By Meg Peters
Review Co-Editor
While every local fire department handles their emergency situations differently, one thing is clear: the quality of resources and quickness of response times could mean the difference between life and death.
Take Orion Township for example. Two recent fire millages approved in 2014 have funded the department’s goal to provide full time emergency services 24/7, 365 days a year.
Now, if a 911 call is made, firefighter emergency medical technicians (EMTs) can be dispatched directly from the fire station, instead of being alerted and then having to drive to the station to pick up the emergency vehicle.
These types of moves help departments save on response times.
On average, the Orion Township Fire Department non-transporting Basic Life Support (BLS) vehicle arrives to the scene within five or six minutes of being dispatched, according to Fire Chief Bob Smith.
Because the township provides BLS non-transporting emergency response services, it partners with a private company, in this case Star EMS, for Advanced Life Support (ALS) transportation services. ALS services differ from BLS services in that paramedics can perform tasks beyond the licensing of an EMT, such as cardiac monitoring, intubation, and administering IV medications, according to FC Emergency Medical Services. Another key function is the transportation. Orion Township is not licensed to transport patients, however, they can in absolutely critical conditions.
Or if Star is taking too long.
In October, there were several instances where Star EMS did not arrive to the scene before 15 minutes, with some instances taking as long as 21 minutes.
An article in the November 11 Oxford Leader quoted Oxford Township resident Kevin Saulter, who survived a heart attack earlier this month, as saying, ‘When I got to the hospital, they mentioned to me that there are only two places here that are going to get you to the hospital on time. One is Rochester Hills. The other is Oxford. If you are living in Lake Orion, good luck.?
The fact that the Oxford Township Fire Department and Rochester Hills Fire Department made quick saves’bringing cardiac arrest victims directly to the cath lab for stint placement within 16 and 18 minutes of dispatching the call’does not indicate that other departments could not do that as well.
The difference between Oxford Township Fire Department, and Rochester Hills Fire Department from Orion, however, is that both of them provide ALS transport to the hospital with their own ambulances.
‘This is not an exact science, that’s the problem,? Chief Smith said. ‘If the public gave me enough money to open up an ALS, and I could have an ambulance here all the time, and we got to your house within six or seven minutes all the time, that would be a great thing. Everybody would be happy.?
Statistics
Smith said an 18-minute-response time’the longest time it took in September for Star EMS to arrive on scene?’is not the greatest thing in the world? but that each call is situational.
‘That was because we had several calls going on. It was during a storm, and the roads were cramped up. That’s no different for STAR than anybody else [any other emergency ALS response unit].?
Of the two 21-minute-response times reported for October, one the ambulance was ‘slowed down? or told to turn off the emergency sirens because the call was for knee pain, a non-priority call. The other call was unaccounted for by the CLEMIS reporting system.
Response times ranged from two minutes to ten minutes, with several calls taking 15, 16, 17 and 20 minutes long for the ambulance to arrive on scene.
Many factors, including priority of the emergency, how many ambulances are stationed in the township, weather, time of day, road closures, and more, can delay response times.
For about 36,000 Orion Township residents, one dedicated Star EMS ambulance is on call every day.?
In the morning it is usually stationed around Fire Station #1 in downtown Lake Orion. By the evening the ambulance has moved closer to Station #4 where a lounge houses the ambulance paramedics overnight. ?
If it is called out for an emergency medical call, another ambulance is sent to Orion.?
Depending on how many medical calls are dispatched within a given time period, there may be instances where emergency responders are traveling from as far as Pontiac to arrive on scene.?
‘Call number one goes out, Star sends their ambulance over and they get there within two or three minutes. Call number two goes out. Call number three goes out. Star gives me ambulances, everything is working fine. Call number four goes out. They call us and say Star is coming from Pontiac. We get out there and assess the patient. Now if this is just, believe it or not, grandma who is constipated,’or an inebriated person the sheriff’s department wants checked out, ok, we will wait for Star.?
Sometimes it’s a judgment call.
In October Star EMS responded to 149 medical calls in Orion Township. Of the 149 calls, 48 waited over ten minutes for Star to arrive on scene, and up to 21 minutes for the longest waits.?
In urban areas, such as Orion Township, Star EMS is required by the Oakland County Medical Control Authority (OCMCA) to respond to an emergency in ten minutes or less 90 percent of the time.?
The OCMCA is nongovernmental, but instead an entity funded by 14 hospitals in or around Oakland County. Their decisions are more than recommendations, and carry a rule of law.
