At the beginning of the Civil War, the average time a wounded soldier lay on a battlefield was three days after the battle. Just in time for the battle of Antietam, the bloodiest battle of the war, the Army of the Potomac, under its medical director Jonathan Letterman, developed the Letterman Ambulance Plan. Under the Letterman Ambulance Plan, the ambulances of an army division moved together, under a mounted line sergeant, with two stretcher-bearers and one driver per ambulance, to collect the wounded from the battlefield. These individuals were specifically assigned to the Ambulance Corps. Prior to this system, individuals assigned to ambulances were mostly unfit soldiers who were not good fighters. Often, they would get drunk on medicinal liquor and ignore their wounded comrades in order to hide from enemy fire.
Soon thereafter, such improvements were copied into other field armies. By the end of the war, a medical transport system had developed that cut the average time a wounded soldier lay on a battlefield from three days to eight hours. The Confederate Army also copied the medical transportation system for its wounded.
Just like the Union and Confederate armies, the fire service is trying to improve patient care and response to wounded or ill patients.
In May, thousands of fire service professionals attended the National Fire Protection Association's World Safety Congress & Exposition in Anaheim, CA. At the meeting, the group voted on several proposed standards.
The most controversial and highly publicized standards were NFPA 1710 (Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments) and NFPA 1720 (Standard for the Organization and Deployment of Fire Suppression, Emergency Medical Operations and Special Operations to the Public by Volunteer Departments). If a fire department is a combination of volunteer and career personnel, whatever authority has jurisdiction will determine whether 1710 or 1720 is applicable.
The new NFPA 1710 and 1720 standards are essentially off-shoots of the old NFPA 1200 standards, which were abandoned after tremendous opposition, mostly from volunteer fire departments.
The biggest implication for the delivery of EMS care for career fire departments is found in NFPA 1710.
On all EMS calls, the new NFPA 1710 standard establishes a turnout time of one minute and four minutes or less for the arrival of a unit with first responder or higher level capability at an emergency medical incident. This objective should occur 90% of the time.
If a fire department provides advanced life support (ALS) services, the standard recommends an arrival of an ALS company within an eight-minute response time to 90% of incidents. This does not preclude the four-minute initial response.
The standard recommends that a "fire department's emergency medical response capability includes personnel, equipment, and resources to deploy at the first responder level with automatic external defibrillator (AED) or higher treatment level." The standard also recommends that all firefighters who respond to medical emergencies be trained at the minimal level of first responder/AED level.
Another requirement in the standard is that all personnel dispatched to an ALS emergency should include a minimum of two people trained at the EMT-P level and two people trained at the EMT level - all arriving within the established times. It is not specified whether both paramedics have to arrive on the same unit or if they have to be from the same department.
Fire departments can have established automatic mutual aid or mutual aid agreements to meet many of the requirements of the standard. Other emergency medical recommendations found in the NFPA 1710 standard include EMS system components, EMS system functions and quality management. (The NFPA 1720 standard for volunteer fire departments does not lay out specific time responses, licensure levels or staffing criteria for medical emergencies, but merely defines what an EMS system is and its various functions.)
It is estimated that it will take years to implement many of these standards. Opposition to the standards is found mainly in municipal government groups and associations like the International City/County Manage-ment Association (ICMA), which see increased costs because of the standards.
The ICMA spoke at the conference in Anaheim and urged rejection of NFPA 1710 in its entirety, citing six different reasons. The ICMA, among other organizations representing government bodies, is still looking to defeat the 1710 standard this month, when the final determination is made by the NFPA Standards Council.
Sources close to the issue say lawsuits can be expected if the NFPA Standards Council adopts the 1710 standard. Just like the Civil War, which was mainly fought on ideology, future fire service battles will center on the NFPA 1710 standard and its ideology. Hopefully, the patient will be the winner.
Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, is the chief paramedic for the St. Louis Fire Department and is the vice chairman of the EMS Executive Board for the International Association of Fire Chiefs. He has lectured nationally and internationally on fire-based EMS topics and operates The Ludwig Group, a consulting firm specializing in EMS and fire issues. He can be reached at 314-752-1240 or via www.garyludwig.com.
