Mesa, Ariz., is the 38th largest U.S. city, and the Mesa Fire/Medical Department (MFMD) serves almost half a million people. As the community grew and the economic outlook shrank, MFMD decided some changes were in order. To provide innovative medical services, the department looked to develop regional, national and international partnerships to adopt EMS best practices and to use evidence-based medicine for self-critique and quality improvement.
These groundbreaking programs have not only created local success, but have also shined a national spotlight on them that has many departments looking their way. Here are a few of the innovations they’ve employed to meet this goal.
Efficient Use of Resources
Responding to several years of increasing calls for service and a corresponding increase in response times while units were on other calls, MFMD developed transitional response vehicles (TRVs). TRVs are staffed with a paramedic and an EMT and are intended for low level, or non-emergent, calls for medical service. TRVs are stationed where they can best supplement the fleet and increase the engines’ and ladders’ availability for medical emergencies and fires.
MFMD also conducted a pilot program with a physician assistant responding with a paramedic on their TRVs. This pilot showed great promise as an innovative way to treat some patients in their living rooms rather than the emergency room. MFMD continues to work with its partners to develop programs that provide services in a financially responsible manner. Concepts being considered include having a physician assistant, nurse practitioner or physician during their residency respond on a TRV with a MFMD paramedic.
TRVs are a major game-changer in resource utilization, but some implemented changes were much simpler. In Mesa, temperatures regularly linger above 100 degrees. In response to the need to keep drug boxes cool and secured, one of MFMD’s members developed a temperature-controlled, secured pharmaceutical cabinet that’s installed on all paramedic apparatus. These cabinets are now being used across the nation.
Collaboration and Mutual Aid
MFMD is a long-standing automatic-aid partner with agencies across Maricopa County and surrounding areas. This partnership provides regionally accepted guidelines for fireground operations.
Recently, many regional medical directors have embraced this concept, providing paramedic off-line algorithms that have been adopted by most regional fire-based EMS agencies. This change enhances the department’s ability to provide EMS, and EMS training, with its partner agencies.
Toxicology paramedic (tox medic) off-lines are included in these regional algorithms. Tox medics have an expanded scope of practice to treat smoke inhalation victims, toxic industrial exposures and weapons of mass destruction. MFMD believes we’re the largest agency in the United States to have every paramedic trained as a tox medic, with toxicology medications in all drug boxes.
MFMD, in conjunction with many partners, is using a multipronged approach to increase the survival rates for prehospital cardiac arrest. MFMD uses minimally interrupted cardiac resuscitation (MICR) protocols. In November 2011, the Mesa Regional Dispatch Center began using an improved dispatcher-assisted CPR program that asks just two questions before initiating hands-only CPR. The initial data is very encouraging.
There has been an increase in the percentage of bystander CPR, a reduction in the delay prior to bystander CPR and save rates that are among the best in the United States. To augment these efforts, MFMD’s Fire and Life Safety Division regularly provides fun-filled hands-only CPR training to entire elementary and high schools.
Moving forward, MFMD is optimistic about using noninvasive ventilation in a prehospital setting. If adopted, MFMD believes it will be the first prehospital fire-based EMS agency in the world to use this technology, which provides significant benefit to respiratory distress/failure patients.
Bob Looby is a captain assigned to the Mesa Regional Dispatch Center.