One of those systems affected in the public sector is the fire-rescue-emergency medical service, where the problem started small and has grown to the point that it is creating major problems, from an increase in response times to legitimate emergency calls to wear and tear of expensive emergency apparatus.
The trend started years ago, when citizens could not secure doctors’ appointment in a timely manner and so they began to depend on hospital emergency rooms to take care of what would be considered an “urgency.” As hospital emergency rooms started to become overwhelmed, waiting times for these “urgencies” increased to hours before patients would get seen by a doctor. At the same time, these individuals saw that patients arriving by ambulance or fire-rescue were taken directly to treatment areas. It did not take them long to figure this out and start dialing 911 when they wanted to go to the emergency room, knowing that a unit would be dispatched to their door in minutes. Individuals in my response area have waited in a hospital emergency room for hours with a fever, gone home and dialed 911 for transport to the same emergency room.
A possible partial solution to this dilemma is a three-part process. First, fire-rescue and EMS departments must recognize the problem of system abuse, either from ignorance or done intentionally. Second, the missing ingredient to our traditional EMS systems as we have known it is the inclusion of the word “urgent” for these types of responses. The third and most important part of this process is the creation of a response vehicle that will enhance the system overall. These units are called urgent response vehicles, or URVs.
What Is A URV?
A URV is nothing more than a utility-type truck certified as a basic life support (BLS) non-transport unit that responds “routine” to what would be considered or coded as an urgent call, not an emergency call. Each URV would be staffed by two EMTs, one of them an officer or supervisor. In a fire department with several battalions, one URV could be assigned to respond out of the battalion station to a specific response area. If more than one urgent call is received in the same response area, a neighboring URV could be dispatched. In a city where a particular area produces a large number of urgent-type calls, more than one URV could be placed into service.
The disposition of the patient would be handled by either upgrading the call and requesting an advanced life support (ALS) unit while rendering BLS care, calling for a BLS transport unit or releasing the patient for private transportation to a health-care center. It must be understood is that URVs are not to be created to replace rescues or suppression units, but rather to enhance the existing system.
URVs would benefit fire-rescue and EMS systems in many ways. First, response times to legitimate emergencies would decrease as more emergency units would be available, since they would not be tied up on urgent calls. Second, millions of dollars would be saved by a decrease in breakdowns along with wear and tear of expensive apparatus that were not designed for the urgent-type volume of calls. One major benefit would be the opportunity to educate the public with the arrival of a URV at their door when they expected the old fire-rescue vehicle or 65-foot aerial truck with three or four firefighter/paramedics.
Yes, the idea of the URV seems like a radical measure for fire-rescue and EMS providers to take for many reasons, including the fear of liability. But in my opinion, these departments would much better serve their citizens with the implementation of this type of unit than if they continue to let the present situation become even worse.
I understand the natural instinct in our profession to resist change. In this instance, however, change is good.
Jose A. Nochea is a 13-year veteran and fire captain with the Miami-Dade Fire Rescue Department in Florida, currently assigned as station commander of Fire Station 40. He is certified as a Florida paramedic and technical rescue technician (TRT).
