April 30--The call came over the radio -- "Rescue One, priority three" -- and Vancouver Fire Department Capt. Bob Carroll and firefighter Natalie Newgent stood up from the kitchen table at Station 3 and headed to the vehicle bay.
Instead of climbing into the fire engine, they got into a sport-utility vehicle, dubbed Rescue One, and headed for Roosevelt Elementary School, a few miles away.
The call was for an allergic reaction. Carroll, a firefighter-paramedic, explained it was ranked a priority 3 call because a school nurse had treated the student with a dose of epinephrine.
Had the call been about a person who had not received epinephrine, the call would have been ranked a higher priority and an engine would have been dispatched.
En route to the school, Carroll contacted the responding two-person crew from American Medical Response, a private ambulance company. The ambulance and SUV arrived at the school at the same time. A short while later the student, with a sheepish smile on his face and his mother walking beside him, was wheeled out and loaded into the ambulance.
In the meantime, the fire engine remained at Station 3, with a three-person crew ready to respond to fires or higher-priority medical calls.
A variation of that April 10 scenario has been playing out repeatedly since a three-month pilot project began April 1.
Capt. Jay Getsfrid, who oversees the department's Emergency Medical Services program, describes it as "taking care of the background noise."
The goal? Cutting response time on higher-priority calls. That means keeping engines on standby at the department's 10 stations while two SUVs roam the department's 91 square miles. Fuel costs will drop, as it costs $1.34 a mile to drive an SUV compared to $7.47 a mile for an engine, but the project wasn't just meant as a cost-cutting move. It should get help to more people faster.
Early results are promising, said Vancouver Fire Chief Joe Molina.
The city council has set a goal response time for priority 1 and 2 calls of 7 minutes, 59 seconds or less. Paramedics should meet that goal for these most urgent calls, such as a cardiac arrest, at least 90 percent of the time.
Without the SUVs, crews were hitting that target only 78 percent of the time.
With the SUVs, the success rate has increased to 94 percent.
In an April 25 memo to City Manager Eric Holmes, Molina wrote that it would be "premature to draw any conclusions about response time and patient acuity until we analyze the larger data set from the three-month trial period."
The target response time for priority 3 and 4 calls was set by the city council at 10 minutes, 59 seconds or less. That goal has been met 79 percent of the time during the pilot project, even though there's only two SUVs for the fire department's coverage area, which includes the city and the rural area within Fire District 5.
Molina said there's room for improvement with coordinating with AMR, whose crews have their own dispatchers separate from Clark Regional Emergency Services Agency.
"This is definitely the first blush of, 'Let's put (the SUVs) in the system and run calls,'" he said last week.
Improving response times
Like 97 percent of paid professional fire departments nationwide, the Vancouver Fire Department provides emergency medical services. Medical incidents account for about 75 percent of the department's approximately 23,000 calls a year. The department stopped responding to the least-serious calls (most level 5 and all level 6 calls) in 2008. Those lowest-priority calls -- a person with a headache but breathing normally, for example -- receive an ambulance-only response.
Rural fire districts might use four-wheel-drive vehicles to respond to medical calls, but primarily for access reasons.
In Vancouver's case, the decision to use SUVs came from a Citizen Resource Team, which spent six months last year studying fire and EMS operations and made recommendations on operational changes.
Molina worked with union leaders and command staff to develop the pilot project.
"With this change, we think we can improve our response times to those time-critical events," Molina said earlier this month.
Firefighters and captains work 24 hours on, 48 hours off, but SUV staffers are working four 10-hour shifts a week, all during hours when calls for medical help are highest.
When the SUV units are off duty, fire engines handle the medical calls.
The number of on-duty firefighters and firefighter-paramedics has increased from 40 to 44 during SUV response hours, between 7 a.m. and 5 p.m. Monday through Thursday.
In the first three weeks (12 days), the SUV crews responded to 132 calls, 35 percent of the calls the department received when the SUV crews were on duty, Molina said.
In determining which types of medical calls should receive an SUV response, the department worked with the county's medical program director, Dr. Lynn Wittwer, to evaluate call types.
"We looked at each call type individually and assessed the frequency of interventions being required or of a person needing to be transported with lights and sirens to the hospital," Getsfrid said this month. "We identified calls that were not life-threatening and that could be handled differently."
Roaming SUVs
The department did not buy new SUVs for the pilot program. Initially the plan was to use Molina's work vehicle, as well as an SUV used by Deputy Fire Chief Dan Olson. Instead, they used Operations Chief Steve Eldred's work vehicle, as it was already outfitted with emergency lights and a siren. Olson's vehicle was then properly outfitted with lights, sirens and other emergency necessities.
Now Eldred, Molina and Olson share Molina's SUV during work hours. The city has changed its policy on take-home vehicles, so the chiefs drive their own vehicles to and from work.
The SUVs are a 2013 Chevy Tahoe and a 2010 Ford Expedition dubbed Rescue One and Rescue Two. In a change of department culture, the vehicles won't always be parked at stations between calls. Molina has been encouraging the crews to roam, much like the AMR ambulances shift spots depending on the location of other ambulances.
"I want them out and about," Molina said. He's told crew members they can take a laptop computer into a coffee shop and work on reports while waiting for calls, so they don't just have to sit in the SUV.
"It's just a completely different model for firefighters," he said.
Ideally, the AMR dispatchers would help the SUV crews figure out where the gaps are in coverage areas.
"The AMR dispatcher will spread their resources around us, so we're not sitting on top of each other," Getsfrid said.
Working more closely with AMR has required getting on the same radio frequency, among other changes, which is a first for the department with a private company.
"We're still working the bugs out," Molina said.
In 2014, the city plans to negotiate its own contract with AMR and break away from Emergency Services Medical District 2, which is governed by the Board of Clark County Commissioners and comprises Vancouver, Clark County's unincorporated areas and the cities of Battle Ground, Ridgefield, La Center and Woodland. The other partners unsuccessfully objected to Vancouver's breaking away, expressing concerns it will lead to higher transportation costs in rural areas, but the Vancouver City Council noted that 70 percent of AMR's calls in EMS District 2 are in Vancouver and say it's time the city controls the contract for its ambulance services.
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Stephanie Rice: 360-735-4508 or [email protected].
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Copyright 2013 - The Columbian, Vancouver, Wash.
