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Editorial: Fire Department showed flexibility, creativity in medical-call solution

Sun., June 22, 2014

Health care reform has come to the Spokane Fire Department. Even residents with reservations about the Affordable Care Act should welcome the local changes.

For years, city residents were accustomed to seeing firefighting apparatus, including hook-and-ladder trucks, respond to a call for medical assistance. The trucks were overkill, but rolled because firefighters needed to have them handy in case they were summoned to a fire.

As medical calls increased – to 86 percent of all fire calls today – trucks wore down, and a diminishing number of firefighters finally made it necessary last year to pull trucks from Fire Station 9 on the South Hill. The station has been handling only medical calls.

The trucks will return soon. But without a change in the traditional responses to medical calls, the availability of full-service firefighting is bound to suffer somewhere in the city eventually.

To increase efficiency, the department in October began experimenting with a system that initially dispatched one of three SUVs with a single emergency medical technician when a call for assistance came in. While responding, they were empowered to assess the severity of the patient’s condition based on their history and information collected and analyzed at the communications center. If answers to questions by dispatchers – who have EMT training – suggested a more robust response was in order, a two-man paramedic team or firetruck with more men and equipment could be summoned.

Also, when firefighters and trucks were dispatched to a fire, the EMTs were allowed to leave the firehouses and reposition themselves and their rigs where they could best backfill for the absent trucks.

During periods when multiple fires or medical calls stretched manpower, an EMT or paramedic crew could be called and on duty much more quickly than a firetruck could be manned.

To make the new system work, firefighters who have insisted on inflexible work rules had to bend, and they did: accepting 10-hour shifts that had the automatic response units – ARUs – in place four days a week.

Since the test ended in February, department officials have been studying the 1,000 medical calls received and patient outcomes during the trial period. Also, patients were surveyed to see if they thought call response had been degraded.

The findings: The strategy made better use of equipment, avoided unnecessary wear and did not compromise patient health. Citizens say government was working smarter.

So, as of Tuesday, the ARUs were back in service until 2016. Meanwhile, the Fire Service Task Force that helped design the program will work with first responders, hospitals, clinics, ambulance service provider AMR and other organizations to improve coordination and patient care.

An aging population, and one with fewer uninsured patients, will increase demand for service. The reforms are a good start toward making the best use of the finite resources available.