1. #1
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    Default First response program

    Hi folks,

    I'm pretty much a nobody in my department (only about 3 years of experience), but I have been thinking about what it would take to start a first response program in my district. Our mutual aid partners have a system where if the primary EMS provider gets a second call and another, more distant ambulance needs to be dispatched, the Fire Department sends an engine staffed with EMT trained firefighters to provide some basic care until the ambulance arrives.

    Like I said, I don't have any real clout but I do think my community could benefit from this system and I'm curious about what it takes to get a program like this started. Keeping in mind that my department currently doesn't run any medical calls (aside from lift assists) and we have no EMTs on the roster, and also keeping in mind that I have no EMS experience myself, I'm looking for advice from people who have a program like this or especially those who have started one in the past.

    - Startup cost: What could we be looking at here? We have basic first aid equipment on every truck, but I know we would need an A.E.D. and medications, etc. If we outfit one engine for first response, what kind of costs could we be looking at? There's also the cost for getting people certified as EMTs, which will not be trivial.

    - Ongoing training: Are there federal training requirements for members to retain EMT certification, as is the case for Firefighter I/II certs? What is the time commitment for this like? I know our training schedule is already pretty strained.

    - Renumeration: Do departments who currently have a program like this receive any compensation for the calls? Do you bill the EMS for mutual aid or something similar, or does it come from the patients? It would be hard to justify the training, the time, the equipment, wear and tear on the trucks and fuel, without some kind of renumeration.

    I guess that's all the questions I had for right now. I'd really like to hear from people who have been through the initial phases of a program like this, but anyone with experience in this area knows a lot more than I do.

    Thanks!

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    It's not a bad idea you have at all, so don't get discouraged through this process, because it will be a process. I myself am not an EMT, but I've been around it my entire life and my wife is works full-time on an ambulance. Others here will likely have other thoughts and more insight, but here is mine...

    Quote Originally Posted by KarnaughAtlas View Post
    - Startup cost: What could we be looking at here? We have basic first aid equipment on every truck, but I know we would need an A.E.D. and medications, etc. If we outfit one engine for first response, what kind of costs could we be looking at? There's also the cost for getting people certified as EMTs, which will not be trivial.
    Your typical "first-in" bag is probably what you would need for most things. Not a lot more than the basic first aid stuff you likely already have with the addition of an oxygen bottle and the associated masks and tubing for it. IMHO, an A.E.D should be on every piece of fire apparatus regardless of EMS runs, but that's just me. Meds, unless you plan on running at an ALS level, will be very, very minimal and pretty much over the counter stuff. I think around here, even at the ALS level, any injected med comes from the hospital.

    - Ongoing training: Are there federal training requirements for members to retain EMT certification, as is the case for Firefighter I/II certs? What is the time commitment for this like?
    Yes, you need continuing education credits as well as a refresher. I'm pretty sure the refresher here has to be done once during every 2 year licensing period. And, there are no training requirements to retain FF I/II certs as far as I know...

    - Renumeration: Do departments who currently have a program like this receive any compensation for the calls? Do you bill the EMS for mutual aid or something similar, or does it come from the patients? It would be hard to justify the training, the time, the equipment, wear and tear on the trucks and fuel, without some kind of renumeration.
    Some may, a lot probably do not. For the department I got started on, there was none. Same for the department I am on now. Both have "rescue" as part of the department make-up. For my current department, there are only a few people that have the certs to run EMS calls (2 EMT-B and 2 EMR). There are no separate meetings for the "rescue" personnel here, but there was a separate "rescue squad" meeting night for my old department. Someone with more knowledge on it than I have can correct me if I'm wrong, but once you have someone that is at an ALS level they can conduct the continuing education for the basics. Otherwise you will need to find an outside source for that. The department I'm on now uses the towns contracted ambulance service for the refresher training, and the mutual aid association that we are a part of has a monthly training night for the continuing education aspect.

    Funding for the rescue end of things has been part of the department budget. Once in place, for my current department at least, it is not an overly huge part of the budget. It's pretty much the consumables that need to be replaced- gloves, gauzes, etc, etc, and really not all that often.

    Good luck!

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    Thanks for the response, Felix.

