Dear Editor:
In response a letter to the editor "Ambulance service not a helpful one" by Carrie Elmes on Feb. 11.
First, I would like to acknowledge how unfortunate that Mrs. Elmes was in this situation. As a parent of two young children I can relate, and I hope the situation resolved with no serious complications. I would also like to point out that I'm a paramedic and feel her misunderstanding and bias towards firefighters attending medical calls requires clarification for the general public.
People may not be aware that ambulance paramedics and fire departments in B.C are a totally separate entities. Though taxpayers fund both, Provincial taxes fund paramedics, and municipal taxes pay for Fire Departments in each community. The two services work seamlessly together on all types of emergency calls, however, with dwindling requests for fire departments to put out fires they are finding it harder and harder to justify large municipal taxes for staff and equipment to sit idle. This has prompted a push by municipal fire services to delve into emergency medical services. Unfortunately, this is where a clash occurs. With the minimal medical training fire fighters have, they only impact patient care positively on less than six per cent of medical calls, examples being CPR on cardiac arrests, applying oxygen and basic airway intervention on short-of-breath patients, and manual stabilization of injuries in patients suffering fractured bones, etc.
The higher trained paramedics arrive and take over care from the firefighters and unless there is a patient requiring CPR or extrication from a car accident, the fire department is cleared. Paramedics receive nine months of intensive training for primary care, three years for advanced care, and four years to become critical care, as opposed to three weeks of training to become and medical responder, a license which all fire fighters must obtain.
In this case, Mrs. Elmes would've activated the 911 response by answering a series of questions asked by the emergency call taker, which initiates a "Medical Priority Dispatch System" (MPDS) coding for the emergency call. The MPDS obviously coded this call as low to medium priority as only Primary Care Paramedics responded. The Resource Allocation Plan (RAP) for each community decides which units respond to which type of MPDS coded calls in that community, including fire department response to medical calls. In this case, it was clearly not warranted to send Advanced Care Paramedics, Infant Transport Paramedics or firefighters when the highly trained Primary Care Paramedics managed the call appropriately.
I understand the fear and frustration as a parent who calls 911 for their child, I had to call for my own infant son just before Christmas. Every emergency is an emergency to the people involved, but as paramedics we see emergencies every day and become experts in assessing and responding appropriately to medical calls. The patients in this case were transported to the appropriate facility, and though Mrs. Elmes claims there were unprofessional, the sick child in this case takes precedent over a sick adult. The appropriate facility was chosen for the care of the child. The waiting room delay only proves the point that this was indeed a "stable" emergency and did not require critical intervention or the patient(s) would have received that.
Finally, to the comment, "What I needed that night was the fire department, and they were not sent, for whatever reason." I'll explain the reason, actually I'll explain the several reasons. 1) Your medical emergency did not rate on a high enough priority through MPDS to warrant a fire department response. 2) As I previously stated, fire fighters only positively impact patient care on six per cent of medical calls, and according to this story, the illness sounds flu-like in nature and there is nothing any fire medical responder will do about that. Neither Mrs. Elmes nor her infant child were in cardiac arrest, suffering broken bones or requiring oxygen intervention therefore fire fighter training in this case wouldn't have helped. 3) The fire department has no authority on patient care once paramedics arrive, and moreover, they lack the legal authority to make decisions on medical transport or actually transport patients, so again, the inference that the fire department would've changed anything related to this call is absurd. What I strongly feel Mrs. Elmes could've benefited from is a caretaker to care for the healthy infant so she could focus on herself and her ill child while waiting for her husband to arrive.
Having a fire department on this call would be the same as a paramedic showing up to a three-alarm house fire, grabbing the neighbour's garden hose and saying "step aside boys, I got this." While it may make the homeowner feel good, It's just not going to help the outcome.
There aren't many fire fighters I meet in the course of my duties that subscribe to the "hero" label they're given by the IAFF public relations and main stream media. Most fire fighters are professionals and understand they have limitations just like the rest of the emergency services.
Pete Smith, Advanced Care Paramedic, B.C. Emergency Health Services
