Advanced Clinical Interventions Performed by Emergency Medical Responder Firefighters prior to Ambulance Arrival

Abstract

Introduction. Data on the clinical interventions performed by emergency medical responder firefighters (EMRFs) are limited outside the context of cardiac arrest. We sought to understand the broader medical role of firefighters by examining fire-ambulance arrival order and documenting specific interventions provided by firefighters with advanced EMR training. Methods. A secondary analysis was conducted using electronic patient care records from a single ambulance service and two municipal fire departments that partner to provide emergency response in two suburbs of Minneapolis, Minnesota. Firefighters in both municipalities are dispatched to all medical calls, regardless of severity, and receive training in the following advanced EMR skills: intravenous line placement, administration of oral nitroglycerin and aspirin, placement of supraglottic airways, administration of albuterol via nebulizer, and injections of intramuscular glucagon and epinephrine. Time stamps for unit arrival on scene were used to determine arrival order and to quantify fire lead time (i.e., the interval EMRFs were on scene before paramedics). Results. Fire and ambulance records were linked for 10,403 patient encounters that occurred over 2.5 years. EMRFs arrived first in 9,001 calls (88%) with an average fire lead time of 4.5 minutes. In the two communities, firefighters performed at least one of the six advanced training interventions in 688 patient encounters (7.6%) when they reached the patient first, the most frequent being intravenous line placement (n = 340; 3.8%) and administration of oral nitroglycerin or aspirin (n = 303; 3.4%). EMRFs arrived first to 96 cases of cardiac arrest and performed chest compressions in 78%, automated external defibrillator use in 44%, supraglottic airway placement in 32%, and intravenous line starts in 18%. A modest positive association was observed between increasing fire lead time and use of cardiac arrest interventions by EMRFs. Conclusions. EMRFs performed advanced EMR training interventions in a small fraction of the patients they were able to reach before paramedics, and further study of the clinical significance of these interventions in the hands of this responder group is needed. EMRF training in these communities should continue to emphasize the fervent and consistent application of BLS resuscitation interventions in victims of cardiac arrest.

Procedures Performed by Emergency Medical Services in the United States

“…Although data exists that examines specific providers in limited geographic areas, there are no national assessments of the frequency of procedures performed in prehospital environment. 8 This information is vital to maximize procedural training opportunities and to optimize training curricula. We sought to characterize the frequency of procedures performed by EMS providers in the United States.…”

Home health nurses’ views on participating in pre-ambulance emergency treatment: A qualitative descriptive study

“…1 A shortened response time can also be achieved by dual dispatch of emergency medical services and other professionals as first responders. 2,3 The first responder on the scene arrives before emergency medical services and shortens the time between collapse and defibrillation; this improves the chances of the patient surviving, and increases the survival rate in the 30-day period after out-of-hospital cardiac arrest. 1,4 First responders from various professions can often be on the scene rapidly if they are in the area, but they have to be prepared for and educated in, for example, CPR and defibrillation with an automated external defibrillator, along with other acute treatments, so that they are confident enough to provide on-scene emergency treatment.…”

“…1,4 First responders from various professions can often be on the scene rapidly if they are in the area, but they have to be prepared for and educated in, for example, CPR and defibrillation with an automated external defibrillator, along with other acute treatments, so that they are confident enough to provide on-scene emergency treatment. 2,3 Potential first responders include home health nurses (HHNs) home care providers, and firefighters. 2,3,5 However, such assignments are rather different from the first responders' usual work and require preparedness and clear information before their implementation.…”

Professional firefighter and trained volunteer first‐responding units in emergency medical service

“…First‐responding units (FRUs) are used in many countries as a means of bringing trained help to the victims of out‐of‐hospital cardiac arrests (OHCAs) before ambulances . There are variations on the concept of FRU organisation ranging from trained volunteer laypersons to professional firefighters and emergency medical technicians (EMTs) who are dispatched as one tier of emergency response …”

“…Generally, FRU personnel perform initial, potentially lifesaving procedures prior to the arrival of the first ambulance. These procedures include, but are not limited to, cardiopulmonary resuscitation (CPR) with or without defibrillation; the opening of the airway with or without the use of simple airway methods, such as an oropharyngeal airway or a supraglottic device; and the control of external haemorrhage …”