Emergency Medical Services

Over the years, the fire service has evolved into providing a sophisticated level of emergency medical response.  Now, over half of the calls that we respond to (56% in fact) are emergency medical calls.

The call to 9-1-1 for a medical emergency triggers specially trained emergency dispatchers to dispatch the response, prioritize the call based on other calls at the same time, and give “pre arrival instructions” to the caller to help the patient prior to the responders getting to the scene.  Updates are given to the responders while traveling to the incident on the radio, and the computer aided dispatch software tracks critical information.

For most calls, a fire engine responds with paramedics that are able to stabilize the patient(s) followed up by an ambulance for transportation to the hospital.  The fire engine is dispatched for a quick response, typically three to four minutes depending on location.  There are between four and seven ambulances on duty at any given time to serve all of Santa Cruz County.  American Medical Response (AMR) is the private provider that contracts with the County for the paramedic transport service.  It’s not unusual for firefighter/paramedics to be on scene for several minutes prior to the arrival of the ambulance.  These are critical minutes, and in some cases, has meant saving a life.

Why does a fire engine respond to medical emergencies?  The fire engine has become the “all risk” response vehicle, each staffed with at least one paramedic.  The two staffed engines in Scotts Valley are fully equipped with paramedic gear, vehicle extrication/rescue equipment and all of the necessary firefighting hose and equipment for any type of fire.  Operating engines enables the crew to be immediately available for response to the next incident as soon as they are available.  Murphy’s Law is that more than one incident occurs at a time, and the use of an all purpose response vehicle allows for better and faster coverage.

Once on scene, the paramedics are skilled at diagnosing and treating a variety of medical emergencies with a focus on those that are most life threatening.  Treatment is started, medical history is obtained and preparations are made for transportation to the hospital.  Treatment could include starting IVs, heart monitoring, administering medication and potentially diagnosing a critical heart problem that would require immediate treatment at the hospital’s catheritization lab.  Upon arrival of the ambulance, the patient is carefully transported to the hospital.

Incidents involving trauma, typically significant injuries from a car crash, require transportation to a trauma center based on the policy set by the County Medical Director, a physician who oversees the medical standards.  Since Santa Cruz County does not have a trauma center, paramedics make contact with the local hospital, Dominican Hospital for guidance.  Based on the type of injury and severity, the patient is transported to a trauma center either by ground ambulance or air ambulance (helicopter).  A number of variables enter into the decision including severity of the injuries, patient preference, weather, traffic, and location.  The two trauma centers are Valley Medical Center in San Jose and Stanford and are specially prepared with multiple specialists on call to comprehensively treat a patient with serious injuries.

The level of cooperation between the Fire District, AMR, law enforcement, neighboring agencies and the County is extraordinary.  The fire agencies have formed a cooperative effort known as the Emergency Medical Service Integration Authority or EMSIA.  The purpose of the EMSIA is to provide medical oversight, joint training, joint purchasing, and cooperation amongst the agencies.