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Original post made
on Jan 23, 2012
We appreciate the new equipment and hope more lives are saved.
Great, so if we could now post an ambulance at PAMF, and stop the need to run fire engines there each time there is a medical emergency, we would be making real progress!
For those not living near by, this happens about once per day ... A real waste!!
Kim Broderick credits the new chillers with an 'upped survival of 25%." Does that mean, i.e. 25% of the 273 patients in year or that 6 out of 273 went to 8. I'll bet there had to be a more cost effective way to save 2 people each year. You could probably put a cardiac surgeon on the old 2006 vehicles for less. BTW how many miles on the 'retired' vehicles? What's normal?
Martin, those Fire Engines wouldn't need to respond there if PAMF contracted a private ambulance provider with more ambulances. They use a private ambulance to handle their emergency transfers from PAMF to Stanford, but when the private ambulance company runs out of ambulances PAMF is forced to call 9-1-1 (and thus get a response from the Fire Station). They simply can't delay the risk of a delay in transfering a cardiac or stroke patient.
Michael, keep in mind that so called "theraputic hypothermia" is now standard of care throughout the nation and it's actually required to be used in Santa Clara County by the EMS Agency. Theraputic hypothermia with chilled saline actually improves survival to hospital discharge better than any cardiac resuscitation drug on the market, believe it or not!
Regarding the mileage, the City in a 2011 memo stated that they had 4 ambulances in their fleet. The two oldest had more than 110,000 miles each, even though departmental policy requires replacement every 85,000 miles. These are really not your family cars...they are ridden HARD and really have to put up with some astounding abuse. The replacements are long overdue. You can read the memo here: Web Link
This really is a great investment for the citizens of Palo Alto who, rightful so, expect high quality and advanced medical care from their Fire Department.
I worked for a private company in Santa Clara county a few years back. During my time, we brought our fords out to PAFD for them to review. I am glad they finally got new rigs, and I am glad they got the Chevy rigs instead. My current fire department uses Chevy cab/chassis and have had less issues, more reliability and cut overall costs.
In response to Micheal Gross- These "chillers" are nothing more than an electronic cooler or fridge. Cost is minimal, and the science has proven that this is the new standard of care. If PAFD (which I believe it does) carries only approved Santa Clara county drugs, then they have never had to use a cooler before. In many services across the country and world, coolers have been implemented in ambulances and engines for years, when said services use certain medication that requires lower temperatures to avoid expiration.
As far as PAMF is concerned, when I was there a few years back, they had an agreement with a few of the private ambulance companies. Silicon Valley Ambulance as well as Westmed Ambulance, have both BLS (basic life support) and ALS (advanced life support) units, which are available for transports from PAMF. When these units are busy, or when the patient is critical, 911 is called and the closer unit and contracted unit is dispatched. In Palo Alto, if nothing has changed, the Fire Department is the first out unit, with the county private ambulance provider second in, if PAFD is out of units.
> City EMS Coordinator Kim Roderick said the department has about
> 273 patients each year that go into full arrest
Information like this is confusing. It's very difficult to know:
o) how many of these 273 patients are in full cardiac arrest when the EMS team arrives?
o) how many go into full cardiac arrest after the team arrives, but before the transport begins?
o) how many go into full cardiac arrest during transport?
A 25% increase of 6/273 is not something to get excited about. How much did the Fire Department invest in these units?
The fire department produces very little information about the effectiveness of the EMS units.
Kip, they are just refrigerators. They cost anywhere from $500 to $900. I have no idea if they are using this brand or not but here is one that is FDA cleared.
Read more about the benefits of theraputic hypothermia here:
It's not really an issue of the Fire Department wanting to invest in the refrigerators or not. They are REQUIRED by the County EMS authority to use them starting next month.
Can a community with so much wealth, and so much "education" really not grasp this concept that a portable fridge unit only costs 400-1000? That the rigs were scheduled for replacement, and that the cooler/fridge units were to comply with standard of practice and requirements per the medical director. I suppose life saving procedures and medication should only be delivered at hospitals, it just costs too much to expect grade A service in a time of need. I dare any of you to go ask a cardiologist what the real facts are. The AHA (American Heart Association) has been doing circles for the last 20 years. The treatment of cardiopulmonary arrest is really just anyone's guess. That being said, we use current research and all ACLS (advanced cardiac life support) providers are to perform to the level and standard of care that the AHA has deemed appropriate. Just to rattle the boat a little bit more, you should be asking why this is only "happening now". I've visited, worked, and have former colleagues working in some of the most rural and poor counties in the country, and they have "HAD" cooler/fridges.....
> they are just refrigerators. They cost anywhere from $500 to $900.
Thanks for the info. Notice that the Weekly article did not make note of the cost. The benefit seems minimal, even though the reader-provided costs seem insignificant.
> The fire department-run service has provided the city with a
> significantly better response time than if it contracted with
> a private ambulance company, he said.
With a jurisdiction of about five miles by three miles (for more than 85% of the population), Palo Alto's fire department barely has to start its engines and it's on the scene of an accident, or the location of an emergency situation.
The question of rapid response has to be seen in terms of results. What are the mortality rates for the Palo Alto Fire Department compared to that of other agencies/private sector ambulances services?
