Have you heard the adage, “We are in the business to put ourselves out of business?” The surest way to prevent firefighter line-of-duty death and injury is to prevent an event from occurring. The fire service has been successful in reducing the impact of fire through code adoption, commercial and residential sprinkler systems installation and a host of public-education activities.
However, in most departments, EMS is the mainstay of modern response yet little has been generally accomplished to significantly reduce the incidence of EMS response.
Consistently, 50% of all LODDs and injury each year are related to cardiovascular causes; 25% are related to responding to and returning from alarms. Reduce the exposure and reduce the incidence. Though actual values differ by organization, some department EMS activity may be over 70% of their overall call volume.
The fire service is positioned for profound impact to improving the quality of lives of our community, resulting in a decreased need to access emergency service for a given population cohort. This ultimately leads to a reduction in EMS calls for service. Reduce the exposure and reduce the incidence.
Community paramedicine is the latest phenomenon, created as a response from multiple demands. Each program is relative to its particular community needs but generally share some basic concepts:
- Meet the health care needs of a given patient population more appropriately
- Reduce demand on stressed EMS systems
- Use resources more efficiently and effectively
Though vernacular may be new, alternative models for healthcare deliveries are not; 10, 15 or even 20 years ago, organizations experimented with various strategies to counter rising EMS response rates. However, few strategies addressed root cause.
Consider the fire service has done a great job marketing 911 and quick response times for every call for service. The public has been conditioned to call 911 for even the perception of an emergency. Firefighters/paramedics would respond with lights and siren keeping response times to a minimum. Engine companies as first responders are frequently dispatched with lights and sirens as well to shorten arrival time. Patients are treated and transported expeditiously and turned over to a receiving facility quickly.
The question needed to be posed: “Is this the best model?”
Imagine the scenario of the chronically ill patient who frequently accesses emergency services for difficulty managing a condition. Common patient conditions might include asthma, congestive heart failure or diabetes. A paramedic with enhanced training in patient assessment, social services and home health meds and the ability to spend time with a patient may identify a root cause for recidivism. Root cause, once discovered, can be mitigated. Often, simple interventions may reduce or eliminate a need to access emergency services.
Organizations involved with community healthcare programs, or community paramedicine, are reporting successes with improving the health and quality of life of patients as well as experiencing increases in availability of larger apparatus and transport units for high priority calls. If a correlation exists between the health and safety of the community and the health and safety of firefighters, more effort should be placed on alternative service models that may prove beneficial to all.