The Alexandria Fire Department provided an online update today on its improved delivery model for fire and emergency medical service, including an infographic that explains the new system and answers to frequently asked questions. In 2014, the Department began transitioning from a single-role model — in which firefighters and paramedics held separate positions — to a dual-role model in which firefighters and paramedics cross-train. When fully implemented, the new model will ensure that the first fire engine or ambulance to arrive at an emergency carries both firefighters and at least one paramedic, and that all fire engines and ladder trucks have a full crew of four firefighters. Fire Chief Robert C. Dubé will also provide an update to City Council at its regular meeting on September 8.
“The dual-role model enables us to significantly increase our response capabilities to better serve our community,” said Chief Dubé. “This approach aligns us with our neighboring jurisdictions and provides much greater flexibility in how we allocate resources across our response system. When the new system is fully in place in you call 911, you’ll nearly always get an Advanced Life Support provider on the first vehicle that arrives.”
In the old single-role model, ambulances were staffed with two paramedics (“medics”), who could provide Advanced Life Support (ALS) care such as starting IVs, administering medications, and performing advanced emergency medical procedures. These medics did not have firefighting certification or carry firefighting gear. Fire engines were staffed with three or four firefighter-EMTs, who were certified to fight fires and provide Basic Life Support (BLS) care such performing CPR, controlling bleeding, administering automatic defibrillation, and providing oxygen support.
About half the time (55%) a patient calls 911 for a medical emergency, an ambulance will happen to be closest and will arrive first. The other half of the time (45%), a fire unit will arrive first. ALS care is needed for about half of medical emergencies, and BLS is sufficient for the other half. This means that about half the time ALS care is needed, it was not available on the first arriving unit under the old system.
“Our goal is to provide the best possible service to everyone who lives, works, and visits here,” said City Manager Mark B. Jinks. “Cross-training greatly improves our fire and EMS service without spending millions to hire more staff.”
In the new dual-role model, staffing is being shifted so that each fire engine will carry one firefighter-medic and three firefighter-EMTs, and each ambulance will carry one firefighter-medic and one firefighter-EMT. The new system will also place ALS providers in all 10 fire-EMS stations, whereas only six stations have ALS providers today. The first dual-role fire engine (carrying one firefighter-medic and three firefighter-EMTs on all three shifts) has already entered service at Station 207 on Duke Street. So far, 38 firefighter-EMTs and medics (approximately 17% of providers) have started or completed the process of cross-training.
Under the old system, many fire units only carried a crew of three, and there were insufficient positions to staff a dedicated heavy rescue unit. Under the new system, every fire engine and truck will have a full crew of four, and there will be staffing for a dedicated heavy rescue unit for special operations such as technical rescue, vehicle extrication, and hazardous materials support. This means safer working conditions for first responders and better support for all types of emergencies. These improvements do not require adding any new positions, which will save nearly $3 million per year versus adding a fourth firefighter to each fire unit by hiring new personnel.
The new system also provides benefits for firefighter-EMTs and medics who choose to obtain the other certification, including increased promotional opportunities, raises of 10% to 20%, and higher levels of disability and retirement benefits. Those who choose not to cross-train may remain in their old roles for as long as they wish, and will not risk losing employment. As they retire or choose employment elsewhere, they will be replaced with cross-trained staff.
All personnel are required to follow the same national, state, and local protocols applicable to their certifications and the emergencies to which they’re responding, regardless of how long they’ve worked for the Fire Department or what their job titles are. All personnel hired since 2010 (whether male or female, and whether firefighter-EMT, medic, or firefighter-medic) have passed the same Candidate Physical Assessment Test (CPAT), and those hired before 2010 are not required to take the CPAT to cross-train. There is no difference in hiring or promotional standards between men and women. Prior to the transition, 14% of firefighter-EMTs and 30% of medics were women (versus national averages of 4% for firefighters and 29% for EMTs and medics). So far, 35% of the firefighter/EMTs and 8% of the medics who have chosen to cross-train are women.
(Photo by Mick, on Flickr)