Concerns over lengthy response times and future availability of the service through its private provider were the main reasons Oxford Fire Chief Jack LeRoy wants his department to provide Advanced Life Support services.
The chief explained to the Oxford Public Fire and EMS Commission Feb. 3 why he believes local ALS is a necessity and why a millage is needed.
For ‘several years,? LeRoy said the average response time of Oxford’s current ALS provider ? the private ambulance service American Medical Response (AMR) ? has been between 16 and 18 minutes.
Oakland County Medical Control Authority protocols require a 12-minute-or-less response time for suburban communities such as Oxford, according to the chief. The national standard for ALS response is 6 to 8 minutes.
To illustrate what it’s like to wait 16 to 18 minutes with an obstructed airway, thin plastic straws were passed out to officials. LeRoy asked board members to try breathing through them while waiting 16 to 18 minutes for ALS from AMR.
In a heart attack situation, LeRoy said for every minute that goes by in which a patient doesn’t receive ALS, their chances of survival decrease by 10 percent. If an ALS unit doesn’t arrive in 10 minutes, ‘they’re dead,? the chief said. ‘Bear that in mind.?
In most cases ? 90 percent of their calls ? the Oxford Fire Department is on the scene in less than six minutes. This promptness can increase a patient’s survival rate by 31.6 percent, the chief said.
The average response time now for the department to provide basic emergency medical care is four minutes.
Being able to provide ALS would allow the fire department to do so much more for patients than is currently allowed with the first-response, basic emergency medical services firefighters presently provide. ALS services include cardiac monitoring, airway management, invasive maneuvers to clear block airways, electronic viewing of the heart from 3 to 12 angles, shocking a severely malfunctioning heart with a defibrillator, advanced trauma care and using of IV drugs for heart problems, asthma, diabetes, high blood pressure and drug overdoses.
As an ALS provider, the fire department would also be able to transport patients directly to the hospital, something it can only do now if an AMR unit is not available.
With a much faster response time than AMR, the Oxford Fire personnel could do all of the above immediately when they arrive on the scene rather than waiting for the private ambulance to come, LeRoy said.
‘I feel (ALS) is necessary,? said the chief, noting he’s been on a scene ‘waiting and waiting for ALS, knowing if Oxford could do it, we could make an impact on someone’s life.?
The chief noted that six weeks ago during an emergency medical call the nearest available AMR ambulance was coming from 14 mile and I-75 in rush hour traffic. ‘That’s not practical. It’s not acceptable,? LeRoy said.
‘Especially if your the one on the ground,? added township Supervisor and OPFEC Chairman Bill Dunn.
Over the last several years, LeRoy said he and members of his department have repeatedly voiced their dissatisfaction to AMR regarding these lengthy response times, but the situation has not improved.
The chief said the main problem is private ambulance providers like AMR lack any local control. ‘The private provider has no vested interest in the community? so it ‘arbitrarily decides the level of service we receive,? he said.
The Oakland County Medical Control Authority ‘has no real authority to enforce? the 12-minute-or-less ALS protocol because private ambulance providers are directly licensed by the state, LeRoy noted.
LeRoy said he also believes local ALS is necessary because one day AMR might decide to not provide ambulance service to Oxford anymore. ‘I consider it a very real threat that we will wake up in the community some morning and we won’t have a private transporter available. They’ll be gone and say, ‘Hey fire department, you better step in and start transporting with your staff. That’s what prompted this.?
Private ambulance companies are for-profit agencies trying to do whatever they can to maximize profits, LeRoy said. These companies make their money on hospital to hospital transports and nursing home to hospital transports, not emergency medical transports, he said.
Add to that, the fact the Oxford/Orion area has become an ‘island? surrounded by fire departments would provide their own ALS, the chief said.
Fifteen fire agencies in Oakland County have upgraded from basic service to ALS in the past five years. In the last three years, fire departments in Addison, Oakland, Independence and Brandon townships have implemented ALS.
All this is cutting into the private providers service base, so the ambulance companies aren’t staffing as many units, meaning an ambulance may or may not be near by, LeRoy said. Cutting ambulance on the street means cutting response times to the Oxford area, he noted.
Providing ALS service would also give the fire department increased staffing to respond to fires because the ALS paramedics would also be firefighters. The added paramedic/firefighter personnel would allow both fire stations to be staffed by two personnel 24-7, resulting in more rapid response times and compliance with the federal ‘two in, two out? requirement.
For every two firefighters who enter a burning structure, there must be two waiting as backup, ready to go in or mount a rescue of the other two, LeRoy said.
More fire personnel on scene will allow the department to begin fire operations faster. A minimum of eight personnel are needed to start fire operations, according to LeRoy, and due to the department’s dependency on paid-on-call firefighters who work other jobs, that minimum can’t always be mustered right away.
That’s why Oxford, like other departments, relies on automatic aid from neighbors like Addison. But even with automatic aid, critical time is still lost because other departments are not arriving on the scene with Oxford, LeRoy said.
LeRoy urged OPFEC to get a fire operations/ALS millage proposal on the May 3 ballot because even if its approved it will take the department between 1? and 2 years to get an ALS program up and running.