The Safety and Licensing Committee met 08/09/2023. One of the items they took up was the Fire Department Service Agreement for Gold Cross Ambulance. This was previously approved unanimously by the committee but then referred back to the committee for further discussion by Alderperson William Siebers (District 1) who had concerns about the staffing levels on the ambulances.
The committee spent around 30 minutes discussing it and then, again, unanimously voted to recommend it for approval after amending the agreement to include a requirement that Gold Cross and the Fire Department will report findings of the agreement to the Safety and Licensing Committee every 6 months.
I’ve prepared a complete transcript of the discussion for download.
The main issue discussed during the committee meeting was the number of paramedics who would respond to Advanced Life Support emergency calls. Gold Cross will staff their Advanced Life Support ambulances with at least one paramedic; however, as discussed at the previous committee meeting, due to employee shortages they could not staff all ambulanced with two. Additionally, the Appleton Fire Department is moving toward being able to provide a paramedic level of service in mid-2024; however, the Appleton Fire Department employees who currently are certified as paramedics are not able to actually provide a paramedic level of service due to the fact that the department does not have the specialized equipment needed to provide that level of service.
The department would also need to submit an operations plan to the state. Once that operations plan was on file with and approved by the state and the Fire Department got the equipment they needed, then they would be able to operate at a paramedic level.
They hoped to be able to get that equipment by June or July of 2024; however, that was dependent on the 2024 budget and whether they were awarded some grants because they needed around $130,000 worth of equipment in order to move forward with being able to operate at the paramedic level.
The standard of care within Wisconsin was to have two paramedics on an ambulance for Advanced Life Support calls. Gold Cross could ensure that a paramedic and an emergency medical technician was on every ambulance, but they could not ensure that two paramedics were on every ambulance. They did, however, have a paramedic in a separate rapid response vehicle that could respond to calls in addition to an ambulance.
Fire Chief Jeremy Hansen and Gold Cross representative Nick Romenesko seemed to hold somewhat differing views on the importance of having multiple paramedics respond to an emergency call. Fire Chief Hansen held that having two paramedics was that standard of care within Wisconsin, and he was only okay having fewer than that because the Fire Department was moving toward being able to offer paramedic level service by the middle of next year. There were a good chunk of calls where an ambulance probably wasn’t even needed; however, “I would argue that about 35 to 40% of the calls we respond to are the more severe where a paramedic could affect patient care. You know, one example is a call that occurred just a few weeks ago. It was for an individual that had a fractured hip. In that time of the gap between the fire department arriving and the ambulance arriving, the fire department could have started an IV, we could have provided pain medication to relieve that individual’s pain. Now, would that—is that a life and death situation? No, it’s not. But it is a patient comfort level? Yes, it is.”
Mr. Romenesko agreed that there were comfort measures and sometimes even lifesaving interventions that could be performed by an additional paramedic, but most of those life saving interventions could be done at a Basic Life Support level and performed by an Emergency Medical Technician versus at an Advanced Live Support level by a paramedic. ‘When you go to a physician’s office or a doctor’s office or go to the ER, they’re not going to walk in and immediately start interventions on you. They have to figure out what’s going on first. And that’s kind of the way we operate in the field as paramedics and EMTs. And in collaboration with the fire department that first few minutes is information gathering, vitals gathering, determining exactly what’s going on with that patient, and then the advanced level of care can be provided.”
The level of care also factored into why the arrival times were set out as they were in the agreement. For Advanced Life Support calls, the Fire Department’s goal was to arrive on the scene 4 minutes and 59 seconds after the call was received by the city. Gold Cross’s goal was to arrive within 8 minutes and 59 seconds after the call was received by the city. Based on that data the Fire Department and Gold Cross had been tracking for the last year, on 90% of calls Gold Cross arrived within 6 minutes and 21 seconds after the Fire Department arrived. Per Chief Hansen, “In that 6 minutes and 21 seconds, we may be able to do a lot, we may be able to do not much. I mean, it may take us that long to find the patient sometimes. So there really isn’t a gap between care. You know, it’s not like we’re there, the ambulance shows up, and we leave. It’s a team when we are there together.”
Mr. Romenesko said, “That gap that we’re talking about is built in for a reason, because a lot of what is done—like I said, you know, in previous meetings—a lot of what is done in that first four minutes, is that BLS level. It’s finding the patient, it’s establishing that care, it’s doing an assessment, it’s taking a set of vitals, it’s determining the best pathway for treatment for that patient. So that gap is typically filled with that.”
The committee ended up amending the agreement to include a provision that Gold Cross and the Fire Department will report findings of the agreement to the Safety and Licensing Committee every 6 months. The agreement already include requirements to track response times and patient care metrics, as well as a requirement for the leadership of Gold Cross and the Fire Department to review that information on a quarterly and annual basis.
Formally requiring that information to be reported to the Safety and Licensing Committee was not something that would require much additional work and was seen as a reasonable way to keep the alderpersons apprised of how things were going.
The committee voted unanimously both to amend the agreement and to recommend the agreement for approval.
View full meeting details and video here: https://cityofappleton.legistar.com/MeetingDetail.aspx?ID=1103674&GUID=DD9AD8C6-1BBB-49A7-BDA1-F0391B34793C
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