Sp Spark rks s Ci City ty Cou Counci ncil l Con Conside sidera ration tion Sho hould uld Pa Para ramedic medic-Level Level Service ervice Be Be Imp mplemented lemented in in the S the Spa parks rks Fir ire e Dep epartment? rtment?
Two-Tiered Tiered EM EMS Sy S System tem • Designed igned in 1986 86 • Firs rst-Tier Tier – Fire re Depar partm tments ents: Fir ire e strat ateg egic icall ally y pla laced ed wit ithin hin 4 minute mi nute dri rive ve time me Provide vide rapid id initi itial al care • Second cond-Tier Tier – REMSA SA Am Ambulan bulances: ces: Provide vide Paramedic edic-lev level el serv rvice ice Provide vide tran ansport port
His isto tory ry of EM f EMS I S In Sp Spark rks s Fir ire De Department rtment • 1986 86 – First t Responder ponder 45% % EMS • 1996 96 – Basic ic EMT-D D (defibrillators) efibrillators) 60% % EMS • 2000 00 – Adva vance nced EMT 74% % EMS • 2016 16 – Paramedic? edic? 80% % EMS *EMS S is is a a Core ore Serv rvic ice e of f the Spar arks ks Fi Fire re Depar partmen tment
Is There re A Ne Need ed fo for SF r SFD Par D Parame medi dics? cs? • On Only y if f SFD ar arri rive ves on scene ene fi first rst • On Only y if f SFD wai aits ts fo for r REMSA SA to ar arri rive ve • On Only ly if if these se EMS S cal alls ls ar are cla lassified ssified as as ur urgent gent
Do Does s SF SFD Ge D Get t to EM EMS Ca S Call lls Fir irst? • Fro rom m Jan anua uary ry 1, , 2015 15 through rough Mar arch h 31, , 2016, 16, there re were re 11,0 ,017 17 EMS cal alls ls where ere both th SFD D an and REMSA SA re responded sponded an and both th ar arri rived ved on sc scene ne • SFD D ar arri rive ved d fi firs rst t 6,6 ,656 56 time mes • 60.4 .4% % of f the time me SFD ar arri rive ved d fi firs rst
How Long Do Does s SF SFD W D Wait it fo for RE r REMSA SA Wait Times for Fire Department Calls with Wait Times 0 to 5 Minutes 5384 Calls with Wait Times 5 to 10 Minutes 912 Calls with Wait Times More Than 10 Minutes 360 Total Calls where SFD Waited 6656 Average Wait Time 0:03:22 Maximum Wait Time 1:09:25 Median Wait Time 0:02:17 Count of Matched EMS Calls 11017 % of Time SFD First on Scene 60.4%
Ave verag rage e Wait it Tim imes Perc Pe rcent ent of ti f time me As As EMS cal alls s occur ccur that SF SFD is D is fi firs rst 4:47 4: 47 fu furt rther her aw away ay fr from m on scene ene by the core re of f the e Cit ity y dis istric rict wai ait t time mes s increase rease 3:50
When n SF SFD Ar D Arri rive ves s Fir irst t Are re Urg rgent nt EM EMS S Em Emerge rgenci ncies es Found? d? Urgent EMS Call Volume Provider Primary Assessment Number of EMS Incidents Airway obstruction 24 Allergic reaction 35 Altered level of consciousness 419 Cardiac arrest 74 Cardiac rhythm disturbance 51 Chest pain / discomfort 283 Diabetic symptoms (hypoglycemia) 114 Hyperthermia 6 Hypothermia 2 Hypovolemia / shock 16 Poisoning / drug ingestion 35 Pregnancy / OB delivery 16 Respiratory arrest 3 Respiratory distress 325 Seizure 189 Stroke / CVA 66 Syncope / fainting 183 Traumatic injury 886 Total 2727
Pa Para ramed medic ic-Le Level vel EM EMS Se S Serv rvic ice Opport rtuni unity ty to Imp mpro rove ve Pa Patie ient nt Ca Care re • SFD FD is is ar arri riving ving at at EMS cal alls ls fi first rst • SFD D is wai aiting ting fo for r REMSA MSA to ar arri rive ve • Ov Over r 40% % of f these se EMS cal alls ls ar are clas assified sified as as urg rgent ent *Thes ese e 2727 27 cal alls ls re repres resent ent oppo port rtunities nities to imp mprove rove pat atient ent car are by pr y providing viding Par aram amedic edic-Lev Level el se serv rvice ice im immedia mediately tely u pon Fire’s arrival
Medic icall ally y Sp Speaking ing – Why Upgra rade? de? Sin ince ce the in inception ception of f our r Ad Adva vanced nced EMT se serv rvice ice in in 2000, 00, me medic icine ine an and as associat ciated ed technolog chnology y has as ad adva vanced: nced: • The e Par aram amedi edic c Scope ope of f Pra ractice tice has as expan panded ed mu much ch mo more re than an the e Ad Adva vanced nced sc scope pe cre reating ating a a gr great ater er ga gap betwee tween n serv rvice ice leve vels ls • Standa andards rds of f Car are e re regar gardin ding g the ela lapsed sed tim ime e betwee tween re recognit cognitio ion n an and definitive finitive car are fo for r par articular icular medic me ical al eme mergenc rgencies ies now w exists sts fo for r me medic ical al sys ystems ems
