There seems to be more emphasis on data and statistics in government to drive decision making. This leads to generalization and promoting mediocrity-especially in emergency medical services (EMS).
However, if an organization is looking to continually improve, it will have to look past some of the statistical information that may show good but not great performance. In the area of EMS, looking at anecdotal evidence may be appropriate to find cases where a higher level of care leads to a better outcome.
Establishing Value
Occasionally I come across an article or information that questions the value of fire-based EMS and, even more specifically, advanced life support (ALS) or paramedic-level services provided by fire departments. I have also seen information that suggests that having too many paramedics in a fire department is not necessarily good in that they cannot get enough practice to maintain their skills to a level that makes a difference in outcomes. In these cases, like others, statistics and data are cited to “prove” the author’s case and show that there is no statistical difference in results between those that provide the higher level of service-and its implication that it is more expensive-or the number of paramedics on a department.
From a purely scientific perspective, I can’t argue with this. Bu, I am sure people who have been saved by fire-based EMS don’t really care about the statistics. I would guess that virtually every fire service paramedic with a little time on the job can cite instances where the advantages of fire-based EMS led to a positive outcome. It could be a case where the good response time made the difference. It could be that the staffing on the call led to having enough hands to do the job. It could be that the organization invested in quality training. Regardless, often the best chance people have is getting the highest level of service as quickly as possible. This means the fire service in many communities. Unfortunately, unlike television and movies, not every ending is happy, so the raw data doesn’t support the expense. Regardless, it should be the potential for a good outcome that drives decisions-not solely statistics and data.
To compete with the bean counters who rely on numbers, fire-based EMS professionals must be well versed in the benefits of the service they provide and must take every opportunity to tell their stories. They cannot stand by idly when accusations are made based on the inhuman statistical analysis of providing emergent care in the field. All emergency service is as much about the emotional aspects of the incident as it is about the actual technical part. If an individual is revived and returns to normal activities because of the right response, it doesn’t matter to that person or his family if he is only one or two out of a hundred. To that person, the system worked.
Often the services provided by fire-based EMS offer the best opportunity for success-even if some may argue that there is no statistical difference in the outcomes. There are some things that can be discussed and they are, for the most part, indisputable. For example, the medical profession has promoted the fact that irreversible brain damage can occur in as little as six minutes. It has also trumpeted the advantages of quick service and even has begun advertising the need to get to the right facility as quickly as possible. They brag about their “door to balloon” time. If this is the case, if all else is equal, then getting an ambulance to the patient with the highest level of care quicker will translate into better outcomes. Of course, this only applies when the outcomes could have been affected.
Keep the Right Score
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Posted: Nov 6, 2015
Velocity cab and chassis; Detroit DD13 500-hp engine; Waterous CSU 2,000-gpm single-stage pump; UPF Poly 300-gallon tank.
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Posted: Nov 5, 2015
By Alan M. Petrillo
The days of a pile of equipment lying on the floor of an apparatus compartment are long gone, replaced by a wide assortment of trays, slide-outs, drop-downs, sliding and swing-out tool boards, and other setups.
Firefighters and equipment manufacturers have become creative in addressing the variety of ways equipment can be secured inside compartments so that firefighting tools are easy to locate and grab.
Brackets and Mounts
Greg Young, vice president of sales and operations for Performance Advantage Company (PAC), says his company’s philosophy is to “develop brackets that meet or exceed National Fire Protection Association (NFPA) requirements as well as offer quick and easy access and safe storage of equipment in fire apparatus compartments.” He adds that PAC makes sure that occupants are protected from sharp edges and conductivity. “For those products that go inside the cab of the truck, like brackets to hold halligans, irons, fire axes, and other tools, it’s not always about the storage; it’s about the safety,” he says. “Some tools are heavy and expensive, and we don’t want them to get loose and seriously injure someone, so our products are designed to withstand impacts like rollovers.”
