Opportunities for Emergency Medical Services to Modernize

The article Rethinking EMS: Don't Knock Homeboy Transport addresses the value of advanced life support rescues.  The author uses scientific data as evidence that the present paradigm based on advanced cardiac life support and advanced trauma life support may be neither practical nor beneficial for patients overall.  The author also discusses the number of ambulance and helicopter accidents during various rescues, issues with pre-hospital dogma include that the "golden hour" of trauma only reflects a very small proportion of patients; and early cardiac drugs may or may not help survival.

The real issue at hand: Tremendous cost, falls in urban administrations under the umbrella of fire safety and there, one does not comfortably venture, if a politician, without be ready for a career-ending catastrophe.  However, there are ways to modernize and make fire-rescue more efficient, while saving huge quantities of capital and operating expenses.

The historical premise of fire-rescue resuscitation is that a cardiac arrest victims must receive CPR within 4 minutes to prevent brain anoxia-lack of oxygen.  However, new CPR studies show that chest compression without rescue breathing is sufficient to provide oxygenation prior to defibrillation for return of spontaneous circulation.

This means that with good CPR, you have more time to defibrillate.  Keep in mind, that at present time, a fire truck is sent to almost every call - arrives within the 4 minute time limit, followed by a rescue vehicle and supervisor on duty.  With proper triage through dispatch the necessity of multiple fire vehicles may be prevented.  Five vehicles do not a true resuscitation make.  If needed, additional help can be brought in.

A tiered approach toward dispatch and resource distribution can be created to save on manpower and machines.  It would be modern indeed, and might benefit from an approach like this:

• Incorporate the local citizenry through smartphone technology to be first responders.  Without the need for rescue breathing, the public should be more willing to provide CPR
• Have police carry defibrillators. 
• Use "Uber type" drivers with basic life support capabilities and defibrillators available.
• Allow paramedics medical legal liability protection to encourage self-transport.

The bottom-line- resource management is key.  Most rescue calls are not really life and death that can be handled cost effectively as remote triage platforms.  Yes, truly critical patients need rapid transport to the hospital for definitive care.  While our fire rescue personal do a great job, they can be utilized much less expensively and much more judiciously, as true first responders, without needed to be CHST thumpers.