.

So, why do EMS and fire departments, along with law enforcement agencies, “run hot” with the need for speed to almost all 911 calls? In EMS some of the running “hot” to all calls stems from the preparamedic era before the 1970s when all that could be done for a patient was fast transport.



It should be noted that many cities and services are now starting to screen calls to determine if a 911 call is truly a life-and-death situation, whether the responding agencies should be sent running lights and sirens and even if the fire department with their fire engines need to respond on all medical calls.

True, until the responding agency gets to the scene we do not really know the extent of an emergency. In reality, as all ambulance services across the country well show, they almost never run lights and sirens back to a hospital. Patient treatment and comfort, along with a safe ambulance ride, are more important than speed.

In reality, there is only one true emergency where speed is an immediate factor. That is in a cardiac arrest and early defibrillation of certain cardiac dysrhythmias. But even in the best response to a cardiac arrest by speed, early defibrillation and the best of skills of all medical staff involved from EMS to the cardiologist, only 20 percent of those patients survive discharge out of the hospital to their home.

It should be noted that with this need for early defibrillation, the Eagle County Ambulance District has funded and bought several layperson automatic defibrillators that are placed with fire departments, ski patrols, golf courses, hotels and public arenas. This is the only area where speed counts. And as seen, the Eagle County Ambulance District has taken the best step by allowing even the lay public to become involved even before the arrival of ambi and fire.

One of the areas that the Quality Assurance Committee of the Eagle County Health Service District (doing business as the Eagle County Ambulance District) looks at is “time out the door.” These are times from dispatch tones to the time an ambulance goes in service and the number of minutes it takes to get to the patient.

This is a requirement for our CAAS certification (Certified Accreditation of Ambulance Services). Eagle County Ambulance District’s numbers are well within the parameters set by CAAS.

But there are many other areas that are also studied that affect patient outcome to a greater extent than speed. Skill level of the paramedic is probably the most important. As a paramedic, I do not rush to a patient, inject a medication into their body and say, while wiping the sweat from my brow, “Boy, good thing I got here in six minutes or less or you may not have made it.”

The reality is 99 percent of all 911 calls do not require speed.

As the paramedic in charge of patient care, I first talk to my patient. What happened? What brought on their symptoms? What is their previous medical history? I then do a physical exam. Take vitals. Maybe I need to hook the patient up to a cardiac monitor, get oxygen saturation levels or determine what their PC02 level is. If they are a diabetic I will get a blood glucose level. Draw bloods for labs at the hospital. I may even activate the hospital trauma system alerting the emergency room and the surgical units. These are only a few of the things I may do in my patient assessment. I then outline a course of treatment and initiate that treatment. This treatment may be stabilization, IVs, advanced airway management, medications for any number of symptoms. Sometimes as paramedics we treat and then are able to release the patient. Sometimes we treat and allow the patient to go to the hospital in their private vehicle, thus saving them an ambulance bill. And of course, if the patient needs transport by ambulance, we continue care until arrival at the emergency department.

There are two main ways to keep those skills sharp. One is by continuing education. Eagle County Ambulance District does this for its employees by bringing in educators to the district and also sending its paramedics to conferences. But the best way for a paramedic to keep their skill levels top notch is by ongoing patient care. That means both running calls where there is patient contact and by having a strong working relationship with the local hospital and all medical staff in the valley.

This is why even though our paramedics work with different agencies, such as fire, ski patrol, mountain rescue and law enforcement, we see ourselves as medical personnel like the staff at the Vail Valley Medical Center. To combine us with the fire departments would take away that contact we need with VVMC.

As paramedics, we rotate buildings between Edwards and Vail every one to two months. When we are stationed in the Vail building next to the emergency department, we are allowed to see the care of patients and lend a hand if needed. We talk to the doctors and nurses. We can walk up to the ICU and see cardiac rhythms on the monitors along with the type of patients they are caring for. Many have even in the past been allowed to view procedures and surgeries, thanks to both the general and trauma surgeons.

I do not know how many people remember that before the Eagle County Ambulance District was formed, the ambulance service was operated by the Vail Valley Medical Center. During those early years money for the hospital was tight. The ambulance service cost the hospital a lot of money to finance its operation. It was seen that something had to be done to relieve this financial burden. So, a committee was formed to find a solution. People from the medical community, fire, mountain rescue and political groups discussed possible scenarios.

One was putting the ambulance with the fire department. There were several factors why this was dismissed. One of the main reasons was because the doctors in the community saw the need for quality on-going advancement of medical skills of the EMS staff. The emergency room physicians need to feel confident that the paramedics are treating their future patients correctly. Also, the local private M’s need to feel that their patients, who they see on a routine basis, are being cared for with the skill deserved, whether that comes in the form of a local 911 call or in a two-hour transfer to a higher level of care in Denver.

All of this is why the hospital donated the land where the Vail ambulance building now sits, so the paramedics could stay in close contact with what was going on in the medical community, not to be stationed in a remote fire station.

In this quest for ongoing patient care and a high level of skill, paramedics run calls. Again, because 99 percent of all calls are non-life threatening and most of the remaining 1 percent are not so serious that a few seconds count in the outcome. There is a fine line between just having a paramedic in every fire station and being stationed so the paramedics can run a certain number of calls to get patient contact.

Ask the fire departments how often they rotate their staffs throughout the different stations. In the Eagle River Fire Protection District, a firefighter can be stationed at the same location for six months at a time. If a paramedic were stationed in a fire house where few calls are received, such as Minturn, Beaver Creek, Wildridge, Eagle-Vail and Cordillera, or if three paramedics were stationed in the East Vail, main Vail and possible future West Vail stations instead of what the Eagle County Ambulance District deems necessary for both patient care and upkeep of medical skills, they would lose their skills in a matter of months.

Paramedics became medical people to help and treat patients. Take that away and you have taken away our heart and soul and may have harmed yourselves in the process.

Douglas B. Foster

EMT-Paramedic


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