The Three-man Medic Company

Three-man Medic Company

By Alan Perry, June 21, 2016

Congratulations on your promotion! Your new assignment is lieutenant on a Medic Company!? It should come as no surprise that the busiest piece of equipment, with the most at stake in the daily performance of it's duties, has finally been elevated to the company level. You and the other personnel assigned to your Medic Company are taking a huge step forward for Emergency Services. Thanks to this new concept your organization will be able to more efficiently and responsibly provide necessary emergency medical services to the public you serve.

“How did this happen?” you ask. Your City Council and the City Manager have been systematically looking at all city department functions looking for ways improve efficiency, reduce costs and improve retention of ALS personnel. The traditional Fire Department staffing model and even its name could be re-aligned to reflect what it actually does. After conducting an “operational effectiveness and efficiency” study and looking at evolving practices in staffing and deployment, the city manager and the interim Fire Chief determined that a major re-alignment of physical and human resources needed to occur. This included adding Company Officers on medics, Field Medical Officer Captains for each battalion and shift, a EMS Duty Chief for each shift, and a Division Chief of EMS.

With nearly 80% of the calls for service being related to medical emergencies, and only 5% actually involving any type of fire, the name has been changed to “Emergency Services”. Every station will have at least one three-man Medic Company in addition to a four-man Engine Company, and every Medic Company will have at least one ALS provider. These Medic Companies can handle 80% of EMS calls without the need for additional resources.

Second run engines have all been replaced by Rapid Response Companies, a three-man company in a medium duty truck equipped for firefighting and rescue operations without a pump or water. These trucks co-respond with Medic Companies on high acuity EMS calls for manpower, and function like flying squads for fire and rescue calls. They are much more cost effective to operate compared to the engines and ladders that were used before, each district has two. Engine Companies are staffed with four, safe levels of staffing are still maintained since Medics Companies co-respond to fires as well.

You noticed the changes in the promotional process you just participated in. The increased emphasis on EMS practices and operations in the process was not random. The City Manager and Fire Chief both realized that promotions within the organization need to reflect the current role of the Department as well as the need for a change in the culture of the organization.

The money your City is saving is being re-invested in a new training facility for public safety (EMS/Police/Fire), and an aggressive public education program focusing on health and safety issues through the Community Risk Reduction Division (formerly Fire Prevention). The Chief has indicated recently that the Department will be moving to correct pay compression issues due to consistent budget surpluses and possibly even provide a second set of turnout gear. As an added bonus, those who choose the EMS assignments receive a 10% salary differential.

In the Fire service these changes might seem radical, in business and politics they can't come fast enough. Many Fire Departments across the country are developing new and innovative ways to provide the public with the best return for their emergency services dollar independent of any industry guidance. At the national level there seems to be some lag in even acknowledging the need for realignment. The NFPA and IAFF are quick to protect the future of the fire Service and the employment of Firefighters but have not seriously addressed the need for any realignment of personnel or resources other than to protect the control and influence of the Fire Service on public safety. The diversity of Fire Service organizations and localities has a great deal to do with the difficulty in developing a recommendation that will work for us all. I think that if we seriously consider what the public both expects and needs in emergency services we can do what we do best, fix the problem so we can get the opportunity to be the heroes we want to be.

Sweet dreams,

https://www.ncbi.nlm.nih.gov/pubmed/10163385

EMS Anxiety

EMS (Supply) Anxiety

By Alan Perry

February 29, 2016

What causes EMS supplies to be stockpiled on your medic or in your station? Is it insecurity or anxiety about a procedure? An unreliable EMS supply system? Lack of communication? A fear of an MCI event? In the ideal EMS supply system all units carry the same equipment and supplies, stocked at pre-defined levels, to assure that units can remain functional without unreasonable delays in restocking them. Unfortunately the practice of EMS supply hoarding, whether on the medic or in the station, confounds this goal. It drives up the cost of consumable items by increasing inventory levels while taking them out of circulation where they frequently become damaged or expire. That creates some of the very problems that the hoarding strategy seems to be trying to avoid, namely unpredictable stock levels or out-of-stock items.

I believe fear can be a factor, although an irrational one, it seems some of the supplies most likely to be overstocked are related to ALS procedures (ET tubes), infection control (masks, gloves, etc.) and trauma supplies (kling, tape, bandages). Could it be that somehow having more of these items allows us to handle those situations more effectively, or are they serving as a security blanket?

Communication is also an important factor; if the apparatus get checked off every shift, supply orders are placed every shift as well. If the supply system is not responsive, and fails to fill the orders as they are received, it can easily lead to duplicate (triplicate, quadrupled…) orders unless providers communicate what orders they have placed to each other. If supplies are not kept in specific locations in specific quantities this will lead to items being kept in multiple locations in variable quantities. The system should define what, where and quantity for items stocked on each piece of equipment. In most Fire-based EMS systems and volunteer systems, there is also a high degree of staff variability on each transport unit, frequently only a single shift assignment a month or pay cycle. In that situation you have little ownership of the apparatus or continuity in its care and restocking, both of which further confound the issue.

Most EMS systems now have dedicated resources they can rely on for MCI events. While a medic may be sacrificed in some instances to manage an MCI incident the majority of units will be used for treatment and transport of single patients. There really is no need to equip each ambulance with enough nasal cannulas, ET tubes and 12x30 trauma dressings to treat a dozen victims –that’s an irrational fear.

The reliability and of an EMS supply system will affect its efficiency. If your providers know the supply system is reliable and responsive to their needs they will be far less likely to set up individual stashes of these precious commodities on the medic or in the station. Providers should be aware of the consequences of these actions, which increase the cost to the organization, have a negative impact on its reliability as well.

Be safe,

Alan