Four-man paramedic firefighter crews perform critical medical tasks several minutes sooner than two-man crews, according to a new national study that sheds light on the Payson Fire Depart-ment’s choices concerning staffing levels on its fire trucks.
On the other hand, several other recent national studies have also demonstrated that the expensive effort to cut those few minutes off the response time on medical calls ultimately benefits a relative handful of cases.
Ironically, a bystander who quickly starts CPR or has on hand an automatic defibrillator can boost survival for heart attack victims much more than any number of paramedics arriving four or five minutes later, according to the studies.
Taken together, the studies pose a stark choice for towns like Payson, struggling with seemingly no-win choices when it comes to the expensive task of staffing an up-to-date fire department.
Payson hopes to get federal grants to at least initially staff a third fire truck in the new station starting as early as January. But the extra truck will only sharpen the town’s struggle to find the money to keep at least three firefighters on each truck.
“The third fire station is a fact now,” said Payson Fire Chief Marty deMasi. “Four-man crews is what we’re shooting for — that’s the standard. And we can make it work with three if we have to. But in the past, we made it work with one. So if the third fire station presents us with an issue, we’ll have to figure out what to do about it. But I think it’s a growth process.”
Payson currently runs three-man crews on every truck on most shifts and four-man crews about 10 or 15 percent of the time. The town has 32 full-time firefighters and 11 paid reserve firefighters. The department’s budget is nearly $3 million annually — about $174 per resident.
For six months last year, furloughs and restrictions on overtime prompted the department to shift to two-man crews on many shifts. The studies suggest that it takes two-man crews several minutes longer to put water on a fire or get a heart-attack victim’s heart started. Moreover, firefighters on two-man crews suffer a significantly greater injury rate, mostly related to a single firefighter trying to lift too heavy a weight.
Currently, each Payson truck has at least one, and sometimes two, paramedics, who undergo an extra 700 hours of training to learn how to do invasive procedures like inserting a breathing tube and administering emergency medicines. The other two firefighters generally have training as EMTs, which means they can bind up wounds, set broken bones, put people on back boards and use an automatic defibrillator to administer a shock to restart the heart. About 18 of the department’s 32 firefighters are paramedics, the rest are EMTs.
A private ambulance from LifeStar is dispatched at the same time as the fire truck and arrives on the scene a minute or two after the fire truck for most urgent medical calls. That generally puts at least two paramedics and three EMTs on the scene of most urgent medical calls within roughly five to eight minutes. However, deMasi said it can take 10 minutes to reach some areas for an ambulance dispatched from the south end of town.
The study by the National Fire Protection Association compared the time it took different-sized fire and ambulance crews to accomplish a long list of critical tasks in about 100 simulated medical emergencies. The three cases involved locating and removing a patient from a second-floor apartment, treating a simulated fall from a roof and treating a simulated heart attack.
In every case, the combination of a four-man fire truck and a two-man ambulance with at least two paramedics shaved several minutes off the time it took to complete crucial tasks. The larger crews generally had about a one- or two-minute advantage over a three-man crew and a three- or four-minute advantage over a two-man crew for most key tasks.
The study also underscored the complexity of the challenge facing fire crews arriving on the scene of a medical call. Most departments keep track of how long it takes to reach a scene, mindful that permanent brain damage generally takes place three or four minutes after someone’s heart or lungs stop working.
The Payson Fire Department’s goal is to arrive within four minutes of receiving a 911 call, although response times of five minutes are not uncommon. In the area that will be served by the new fire department, response times are generally about two minutes longer than in the rest of town.
However, the Fire Association study showed that on medical calls it generally takes crews several minutes after they arrive to locate and assess the patient. So if the patient needs a shock to restart their heart or a breathing tube, it can take an extra two to six minutes for crews to start life-saving treatment.
Spurred by studies showing that the survival rate for heart attack victims drops dramatically the longer the heart remains stopped, fire departments for decades have engaged in an expensive effort to build enough fire stations and hire enough crews to cut precious minutes off those arrival times.
For instance, Payson will spend about $1.5 million to build a new station and $1 million annually to staff it in order to cut several minutes off the response time in about one-quarter of the town’s area. But that quicker response time will likely make a vital difference on only a handful of cases annually.
deMasi estimated that medical calls account for about 70 percent of the department’s call volume and only about half of those calls involve some sort of life support or medical treatment. He didn’t know how many of those included heart attacks, an inability to breathe or heavy bleeding — the types of cases where cutting a couple of minutes off the response time can save a life.
However, deMasi said the great challenge in establishing an emergency response lies in designing a system the town can a afford and that can still marshal the resources to respond to that rare, deadly event.
He recalled a case two weeks ago involving a two-car crash just south of town on the Beeline Highway.
The crash drove both cars off the highway and down a 50-foot embankment. One car rolled, the other was partially crushed — trapping four people inside the two cars.
One of the victims suffered critical head injuries. A second suffered a crushed chest, which effectively splintered and separated many of their ribs. The other two people were also trapped in the car with serious, but non-life-threatening injuries.
One Payson fire truck with a paramedic and two EMTs arrived on the scene within minutes, followed closely by an ambulance with a paramedic and an EMT.
The firefighters quickly called for help.
That resulted in the dispatch of a second Payson fire truck and two more ambulances. A fourth ambulance was tied up in town on another call.
Payson put out a call to Hellsgate under its mutual aid agreement and Hellsgate sent a engine with a paramedic and an EMT to stand by at one of Payson’s fire stations, in case another emergency call came in.
That gave the first responders on the scene four paramedics and six EMTs to save the four seriously injured people. The firefighters had to climb down the steep embankment, cut open both cars with the jaws of life, assess the condition of the victims, get them out of the cars without hurting them further and haul them up the embankment to the highway.
In consultation by radio with emergency room doctors at Payson Regional Medical Center, they called in a medical helicopter to airlift the two critically injured motorists to the trauma center at Scottsdale Medical Center. The helicopters landed nearby within minutes and the ambulances hurried the other two patients to the hospital in Payson.
“Now if that had happened in Phoenix, they would have no doubt called a full first alarm and rolled seven engine companies,” said deMasi. “They can do that: When you have 200 engine companies to call on, you can do that sort of thing. You have to remember that our third fire station won’t just serve that neighborhood — it serves the entire area.”