Upper Arlington News

Guest column

Protocols help provide city with best service in emergencies


The Upper Arlington Fire Division is not the same entity that we envisioned from 20-plus years ago, but has evolved to be a true full emergency service with many roles, one of the more prominent being emergency medical services (EMS).

We often get questions from the public who wonder why a traditional fire truck may arrive when they expected an ambulance, or why both a fire truck and an ambulance respond to a medical emergency. In this column, I hope to provide some insight on the methodology behind our protocols.

The division responds to approximately 3,200 emergency medical incidents each year and the level of response is based on the information provided to the communications dispatcher when the 911 call is received. The dispatcher gathers the information provided by the caller and categorizes it into predetermined levels of response that are based on national standards of care and local protocols we have developed with the advice of the Medical Advisory Board (which is comprised of resident physicians who volunteer their time and knowledge to provide guidance to the Fire Division).

In Upper Arlington, both fire trucks have much of the initial equipment necessary and personnel with the required EMS training to respond to a medical emergency and operate as an advanced life-support crew until a medic vehicle and team arrives on the scene.

Response is typically placed into one of three categories -- advanced life support, basic life support and non-emergency -- based on the severity of the medical condition and the number or scope of tasks that need to be accomplished by our first-responders.

These tasks can involve starting IVs, electrocardiograms, breathing interventions or pharmaceutical administration and may take place at the emergency scene or while en route to the hospital.

In the most severe medical emergencies, such as cardiac arrest, possible stroke, possible heart attack, unconscious person or difficulty breathing, there are a number of immediate procedures that may directly impact the outcome for the patient. This level of response includes a two-person medic crew and a fire truck.

If it becomes apparent that the emergency does not require the highest level of response, the additional crew is cancelled or returned to service as soon as is practical.

For non-life-threatening incidents that likely require transport to an emergency department (fractured bone, severe illness, already diagnosed medical condition), a two-person medic crew responds and completes the incident without additional resources assigned.

The final response category is the non-emergency or service level response, such as checking the well-being of a resident or assisting a disabled patient. In these cases, the closest fire division crew responds without additional resources. Oftentimes, these responses are handled by a fire apparatus crew, so the medic crew remains available to respond quickly in the event of additional medical emergency calls.

Another reason a fire truck might respond to a medical emergency is as a first-responder when our medic crews are not in a position to arrive within the desired response time; they could already be on another run or returning from transporting a patient to a remote hospital location such as Nationwide Children's Hospital.

One might speculate that this level of resources is not necessary, but the data tell us otherwise. In 2012, there were 1,971 emergency incidents that occurred simultaneously. In 132 cases, a third emergency medical incident occurred at the same time, requiring assistance from a neighboring jurisdiction.

We are constantly evaluating the various levels of response and working to provide the most appropriate level of care to the community, while recognizing how valued our safety services our to residents and that -- in the event of an emergency -- you want to know that help is quickly on the way.

Jeff Young is chief of the Upper Arlington Division of Fire.