EM EMS Ce S Cert rtif ific icati ation on Levels vels Ad Adva vanced nced EMT: T: • Performs rforms Bas asic ic an and a l a limite mited d set of f Ad Adva vanced nced an and phar arma macolo cological gical in inter tervention ventions: s: Some me advanc nced ed airwa way proce ocedure dures I.V .V. . access ess 8 medications ications common mmon to EMS
EM EMS Ce S Cert rtif ific icati ation on Levels vels Par aram amedic edic: • Includes cludes Bas asic ic an and Ad Adva vanced nced skills ls coupl upled ed with th inva vasive ive inter terventions ventions an and phar armacolog macology: y: Car ardiac diac car are including cluding car ardiac diac mo monitor nitor an and defibrillator fibrillator cap apabilities abilities Phar arma macolo cological gical Intervention erventions s in includin cluding g ad adva vanced nced intrav ravenous enous techniques chniques an and an an expan panded ed me medica dicatio tion n list Ad Adva vanced nced ai airw rway ay techniques chniques
Pa Para ramed medic ic Inter terventio ventions ns Car ardiac: diac: Airwa Ai rway y / Medic ical: al: • 12 12-Lead Lead EKG KG • Endotrac dotrache heal l intubation ubation • End d Tidal al CO 2 mo monitoring nitoring • Cricothyrotomy icothyrotomy • Man anua ual l Defibrillation fibrillation • Needl edle e Thora orace centes ntesis is • Syn ynchronized chronized Car ardioversion dioversion • Gastric ric tube e place cement ment • Tra ranscu scutane taneous us pac acing ing • CPAP P ad adminis ministration tration • Vag agal al ma maneuv euvers ers • Various ous routes tes of f medicine dicine • CPR R fe feedback dback an and dat ata ad admi ministr nistration ation
Pa Para ramed medic ic Medic icati ations ons • Ad Addin ing g si similar milar me medic ications ations as as ou our r re regional gional par artners ners would ould quadruple adruple our r current rrent me medication ication list: 13 ad additional itional car ardiac diac eme mergency rgency me medic ications ations Multiple tiple pai ain n ma manag agement ement me medica dications tions Medic ication ations s fo for r other her seriou rious s eme mergencies rgencies including cluding se seizur izures, es, pre regnanc gnancy y problems, roblems, re respir spiratory atory eme mergenci rgencies es an and al altered red leve vel l of f consciousness onsciousness • Medic ication ations s can an be tai ailore lored d to our r Commu mmunity nity needs eds
St Standards rds of Car f Care • STEMI EMI – re recognition cognition to notification tification to tra ransport sport to definiti finitive ve car are – AH AHA A re recomm commends ends to st stri rive ve to re reduce uce this s time me as as mu much ch as as possib ible le • Pro roto toco cols ls – pro rovides vides fo for r mo most st ap appropriate ropriate tre reatment atment • Stro rokes kes – AH AHA A pro romote motes ear arly y re recognition cognition as as po possible ssible • Ai Airw rway ay Man anag agement ement - bra rain in death ath can an occur ccur as as ear arly y as as 4 to 4 to 6 mi minutes nutes wit itho hout ut oxyge ygen • Pai ain Man anag agement ement – go good od patient ient care and eff ffici icien ency cy *Core ore Meas asures ures an and Qu Qual ality ity As Assurance rance Crite riteria ria in high gh performing rforming EMS S Sys ystems tems
Pa Para ramed medic ic-Level Level EM EMS Se S Serv rvic ice Other er Reasons sons fo for Im r Imple lement mentati tion on • Enha hanced nced Au Automatic omatic Ai Aid with th TMFPD PD • Bac ack-up up plan an fo for r delivering livering Par aram amedic edic leve vel l car are • City ty of f Spar arks ks is a f a full-service ervice city
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