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| Performance Advantage Co. (PAC) makes more than 50 types of brackets for fire equipment, including these brackets holding a fire ax and two closet hooks on a PAC Trac swing-out tool board. (Photo courtesy of Performance Advantage Co.) |
Tom Trzepacz, PAC’s sales executive, says that his company’s most popular fitting for inside a fire truck cab is the IRONSLOCK, used for halligans and fire axes. “It’s rated for over 9 Gs of force and has a release strap to keep the tool secure,” Trzepacz says. “It’s designed for a 30-inch halligan and an eight-pound or six-pound flathead ax.” He points out that PAC makes more than 50 different types of brackets. “The HandleLock is our most versatile and widely used bracket,” he says, “with positive locking and secure mounting that can go in a cab or compartment or on the outside of apparatus. We also have a new heavy rescue tool pocket that will work on any make or model hydraulic rescue tool and can be mounted at 90 or 45 degrees, vertically, or horizontally.”
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| Often fire departments will use a variety of equipment-fixing methods inside a compartment, as shown here with these tools held in Performance Advantage Co. (PAC) brackets on a two-sided swing-out tool board, as well as a fixed tool board at the rear of the compartment. (Photo courtesy of Performance Advantage Co.) |
Ryan Glover, marketing manager for Ziamatic Corp., says Ziamatic’s goal is to keep firefighters safe, so the majority of its equipment is tested to exceed 9 Gs of force. “We test both in-house and through third-party testing,” Glover says. “We make mounts for every ki
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Posted: Nov 5, 2015
After spending time at Interschutz in Hannover, Germany, in June, I could not help but think about how much better the fire service would be globally if there were a crosspollination of the worldwide fire service.
This is illustrated by a quote from Matt Ridley’s book, The Rational Optimist: “It is the ever-increasing exchange of ideas that causes the ever-increasing rate of innovation in the modern world.” Interschutz is the world’s largest fire expo and occurs every five years. This year, 51 countries were represented and 157,000 people attended-an increase from 123,000 in 2010. However, it is primarily a European show with a heavy German influence.
Hannover is home to the largest exhibition center in the world. It has 5.3 million square feet of indoor exhibit space. This is more than double the size of McCormick Place in Chicago-the largest available space in North America. In addition, there are more than 624,000 square feet of open air exhibit space. The center houses 27 exhibit halls (most with restaurants), and many of the halls could accommodate three to four football fields. Interschutz used about 25 percent of the available interior space.
Apparatus
There are distinctive differences between European and American apparatus. As mentioned earlier, a crosspollination of technology and design would benefit the fire service in both Europe and America. There has been limited transfer of design. For example, roll-up compartment doors have been a mainstay of the European fire service for decades. Only in the past 20 years has the U.S. fire service embraced roll-up doors, and they are now more common that hinged doors. The Europeans have also followed American design by making many of their apparatus larger than in the past. As service delivery to more types of emergencies expands, the larger trucks are becoming more necessary.
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| Apparatus on display at Interschutz 2015 featured cab access that ranged from outstanding to very difficult. (Photos by author.) |
Counting both inside and outside displays, there were nearly 1,000 vehicles exhibited. European design has many common characteristics for all apparatus. All pumps are rear-mounted with the pump controls at the rear of the apparatus. There are no hosebeds. All hose is rolled and stored in compartments. Structures in Europe are clustered on postage-stamp-sized lots, with underground taps for a water supply very close to each structure. This eliminates the need for “laying in” with a supply line. Surprisingly, the Europeans (with the exception of hose reels) have not adopted the idea of preconnected hoselines-a decades-old design of the U.S. fire service. I witnessed one demonstration of fire attack, and it seemed like an eternity for the crew to make their hose connections-and this is with threadless hose couplings.
Cabs
For the most part, cab access for European-style apparatus is very difficult. It is a straight vertical climb with not many stepping surfaces. The increased height of the apparatus compounds this problem. The problem was illustrated by one company actually having portable steps placed beside the officer-side door so attendees could easily get in the cab. There were several huge aircraft rescue and firefighti
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