Although Star had an average emergency response time of 8.7 minutes for October, they missed their ten-minute bracket about 32.2 percent of the time, or 20.2 percent with the 10 percent buffer for the variables.
Same goes for September. Star EMS provided emergency transport for 126 medical calls. Almost 30 percent of those calls, or 37 calls in total, were not answered within the ten-minute requirement.?
‘We know we have a very high standard, but we do that because we all agree that we want to provide the best care possible to our callers and citizens. So in some cases maybe it’s unachievable, but we try and arrange what’s best to meet that,? OCMCA Medical Director Steve McGraw said. ‘We expect it 90 percent of the time, but we know that there are certain things that can mitigate that.?
Despite some of the longer response times, Chief Smith said on average Star was meeting their requirement.
‘I have a whole month here and they were meeting the ten minute requirement 90 percent of the time,? he said.
And, like many surrounding fire departments, Orion Township participates in a mutual aid agreement. If, after arriving on scene, Orion EMTs decide a call is too critical to wait for the ambulance, they can call on Oxford Township, Auburn Hills, Independence Township, and others to supply ALS transportation.
What do the others do
Oakland Township Fire Chief Paul Strelchuk said it’s not as much about the response times as it is about the equipment.
Chief Strelchuk has been with the Oakland Township Fire Department since it opened in 1995.
‘It doesn’t matter if you’re ALS, BLS, whatever it may be. With the response times, you’re talking about how long did it take me to get from point ‘a? to point ‘b?, and that time is not going to change,? he said. ‘When you start talking about having the proper resources on the scene, that’s where our difference comes in. Before when we were just a BLS transport department, that advanced life support equipment wasn’t on the scene sometimes for 25, 30, 40 minutes, and we didn’t have any of that stuff [advanced medical equipment].?
Oakland Township Fire Department responded to 45 medical calls in October, with their average response time at 5 minutes 27 seconds. Their fastest time on scene was two minutes, and longest time was 13 minutes, the reasoning being that the fire department could not arrive on scene until it was secured by the sheriff’s department.
Typically their paid-on-call firefighters arrive first with their medical jump kits as their full time paramedics drive the ALS ambulances to the scene.
Oakland Township converted to an ALS system in 2004. They operate out of two fire stations, utilizing two ALS ambulances, and one BLS ambulance for a population of about 16,800.
The department received a 1 mill tax in 2002, and shortly after that made the jump to ALS. Fees that are collected from each transport help pay for the service. Chief Strelchuk estimating this the department will generate about $250,000 from their ALS services in 2015.
Rochester Hills
The Rochester Hills Fire Department converted to ALS in 2002. With five fire stations, five ALS ambulances and one BLS backup ambulance, the department services about 73,000 people. The ALS ambulances are on call at all times, and the BLS ambulance is manned from 8 a.m. to 4 p.m.
One of the main reasons the department converted from BLS to ALS was, like Oakland Township, to decrease response times.
Like Chief Strelchuk, Chief Sean Canto of Rochester Hills has his own opinion.
‘Average response times can kind of be deceiving,? he said.
For example, one of his medical units could make several calls a week right across the street to a nursing home, tallying in 30 second response times each time. If they make ten other calls arriving ten minutes or later to each call, by averaging the 30 second response times in with those the average would turn out to be about five minutes.
‘You’ve got to be careful when people say average, because what does that truly mean. Not that average response times aren’t good, but you want to look at the bigger picture and make sure you’re not missing anything.?
Rochester Hills Fire Department response times were pulled from the month of November, the first month new staffing arrangements had up to three full-time responders on duty per station.
On average, the Rochester Hills Fire Department arrived to the scene within six minutes from the time of dispatch, including about 90 seconds for the 9-1-1 call to process at the Oakland County Dispatch Center, and up to one minute and 20 seconds for the responders to leave the station.
From November 1 to November 23, Rochester Hills Fire Department transported 268 priority calls. About 72 percent of the calls were responded to within six minutes or less, and 11.2 percent of the calls took eight minutes or longer. About eight calls took 10 minutes or longer.
For Chief Canto, response times are critical.
‘They’re absolutely important. If you look at a person in cardiac arrest, for each minute you start extending out, your survival rate goes down. If you get on scene within seven minutes, they have a 30 percent chance of survival. If you get on the scene in five minutes, you have a 50 percent chance of survival.?
