‘The Right People to Your Door Quicker’

In an effort to more quickly respond to medical emergencies, an increasing number of local fire departments are placing paramedics on fire engines that are the first-line response to emergency calls.

The practice, known as front loading, represents a shift in the way departments deploy paramedics, who traditionally travel in vans or ambulances that follow behind fire engines.

The Orange County Fire Authority began the practice two years ago, and paramedics are getting to the scene more quickly than under the old system, said Capt. Scott Brown of the Fire Authority, which serves about a million residents.

Other fire departments such as Orange and Santa Ana are also making the switch.

“The whole purpose is to provide a higher level of care initially,” Brown said. “It can make the difference between life and death.”

The goal of front loading, he said, is to guarantee that a paramedic arrives with the first vehicle at every emergency scene. Medical emergencies constitute about 70% of the calls received by the authority, and every second counts in providing aid.

Under the system, paramedics on the first fire engines immediately provide aid to victims before an ambulance or paramedic van arrives. Under the old system, firefighters would provide basic medical aid until paramedics got to the scene.

Brown said the shift is important because paramedics generally have much more extensive medical training than firefighters.

The department has not compiled data on the degree to which front loading has cut paramedic response times, he said. But he said the department is so pleased with the results that it hopes to extend front loading to all communities it serves.

The city of Orange’s fire department is considered a trailblazer in front loading, having the county’s only fully implemented system, according to Fire Chief Vince Bonacker.

“It gets the right people to your door quicker,” he said. “It’s just a natural extension of the services we provide.”

Bonacker said improving paramedic service is crucial considering that 5,515 of the department’s 7,827 calls last year were for medical aid.

The Santa Ana Fire Department has front loading on some of its engines and is carefully studying Orange’s operation before deciding whether to adopt the system citywide, said Fire Chief Marc Martin.

“I admire them for their willingness to improve the system,” Martin said of the Orange firefighters.

When the Orange County Fire Authority began front loading in 1997, county firefighters expressed concern that the department would eventually abandon the use of separate paramedic vans.

But officials said they will continue to use the vans, which contain more medical supplies than an engine and can transport a patient.

David Rose, in charge of emergency medical support for the Orange County Professional Firefighters Union, said he now supports the front-loading effort.

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Big Red Lifesaver

A paramedic engine in the O.C. Fire Authority performs the same tasks as a regular engine company, but with advanced life support equipment. After evaluation and treatment by firefighter/paramedics, patients are transported in an ambulance to a hospital.

TYPES OF UNITS

A paramedic engine is staffed by two paramedics and firefighters. In Orange County, all firefighters are emergency medical technicians (EMTs).

An engine company, with three firefighters/EMTs, carries basic life support equipment

A paramedic assessment engine is staffed by a paramedic and two firefighter/EMTs.

What the Paramedic Engine Carries

The paramedic cabinet is in the back, and all engines carry identical supplies and equipment:

APCOR: A coronary observation radio used to communicate with doctor at a base hospital. Paramedic can transmit condition and vital signs, and can discuss and coordinate treatment.

Back boards:

Often used with cervical collars to immobilize and transport patients with spinal injuries. Engines usually carry at least two back boards. About 6 ft. long.

Airway bag: Contains masks, tubes and devices to clear a patient’s airway. An endotracheal tube can be inserted through a patient’s nose or mouth into the windpipe to deliver oxygen.

EKG scope: A portable electrocardiograph, used to measure and display the electrical activity in a patient’s heart. All OCFA paramedics use the same brand of machine.

Drug box: Needles and IV bags. Cardiac, asthma and allergic reaction drugs. Pain drugs, including morphine and Valium.

Source: OCFA

Graphics reporting by PAUL DUGINSKI / Los Angeles Times