Without fundamental stats like mortality rate, number of people expiring between the initial 911 call and the arrival of the EMS people, review of EMS service by medial staff at receiving hospital .. claims about how good the EMS service might be are likely to be more self-serving than accurate.
Kip, it is a big debate (response time in emergency services). As far as fires are concerned, the sooner the better, and that is just physics. EMS though is different, and the industry standards of 8 minutes (since the conception of EMS with the white papers some 40 years ago) has never been actually scientifically looked at. Current research as of this month in the peer reviewed journal- "Prehospital Emeregency Care" has some pretty damning evidence, which ultimately debunks the whole 8 minutes to save lives. If you can gain access to the article, it is a good read.
> From Paramedic ... "In Palo Alto, ... the Fire Department is the first out unit, with the county private ambulance provider second ..."
We need to change that, so that the Fire Department is the "last called" for patient transfers.
We don't need a fire truck (and ambulance), to transfer a patent from PAMF to Stanford.
Closer in not needing those big fire trucks at each Palo Alto fire station. Since 90%+ 911 calls are medical type in nature, we need to have one of these at each fire station and less of the big trucks.
Martin, regarding your comment "We need to change that, so that the Fire Department is the "last called" for patient transfers."
The fire department is actually called only as a last resort. PAMF's contract with local private ambulances allows them to transfer critical patients using red lights and sirens ("Code 3" transport) if the physician prescribes it. Private ambulance companies (like Westmed and Silicon Valley)also have advanced life support ambulances that can be used for transfers if that level of care is needed.
Again, the problem is that these private companies that PAMF contracts with routinely runs out of ambulances as they aren't required to have dedicated ambulances to PAMF. The result is that PAMF is told by the private dispatching company that it will take xxx minutes for a private ambulance to arrive. There are some conditions where this delay is unacceptable - namely stroke (you only have 3 to 4.5 hours from symptom onset to receive clot busting drugs...if you went to Urgent care rather than the Emergency room which happens a lot, you are really behind the curve) and acute heart attack (where best results are achieved if a coronary artery can be opened within 90 minutes of symptoms onset). I think you will be hard pressed to find a physician at the Urgent Care setting willing to wait for the private ambulance when 9-1-1 is literally around the corner.
> big debate
Googling "prehospital emergency care" generates a lot of "hits". The first one that seems to deal with the topic of "metric" that looks interesting is--
Evidence-Based Performance Measures for Emergency
Medical Services Systems: A Model for Expanded EMS
No doubt there are others.
Thanks for the tip.
Having twice had my life saved by PA ambulances' transporting me from PAMF to Stanford Hospital, I think all the nay-sayers should condider the fact that someday they or one of their loved ones may be the person requiring transport, and then reconsider their complaints.
So Mark, when PAMF calls the fire department for a patient transfer, why does a fire truck need to respond as well? Is this a person/vehicle labor issue? If so, we need to fix this.
Martin, I see your point but I think it's more on the perspective of "when you call 9-1-1 expect worst case situation". When you do a 9-1-1 call, the emergency dispatcher gets the ball rolling very fast on getting an emergency response there...there isn't necessarily enough time to interrogate the caller to determine if there's a need for an acute transfer to Stanford (which probably only needs the ambulance), or if it's a patient in the 3rd floor bathroom in cardiac arrest (which will need a full crew).
It probably falls more on PAMF to contract a private company that can provide more ambulances, rather than the city to address your concern.
In a true emergency, one medic and one EMT on a medic truck is not enough. Rolling out an engine with 3-4 EMTs on as well, helps the crew do their job. In the case of a cardiac arrest, A solo medic (which is the case in some parts of the country) has to start a line, have the EMT set up the monitor, check the monitor, treat rhythm appropriately, intubate, all while talking to bystanders to get the full story and find out if there are any reversible causes to the condition. In the ER they seem to like to have double the people when a patient crashes.
Re Mark: "... It probably falls more on PAMF to contract a private company that can provide more ambulances, rather than the city to address your concern...".
Any PAMF executive management care to address this?
Martin, that was out of context, PAFD is first out for 911, that was not in relation to PAMF transfers. For PAMF transfers, if nothing has changed they are last out, and only for when PAMF dials 911 instead of direct line non emergency.
PAFD only gets called to PAMF when a patient is "emergent", in other words the patient's condition is such that he needs immediate transport by an advanced life support team to Stanford Hospital. A full medical response goes because often times a patient in this condition goes "down the tubes" quickly and more transport people are needed to care for the enroute to the hospital. Believe it or not, paramedics are actually better equipped than most doctors to deal with advanced life support issues in the field. Doctors and paramedics both ususally excel at their specialties. Transports happen from PAMF because many times patients present themselves there when they should have gone to the ER or called 911 from home. Also, patients sometimes deteriorate after the arrive at PAMF.
All, as a former Fire, Law and EMS person and born at Stanford Hospital you need to know that Your PAFD EMS system is One of the Longest Serving and Most Efficient in the area! I have worked side by side with many of them and my wife and I recieved care in 2002 during a Deadly auto accident on Hwy 101. So from receiving treatment first hand, You All should treat your Emergency Services like an Insurance Policy, if you don't Replace, Upgrade, Train, and have the Latest and Greatest You maybe the one waiting for another ambulance provider that doesn't make it on time to Save Your Life!!
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