By Robert J. Post
“I called 911 and requested an ambulance and a fire engine showed up first.” What’s going on? What’s going on is the Barrow County Department of Fire and Emergency Services has taken positive steps to improve the delivery of emergency medical and fire suppression services to the citizens of Barrow County. Prior to October 2007, response times to emergency medical calls exceeded the nationally recognized standard of eight minutes, 90 percent of the time for advanced life support (ALS). Advanced Life Support is the highest level of emergency care performed in the field. A minimum of one paramedic with advanced equipment is required for a unit to be classified as ALS.
In fact, in some instances response times exceeded 10 to 12 minutes. The reason for these response delays were too few licensed response units and the practice of transporting non-emergency patients out of the county.
Since October, additional response units have been placed in service resulting in response times that now meet the national standard of eight minutes.
Before October, Barrow County Fire Services attempted to operate six ALS ambulances each 24-hour shift. These units were supplemented by two licensed first responder engines at Fire Station 1 in Statham and Fire Station 5 at County Line.
But due to staffing shortages caused by employees on vacation, out sick, on worker’s compensation, in school, and several vacant positions, rarely were six ambulances in service. A review of staffing statistics revealed that from January 1, through September 30, 2007, the department operated less than six ambulances 89.01 percent of the time. While during the same period, only two firefighters were assigned to each of the county’s six fire engines.
These factors had a negative impact on the emergency service delivery abilities of the department both in the areas of emergency medical care and in fire suppression capabilities. Because department ambulances were constantly out of the county transporting non-emergency patients to Gwinnett and Athens area hospitals, units routinely were unavailable in the county to answer emergency calls for service. This resulted in delays in response and regularly necessitated the need to call Jackson, Gwinnett and Hall counties for assistance.
To improve service capabilities of medical and fire suppression services, an evaluation of unit responses was conducted to determine what areas of the county had the least number of calls for medical service.
It was found that only one out of every 10 calls were in the Statham and County Line areas of the county. It was decided that the ambulances in these areas would be taken out of service and replaced with Advanced Life Support (ALS) engine companies with three firefighter paramedics/ EMTs assigned to each shift.
An ALS engine has the same service capabilities as an ALS ambulance with the exception of the ability to transport. This change improved the response times to these areas and enhanced the fire suppression capabilities by providing an additional firefighter on each engine.
Additional equipment, including state-of-the-art automatic external defibrillators (AED) were obtained and placed in service on each of the six county engines. These units were then licensed with the State of Georgia as first responder or ALS units.
With addition of these units, the department’s medical response capability increased from six units to ten units.
The out-of-county transport of non-emergency patients was the next area that was evaluated to determine what could be done to reduce the impact this practice had on the emergency response capability of the department.
When an ambulance transports out of the county, the unit is out of service an average of 1½ to 2 hours. With approximately 35 percent of the transports in this category, the availability of ambulances to respond to true emergencies within the county is greatly affected.
Department officials met with a private ambulance provider to explore the possibility of a non-binding exploratory joint venture where the private service would provide transport of non-emergency patients to area hospitals. This would allow department ambulances to remain in service within the county to answer emergency calls.
On October 15, Pro Care EMS was designated as Med 20 and began operation out of a facility in Winder. Since its inception, Med 20 has transported non-emergency patients to out-of-county hospitals in excess of 800 times at a fee less than that charged by the county. This has allowed department ambulances to remain in service in the county approximately 1,600 additional hours or a total of 66.7 days.
With this program in place there has been only one occurrence when a department ambulance was not available in the county to respond to a call for emergency service.
The final area of the service delivery program that was evaluated was the dispatch protocol of units to specific types of emergency medical calls.
In the past, it was standard practice to dispatch only an ambulance to requests for medical assistance. This was in part because of a lack of proper medical equipment on other department apparatus and outdated policies regarding emergency medical service delivery. Changes were made to the dispatch protocols that would now send the closest department unit(s) to the incident. This might be an ambulance, an engine or a combination of the two depending, on the nature of the call.
This change resulted in significant reductions in response times and has increased medical care for the patient. The practice of sending the closest unit to a call is not new in the emergency medical business. Progressive fire service organizations like Gwinnett, Dekalb, Cobb and Forsyth have been doing it for years. The goal is to get trained medical personnel on the scene in as short a time frame as possible.
These first-in units can then evaluate the patients’ condition and provide medical care to stabilize the patient. Once this is completed the patient, if necessary, is then ready for transport. This then completes the cycle of response, evaluation, treatment and transport.
The Mission Statement of the Barrow County Department of Fire and Emergency Services is protect and preserve life and property. The changes that have been put in place to enhance the emergency medical service capabilities have enabled the department to further achieve that mission.
This is the first in a series of articles about the Barrow County Department of Fire and Emergency Services.
Robert Post has been the Chief of the Barrow County Department of Fire and Emergency Services since July 2007. Chief Post has more than 35 years of fire and emergency medical service experience. Prior to coming to Barrow County, he served 34 years with the Gwinnett County Department of Fire and Emergency Services, where he was Assistant Chief of the Business Services Division. Questions can be directed to 770-307–2987.