Carson City Fire Department launching new ambulance service

A new Basic Life Services program is taking to the streets, Carson City Fire Chief Sean Slamon said, improving emergency medical services in the community and easing the stress currently placed on existing ambulance units.

"We recognize that we are stressing an already busy system," Slamon said. "Currently with our three ambulances that we provide paramedic services with, they are getting busier and busier."

According to Chief Slamon, the Carson City Fire Department (CCFD) ambulance service provided 6,137 transports last year.

As of August 2017, the department had responded to about 4,000 ambulance transports year-to-date, the chief said, which is expected to exceed the numbers from 2016 by year's end.

"Our numbers are spiking eight months into the system," he said. "We're probably going to see another 2,000 to 3,000 calls on top of that. We'll be closer to 7,000 at the end of this year if the trend continues."

Chief Slamon said unit-hour utilization (UHU) has also risen with the increase in ambulance transports. The more UHUs there are, he said, the more stress is placed on a paramedics unit.

When more than 30 percent of a paramedic's shift is spent actually providing care to a patient, Slamon said, that is the stress threshhold for EMS responders.

"In an eight-hour day, how often are they taking care of a patient, either treating them, transporting them, or transferring them to another hospital? How often are they being utilized?" the chief said said. "When we get above the 30 percent level, that's the point to where it's starting to stress an ambulance."

In addition to patient care, paramedics also have to write reports in between calls. When call volume gets so high that one-third or more of a shift is spent responding to them, there is less time for other tasks required of the paramedics.

"When you get into the 30-35 percent range, you have a pretty busy unit hour utilization need for ambulances," Slamon said.

Chief Slamon said the entire department — from administration to the union and the firefighter-paramedics themselves — came together to form a solution to the increasing need for emergency medical services.

"We got everyone together in a room, saying we are stressing our ambulances right now, we are stressing our paramedics, we need to do something different," Slamon said. "Fiscally, we don't have the ability to add another rescue ambulance with firefighter paramedics on it. What's another way we can do this? This is really looking at creative, alternative ways to improve the level of service at a reduced cost."

The answer was an all-new Basic Life Services (BLS) program that responds to less critical medical calls and eases the strain on paramedic units.

A brand-new BLS ambulance unit arrived at CCFD Station 51 last month, Slamon said, and is about to be put into service with its Emergency Medical Technician (EMT) staff.

"This was a great collaboration between the labor group and the fire department," he said.

Purchase of the new ambulance unit was approved July 6 by the Carson City Board of Supervisors as a way to help curb the increase in call volume for ambulance services in Carson City.

"What we've seen is about a five to 10 percent increase in medical call volume per year over the last several years," Chief Slamon said. "And that's a nationwide trend, everybody is experiencing very similar numbers."

In Carson City, paramedics are dual role first responders, Slamon said, meaning they are trained in both advanced life support (ALS) and firefighting.

This can often stretch fire department resources thin, he said, when firefighter-paramedics are needed to respond to multiple types of emergencies.

"Right now we still rely on mutual aid ambulances to come in at times because we have no ambulances to respond occasionally," Slamon said.

The department has had to use ambulance services from outside of its jurisdiction in order to keep up with the number of medical calls it receives, Slamon said.

"People don't realize how much we rely on outside agencies to help," CCFD Battalion Chief Dan Shirey said.

The new BLS program is expected to alleviate the workload of ALS ambulance crews by delegating less serious medical calls to professionally trained EMTs, Slamon said, thereby freeing paramedics up to respond to life threatening calls requiring a higher level of care.

"Basic Life Services will respond to a lower tiered call," the chief said. "There are about five or six tiers that our dispatchers will go through to establish a criteria in which the medical complaint kicks in."

Tiered criteria for determining the priority level of medical calls uses an A to E alphabetical system, Slamon said. The higher the letter, the lower level of care that is required.

Life threatening calls requiring ALS services via paramedics are designated D through E on the scale, the chief said. These include cardiac arrest, stroke, severe diabetic episodes, and dangerous or life-threatening traumatic injuries, among others.

Shirey said the BLS unit will respond to non-life-threatening emergencies such as illnesses, non-dangerous bleeding or hemorrhaging, exposure, non-dangerous injuries sustained by falls or other accidents, minor burns, animal bites, uncomplicated pain, psychiatric problems as well as patient transfers.

"Our EMTs will respond to these calls," Shirey said. "But if on arrival they determine the scene requires advanced life support, a firefighter-paramedic ALS ambulance unit will be called to the scene."

Likewise, some medical calls that are described as ALS in nature may be downgraded by paramedics upon arrival once they have evaluated the situation, he said. Then BLS can be dispatched to provide appropriate emergency medical services.