Chief Canto said the department statistically can handle three emergency medical calls with no problems. They may have to call on mutual aid for anything after that. No calls have been over 15 minutes for 2015, and while he can’t necessarily eliminate the possibility that any calls took 12 minutes, if they had, they were probably not priority, emergency calls.
Independence Township
The longest response time recorded for the month of October in Independence Township was eight minutes and 10 seconds, according to Chief Mitch Petterson.
Like the previously mentioned departments, Independence Fire Department provides ALS transport services to its citizens, utilizing six municipality ambulances for about 36,000 people in the township.
Independence went ALS in 2001 utilizing a 1 mill tax to jumpstart the program. Eventually the 1 mill was rolled into the fire/EMS millage.
Two ambulances are on call at all times, and if staffing is available, a third ambulance is also on call. The other three ambulances are used as backup if the day or night gets busy, pulling off duty firefighter paramedics back to work if need be.
Like every chief mentioned, Petterson said typically medical calls come in spurts, from having zero calls to five in a short time frame.
‘We might just call STAR to cover that run for that third medical, or if we got the staffing, we’ll provide the third ambulances, and well bring Star in after that to cover the fourth and fifth run,? he said.
Independence calls on Star quite frequently, sometimes several times a week.
‘It’s just impossible to economically build a system to cover every run. You have to build a system on averages, and two [ambulances] typically works for us, and those days come when you typically need more.?
Independence’s average response time for October was six minutes and 13 seconds from the time of dispatch to arrival on scene. Units responded to 172 calls in October, with their quickest response time less than one minute.
Like Orion, Rochester Hills, and Oakland, not every call is prioritized as an emergency priority in Independence, which can also skew response times.
‘Our dispatch system, just like in Orion, codes those calls and gives them priority. They could be eight, nine, ten minutes because we are driving in normal traffic.?
Still, 18 to 20 minute calls are not common in Independence Township.
‘Twenty-one minutes is a little longer than we have because we’re providing our own responses, but we will have those response times based on what type of call it is.?
Petterson said once the department switched to ALS services, response times became more consistent.
‘Private ALS services get busy just like everyone else, and when they do, their coverage gets thinner and thinner, and when they respond to calls they move those units to evenly cover whatever area they’re covering.?
Petterson said one of the benefits of having their own ambulances is knowing where they are traveling from at all times.
Star EMS covers multiple communities in Oakland County. If times are busy, ambulances may be pulled from Auburn Hills, Franklin, Bingham Farms, Highland Township, City of Bloomfield Hills, White Lake and/or Pontiac.
‘If our two ambulances are gone, we know that, and we can immediately make a call for someone to cover. When you’re dealing with a private company, you’re not controlling them, and you don’t know where they are at all times,? Petterson said. ‘Star is a great company, and they provide a great service to Oakland County. They cover a lot of area. There’s just times when everyone gets busy. That’s the issue.?
Then, drive time to the hospital, which could be up to 15 or 20 minutes from Orion, must be added to the equation.
Recap
Supplying an ALS transporting unit is not required by Oakland County.
If Orion Township were to provide ALS transport to its residents, however, an additional tax would have to be placed on the community, Smith said.
‘I don’t prefer [to use a private company] but what I’m doing right now is trying to be fiscally responsible to the public,? he said.
Even if the township converted to ALS, the department might still see 18-minute response times, he said.
Becoming an ALS transporting department isn’t just buying a couple ambulances and putting them on the roads. It’s training the entire staff to operate at a paramedic level, purchasing the correct liability insurance, applying for new licensing, buying all the equipment, hiring a billing company, and can take up to two years or more to get underway.
‘I was involved in ALS for 25 years. The private company servicing the township is excellent, but the money in private EMS is hospital transports. Their unavoidable weakness is you never know where they will be when the time comes. Township ALS backed by the private company is the way to go. When the chest pain comes, do you want to know where your rig is coming from?? Dan Durham said in a post on the Review Facebook page.
Smith estimates it would take 1.5 to 2 mills to fund the transition, based on the millage Oxford Township used to convert their department to ALS.
The Oxford Township Fire Department did not return multiple calls or emails for comment.
‘I’m not saying no to it [ALS]. Nobody is saying no to it. It’s just we have more priority things to take care of.?
The township is finalizing their purchase of an aerial ladder truck, and still must replace several other rescue trucks, and other equipment, he said.
‘My system is not working any different than their systems, other than their guys are wearing fire department uniforms when they walk into your grandma’s house. My system is not broken. It’s not perfect, but their systems are not perfect either.?