EMS/Training Chief Robert Allard is a 4 year employee with over 26 years <strong>of</strong>experience. In addition to his responsibility overseeing the emergency medicalresponses <strong>of</strong> our department and providing training in all disciplines to divisionalpersonnel in skills maintenance <strong>of</strong> mandated and desired training areas, he isalso our department’s Medical Quality Assurance Officer, Safety Officer andInfectious Disease Control Officer.20%2008 EMS CallsBy Patient Age15%10%5%Average median patient age <strong>of</strong> emergency medical servicecalls in 2008 was 58 years <strong>of</strong> age: <strong>Titusville</strong>’s medianpopulation age is 41 years (2000 census)0%0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99 100-+Age76.3% <strong>of</strong> emergency calls responded toin 2008 by our department fell withinthe emergency medical service fields.All <strong>Titusville</strong> fire stations and all <strong>of</strong> ourfirst-run units provide Advanced LifeSupport (ALS), an enhanced level <strong>of</strong>emergency care for our community.◙ Of 1068 trauma calls, 801required transport to ahospital facility by groundtransportation◙ 80 trauma calls were severeenough to call a “traumaalert” and 72 were transportedto a certified traumacenter via helicopter (31%were vehicle v.s. motorcyclecrashes)◙ Level 1 Trauma Centertransport was initiated for 15patients with severe burns(>10% body surface area)◙ Treated 20 gun shot wounds◙ Responded to 31 stabbings◙ Present at 15 obstetricalevents◙ Conducted 10 water rescues◙ Responded to 232 pediatriccalls (0-14 years <strong>of</strong> age)6412319062008 EMS CallsTotal: 49321594797340Other Medical CVA IllnessTrauma Respiratory Cardiac RelatedNOTE: OTHER MEDICAL includes such emergencies as: dizziness, insect stings,heat-related injuries, lightning strikes, patient lift assists, snake bites, etc.13
<strong>The</strong>re is a vast difference in the scope <strong>of</strong> practice providedbetween Paramedics and Emergency Medical Technicians (EMTs).Roughly put, an EMT can treat the outside <strong>of</strong> a patient, whereas aParamedic can also treat the inside <strong>of</strong> a patient. More specifically,an EMT is able to provide basic life support such as bleedingcontrol, splinting, oxygen and compressions. However, theParamedic provides advanced life support in the form <strong>of</strong> IV’s,cardiac respiratory medications, advanced internal airway proceduresand cardiac defibrillation or pacing. An EMT completes aone-semester program with 225 contact hours with clinical experiencein the field and emergency room before being eligible forParamedic school. <strong>The</strong> Paramedic program is 1500 contact hoursover the course <strong>of</strong> one-year, with the student completing clinicalrotations in every facet <strong>of</strong> patient care within the hospitalsetting, as well as an intensive field internship. As an extension <strong>of</strong>the emergency room, the scope <strong>of</strong> practice provided by Paramedicsinclude skills utilized by nurses and respiratory therapists, and98% <strong>of</strong> their decisions and treatments are made without the advice<strong>of</strong> the physician, by operating under approved and adoptedstanding orders and protocols. (Immediate ER physician contact isavailable 24/7 for direction, if needed.)Coupled with ALS, a rapid response to the emergency medicalscene and transport <strong>of</strong> the patient to the appropriate facility isvital for a positive outcome for the patient. In 2008, <strong>Titusville</strong>Fire and Emergency Services averaged a 4.36 minute emergencyresponse time within the city. <strong>The</strong> national standard is to maintainan 8.00 minute or less response time, with national averagesactually being higher than the desired standard. <strong>The</strong> AmericanHeart Association states “advanced life saving procedures mustoccur within 4-6 minutes to assist any basic life support procedures(CPR) already in place”. A rapid response, assessment andappropriate ALS treatment by a Paramedic allows for immediateintroduction <strong>of</strong> defibrillation, cardiac pacing and medications suchas nitroglycerin and morphine so that a patient doesn’t have towait for later arrival at the hospital emergency room to havethese treatments applied. <strong>The</strong> Paramedic is also able to interpretadvanced 12-lead EKG’s and jump start the ER’s process <strong>of</strong>mobilizing their cardiac heart catheterization team.As partners with Parrish Medical Center’s Acute CoronarySyndrome Team, this advance notification has PMC leading the wayin ”door to balloon” times, with their average time drastically lessthan the required state and national requirements. <strong>The</strong> same goesfor the Paramedic assessment and recognition <strong>of</strong> the patient experiencinga stroke. PMC’s accredited “stroke center” statuspermits patients to be expressed through the ER for furtheradvanced diagnostics and rapid intervention.As the population <strong>of</strong> <strong>Titusville</strong> ages, specialized training in elderlycare is emphasized in the education <strong>of</strong> Paramedics. Providing theALS level <strong>of</strong> service and rapid response and partnership with PMC,this group <strong>of</strong> cardiac and stroke patients are experiencing morepositive outcomes than ever. In 2008, <strong>Titusville</strong> Fire and EmergencyServices had a 27.9% success rate in resuscitation <strong>of</strong> our cardiacarrest patients; this compares to a national average <strong>of</strong> 1-2%, and42 patients were neurologically assessed and classified as “strokealert status” by on-scene emergency Paramedics. With theintroduction <strong>of</strong> post-arrest cold therapy implemented in the prehospitalsetting, along with PMC’s extended cold therapy treatmentfrom the ER to ICU, even better outcomes are predicted in thefuture. Nationwide cold-therapy studies have shown this new procedureis very favorable in the reduction <strong>of</strong> neurological deficit outcomesfor the patient.Advanced life support, rapid response times and a hand-in-handpartnership with PMC provides the best opportunity for our citizensand guests in <strong>Titusville</strong> when the unexpected emergency medicalincident happens. Community outreach programs such as Women’sHeart Health, Vials <strong>of</strong> Life, CPR for Citizens and First Aid/CPR forbabysitters helps ensure the chain <strong>of</strong> survival is afforded to all.ᄋ♥ 797 (16% <strong>of</strong> medical calls) werecardiac-related calls♥♥86 (10.8% <strong>of</strong> cardiac-related calls)involved cardiac arrest24 (27.9%) arrested patients weresuccessfully resuscitated by <strong>Titusville</strong>Fire and Emergency Services personnelᄋ 42 patients were issued Stroke AlertStatus and transported to ParrishMedical Center14