"On a lower level emergency, if we have information that there are minor injuries, we can send the BLS ambulance there," Slamon said. "It keeps the advanced life support ambulances available."

With implementation of the new BLS program and its criteria, fire department staff as well as emergency dispatchers are trained to accurately assess medical emergencies so that they can be prioritized appropriately and designated to the right ambulance unit, Slamon said.

"There will be a series of questions that our dispatchers will go through to be sure there are no hidden things," he said. "Our goal is not to push away any advanced life support calls to the BLS ambulance."

The goal, he said, is to free up paramedics for the more critical medical emergencies that arise.

That's where the EMTs and their BLS ambulance unit come in.

"There are a lot of falls and trips, motor vehicle accidents with minor injuries," Slamon said. "It's really just clearly a lot of incidents, like ground-level falls, where the patient is conscious and talking, but they may have a laceration, possible broken bone, but not an arterial breach; an otherwise stable patient."

BLS will also provide substantial relief to paramedics who currently also respond to calls for patient transfers, the chief said.

Routine transfers occur between hospitals and other care facilities, he said, more often than not requiring basic life services, such as oxygen administration, to keep a patient stable while en route to their destination.

"Those we will clearly know it's not advanced life support, because these are medical facilities that are telling us the condition of the patient," Slamon said. "It's very common for us to transport patients from Carson Tahoe to Renown, and it may not be an advanced life support need. But right now, that's been our only option."

EMTs employed by CCFD will already have the minimum of 240 hours of medical training required for their certification, the chief said, allowing for BLS services such as oxygen administration and defibrillation.

But EMTS aren't paramedics, he said. There are considerably more hours of training required to become a certified firefighter-paramedic.

"They can't get into the advanced medical narcotics that paramedics are able to administer," Slamon said.

The BLS ambulance unit also will not be outfitted with firefighting equipment the way ALS paramedic ambulances are, Shirey said.

As such, EMTs will not be fighting fires or providing the ALS care that CCFD firefighter-paramedics currently do.

"Basic Life Services EMTs are single role," Slamon said. "They are not firefighters."

But they will begin responding to many calls that current firefighter-paramedics are responding to, he said.

The new BLS ambulance will look very distinctive from current ALS ambulance vehicles in the fleet.

"For the average person, you won't be able to tell the difference inside," Slamon said. "But the exterior will look different. It will be more of the van style, instead of the box style. That will be the striking difference."

Inside the unit is a patient gurney, as well as oxygen, defibrillation equipment, backboards, braces, and other standard emergency medical equipment.

But it won't have the drug box or intravenous equipment featured in paramedic ALS units.

Besides helping to alleviate the call volume on paramedics, the new BLS program is also expected to help save the department and the city money, the chief said.

Because EMTs require less training than firefighter-paramedics, he said, their salaries are lower and more cost-effective overall.

CCFD is also starting out the BLS program conservatively with just single ambulance unit to see how the program does in the field.

"It's a stepping stone," Shirey said.

The BLS ambulance will operate on a 40-hour work week, Slamon said, likely during weekdays to start with.

But no schedule is set in stone for the unit, he said, because the needs for BLS services often fluctuate, spiking during different days and at different times.

"That's something we are going to continually run the data on and watch," Slamon said. "The times and days of the week that we may run it will change as the data shows where are our call volumes, our spikes and our needs are."

The department is looking at an eight-hour work day somewhere between the hours of 8 a.m. and 6 p.m. either Monday through Friday or Tuesday through Saturday to begin with.

If we start seeing a trend, we'll adjust the schedule as needed," he said. "It's meant to be pretty dynamic, all based on the bell curves of calls and trying to do predictive analysis as to when the highest call volume is."

Both Slamon and Shirey said they anticipate the BLS program to have a significant impact on the community, the department and the city. They are both hopeful it could lead to more than one BLS ambulance among the fleet.

"I expect that the data is going to tell us that we could probably use another BLS ambulance in the future," Slamon said. "The program will be that effective."

But before that can happen, he said, the department will have to show its effectiveness on paper by compiling numbers that keep track of the new unit's activity.

"We're going to have to show that it's been effective for our citizens and that it's cost effective for the city," he said.

Shirey said the EMTs have been selected for the program and will be in training this week. He hopes the BLS ambulance service will be rolling on Carson City streets as early as next week.

"We are very excited about this program and the impact it will have on the community of Carson City," he said.

Chief Slamon said credit for the program moving from concept to reality is given department-wide. But he said acting Operations Chief Jon Arneson, EMS Chief T.J. DeHaven, and the department's labor group were especially instrumental in bringing the program to fruition.

"We've got some great champions that recognize our citizens come first," Slamon said. "It was a great decision that came from both sides. It's a win all the way around."