    I may have misspoke when I said there was a national requirement, here in VT we need to meet certain training criteria to maintain our FFI/II status with the Vermont Fire Academy. These are met by department training programs, and the info is submitted to the academy every year to maintain their records. If you let it lapse for two(?) years, you lose your cert.

    From my perspective, it would make sense to have our EMTs do a refresher class with our first-due rescue as often as required. That way we're meeting the standards, and also learning the practices and policies of our primary EMS provider.

    Have you had any experience with adopting a program like this? I can see some of the guys here being resistant to it, simply because we've never done it and they might not want the extra hassle, liability, cost, etc.

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    Nope, never started one up, never been involved with a startup either. The 2 different departments that I have been on have had that aspect already established for many years, usually since the inception of the department.

    FWIW, we almost never send any apparatus for an EMS call. That I can think of, in the last year we've had apparatus respond once on a pure EMS call (not MVA), and that was a bit over a week ago for a carry-out sledding accident. And, we responded with an engine and the rescue because there were 3 of us already at the station. My old department would send a light rescue quite often, but there were residents living at each of the 2 stations. Most times on both departments, it's POV response.

    Honestly, around here, the only places that I know of that don't have an EMS aspect to the FD are the larger towns/cities. Some of them automatically respond with the ambulance purely for manpower reasons, others don't respond at all unless requested. Usually working codes get FD response across the board.

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    Start with your local/regional/state EMS office. They'll be able to tell you exactly what you need. You may need to register as a non-transporting agency.

    Here in NY, straight BLS doesn't really need much more than the equipment (and the appropriate certified personnel). When you start adding AEDs and meds (BLS squads here can now do Albuterol, Epi, and NARCAN, with appropriate authorizations from the regional EMS agency), you need a medical director to provide oversight. We don't do any advanced skills, but we still have a medical director.

    There may be a required equipment list.

    The basics for BLS will probably run you a few hundred dollars per bag, not counting an AED, maybe a pulse-ox, or other specialized gear.

    EMTs in NY have to recertify every three years, either by taking a refresher course and testing out, or by way of an ongoing "CME Recert" program, whereby they need to get a specified number of CME hours over the three year period and once that's verified, the get recertified without having to test out or attend classes.
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    Quote Originally Posted by dfelix22000us View Post
    Your typical "first-in" bag is probably what you would need for most things. Not a lot more than the basic first aid stuff you likely already have with the addition of an oxygen bottle and the associated masks and tubing for it. IMHO, an A.E.D should be on every piece of fire apparatus regardless of EMS runs, but that's just me. Meds, unless you plan on running at an ALS level, will be very, very minimal and pretty much over the counter stuff. I think around here, even at the ALS level, any injected med comes from the hospital.

    Not true here in Wisconsin, Basic EMTs can administer epinephrine, albuterol, atrovent, and narcan. With epi and narcan being injected meds. We can also give baby aspirin to cardiac patients and assist them in administering their own nitroglycerin.
    I long for the days when the most exotic stuff we had was oxygen and MAST pants.
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    If we choose to carry NARCAN, it's intra-nasal - no needles. And epi for BLS is via an epi-pen, so no need for dealing with separate needles, syringes, etc.
    Opinions my own. Standard disclaimers apply.

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    Quote Originally Posted by tree68 View Post
    If we choose to carry NARCAN, it's intra-nasal - no needles. And epi for BLS is via an epi-pen, so no need for dealing with separate needles, syringes, etc.
    Sorry late night posting, you are right on the Narcan.

    My career FD didn't use auto-injectors, even at the BLS level we drew up epi and injected it using a syringe.

    Another med we can administer is Gucagon.
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    Don, now that you mention it, I think the basics here can administer most if not all of those drugs. Like I said before though, I'm not an EMT so I'm not entirely sure.

    Also for the first in bag, you'll need intubation supplies, a glycometer, BP cuff, etc...

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    Thanks for the replies everyone. I think my first stop will be to ask the chief for permission to investigate whether or not it would be beneficial for the community, and to research what we would need and how much it would cost. If he is not interested, case closed. If he is I'll start with the VT department of health and work from there.

    Thanks again!

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