After a year of debate about overworked ambulance crews and slow response times, the Kansas City Fire Department on Monday took the first step toward a cure.
The department unveiled four pilot projects designed to relieve the busiest crews and get a quicker response time in some cases.
Both fire management and labor officials said they now agree on how to start fixing problems and making the best use of resources in the blended fire/ambulance system.
"The workload for the ambulance side of the Fire Department is substantial," firefighters union president Mike Cambiano said after an ambulance task force released its report. "They were being run a lot harder than they should have been. This is about changing their work conditions to make sure we maintain the highest level of patient care."
Basically, the plan explores changing the current approach of sending a fully equipped ambulance and paramedics to 90,000 calls annually.
Over the next few months, the department will explore ways to free up paramedics in ambulances to concentrate on the most serious calls while sending fire trucks and less fully equipped ambulances to the lower priority calls that can sometimes swamp the system.
That means changing a 30-year-old mindset that says a fully equipped ambulance and paramedics should be sent to every 911 medical call, said Joseph Salomone, director of Kansas City's Emergency Medical Services system. The newer thinking, he said, is to deliver advanced life support care to the fraction of patients who actually need it, and the appropriate and best level of care to the majority of patients who don't.
"The whole goal is not to assume that everybody needs the same thing, but to deliver the right thing," Salomone said.
City Councilman John Sharp, the council's representative on the Emergency Medical Services Coordinating Committee, approved of the four pilot programs and said two of them should in fact improve response times and patient care. But he warned that the city must be very prudent in deciding when to send a fire truck or basic ambulance instead of a fully equipped ambulance to a medical call.
"There are clearly some calls where people want an ambulance and they don't need an ambulance and they certainly don't need paramedic level care," Sharp acknowledged. "But you've got to be real careful about that."
Sharp, who headed up Kansas City's MAST ambulance service from 1991 to 2003 said he had heard of other cities that abandoned such a "tiered system" because there is a danger in underestimating the seriousness of a call, which can lead to the unnecessary loss of life.
Currently, Kansas City's ambulances respond to about 90,000 calls a year. About 15,000 of those are non-emergency scheduled transports. Out of the 75,000 other calls, about 25,000 are life-threatening calls that legitimately require both a fire truck and an ambulance to make an emergency response.
It's the 45,000 to 50,000 other calls -- where a paramedic and advanced life support ambulance currently respond -- that fire officials say could sometimes use a lesser response without jeopardizing patient care, while freeing up the ambulance for the high priority calls.
"If it's out there on a hangnail, we don't have it to send to somebody with a heart attack," said Richard Gist, principal assistant to the fire chief. "We're inching our way toward understanding what the best balance is."
Interim fire chief Paul Berardi assured Sharp that the pilot projects will be implemented cautiously, in a controlled environment, and the data will be studied to determine whether to expand it on a systemwide basis.
"This is one way to get efficiency out of our resources," Berardi said.
Kansas City has been trying to do that ever since the Fire Department and the nonprofit Metropolitan Ambulance Services Trust merged in April 2010. But the system has faced criticism that it wasn't meeting required response times and that some ambulance crews had to respond to more calls than advisable in a 24-hour shift.
The recommendations grew out of heated discussions between labor and management over the last two months. The two sides agreed to this incremental reform approach, Cambiano and Berardi said.
The department is looking at the merit of new approaches with these pilot projects:
--Sending fire trucks to respond to designated calls when an advanced life support intervention or transport to a hospital is not required. Cambiano said paramedics are worried about how this will be implemented. Fire officials said they will analyze those calls carefully to ensure patients aren't at risk.
--Assigning paramedics to pumper trucks, which can quicken the delivery of care at the scene, and reduce the time on the scene where transport to a hospital isn't needed. Cambiano said there are already 40 paramedic-trained firefighters who haven't been able to use their medical skills on fire trucks. This program would start slowly, but Sharp was enthusiastic and said it should have been done years ago.
--Giving emergency medical technicians advanced training to perform advanced medical interventions on a limited basis as first responders on fire trucks. The department has a $280,000 grant to start this training, and Sharp also thought this could be a big improvement.
--Using basically equipped ambulances and emergency medical technicians on designated non-emergency transports from a hospital to a location of lesser care, such as a home or nursing home. Currently, a paramedic and fully equipped ambulance handle all 15,000 of those types of calls. Fire officials said they will be selective in the calls handled.
The pilot projects will take weeks or even months to implement and even longer for results to emerge. But City Manager Troy Schulte gave his approval.
"This is fantastic work," he said of the recommendations. "Let's roll her out."
Copyright 2012 - The Kansas City Star
McClatchy-Tribune News Service
