Emergency Medical Services (EMS)

The chain of survival for an injured or sick person starts with the recognition that there is a problem. Once that problem has been identified, getting help for that person is as easy as calling 9-1-1.

Once on the phone with our dispatchers, the caller is asked for information that helps identify the kind of help that is needed and where it is needed. Contra Costa Regional Fire Communications Dispatchers are trained in what is known as emergency medical dispatching (EMD); this means that, for some medical emergencies, our dispatchers can talk a caller through the best ways to help the patient before arrival of medical professionals, such as bleeding control, CPR (http://www.handsonlycpr.org/) or child birth instructions.

Our dispatchers will send both the closest fire engine and closest ambulance to medical emergencies. For medical emergencies, as with fire incidents, time is often of the essence: the brain starts to starve after 4-6 minutes of oxygen deprivation; trauma patients have “the golden hour,” which is measured from the time of injury to the time the patient reaches the trauma surgeon's table at the hospital – faster treatment and transport to a trauma facility are the goal for best patient outcomes (http://cchealth.org/groups/ems/pdf/trauma_plan2009.pdf). Though we are not trauma surgeons, we pride ourselves in giving trauma surgeons something to work with. When a true emergency exists, patients need as many trained hands as possible as quickly as possible. This is why a fire engine and an ambulance are dispatched at the same time.

For example, for a cardiac arrest, an engine company of three firefighters and an ambulance crew of two personnel would use two people for CPR (one to breathe for the patient with a basic "bag-valve-mask" and one to pump the patients chest to keep blood circulating), one paramedic to start an intravenous line (IV) and infuse fluids and drugs, one paramedic to prepare an advanced airway (intubate), and one person to gather history on the patient (such as name, age, disease history, allergies to medication, medications the patient has been taking and history of the current incident). Three people will ride in the back of the ambulance with the patient to the most appropriate hospital. Someone will drive the ambulance and someone will drive the fire engine to meet the ambulance at the hospital. This is the bare minimum number of personnel to provide good CPR, good airway, and provide appropriate drugs to a patient who has gone into cardiac arrest. Once at the hospital, a team of approximately TWELVE people descend upon the patient to continue what a team of five started in someone's back bedroom or maybe someone's back seat after a vehicle accident.

You may often hear the medical terms BLS or "basic life support" and ALS or "advanced life support." Basic life support in its simplest terms is the level of medical care that we can provide to you during a medical emergency. All firefighters in Contra Costa County are trained as emergency medical technicians (EMT's) and some of the skills they can perform are providing oxygen, performing CPR, obtaining vital signs such as a blood pressure and heart rate, delivering a baby, or splinting and bandaging an extremity. On most fire engines in the County at least one firefighter is trained to a higher level of medical care as a paramedic and they are able to provide ALS skills; starting intravenous lines, administering medications, intubating patients, analyzing heart rhythms on a heart monitor similar to an EKG, and performing a wide range of other skills in the field.

Depending on the kind of medical emergency the patient has, the crews on scene will decide on which hospital to “destinate” the patient to. Trauma patients may need an emergency room (ER) that specializes in trauma care. Heart attack patients will need a local STEMI center (http://cchealth.org/groups/ems/stemi.php). Stroke patients need a stroke center (http://www.cchealth.org/press_releases/2012/2012_0103_stroke_system.php). Burn patients may need a burn center. Children may need to go to Children's Hospital in Oakland. These destination decisions are not automatic; experience, protocols, distance/time of day and “online medical direction” (calling the doctor on duty at the hospital) come into the decision, depending on the emergency. This also goes for the decision to use a medical helicopter.

Once at the hospital, crews continue care until relieved by hospital personnel with higher training and additional resources. Depending on the patient, any number of specialized teams may get involved in the care. A STEMI patient may even bypass the ER to go directly to a Cath Lab. A pregnant patient may go straight to labor & delivery.

Complicating many medical emergencies are the environments victims are trapped in: hazardous materials, confined spaces, collapses, running machinery, crushed vehicles, steep cliffs, raging water and violent scenes are all impediments to care that must be overcome by firefighters and police officers before care and transport of a patient is possible.

The best care of the patient is the ultimate goal in our 9-1-1 emergency medical services system!