Thursday, July 03, 2014

Philly Fire at Level Zero

Philadelphia Daily News has an inflammatory headline today: In case of emergency, say a prayer? Sad part - It's spot on. Getting EMS care in Philadelphia is as much luck as it is anything else. It's a finite resource that has long been neglected.
Tuesday brought seasonally expected high temperatures, and with that, predictable high EMS call volumes. That’s NOT a surprise to anyone who follows the saga of PFD*EMS. Add in a small-scale disaster, such as the food truck explosion that happened Tuesday afternoon, and the system went back to Level Zero. And was there a couple other times during the day.

Level Zero is a term in the EMS industry. It means the City has ZERO available transport EMS resources – everything is committed (on calls, at hospitals, cleaning up, completing post-run paperwork, restocking, or out of service for training).

Here’s the thing. Even when Philly DOES have EMS units available… they may not be in every neighborhood. On busy days, it’s routine to see ambulances leapfrog across the city, getting sent on 20 or 30 minute responses as soon as they clear a hospital. Is there really a difference if it takes 10 minutes to dispatch an ambulance that’s coming from 20 minutes away, or if an ambulance from 30 minutes away is dispatched without a delay? Other than the statement of “no medic available” on the radio? The scene gets the closest available suppression apparatus, and they wait for an ambulance.

It’s common in major cities to supplement municipal EMS resources with mutual aid providers. In some towns, that consists of agreements with adjoining towns to help provide coverage for normal flows of service. In other towns, that involves a public-private partnership where ambulances that are primarily used for non-emergent transport are used to supplement the 911 system. Some areas do this more frequently than others, but it’s a common solution.

Philadelphia doesn’t seem to know how to call for help. They have a procedure where quite a few agencies have radios mounted in ALS ambulances that can communicate with PFD’s dispatch so that these units can be used in a disaster. These radios are used in the annual airport drill, and regularly tested, and that’s the end of it.

Philadelphia invested money in the system, and unveiled it 4years ago. Yet, to my knowledge, it has never been used for an actual event. Especially these occasional surge events that happen EVERY SINGLE SUMMER. These surges happen in extremely hot weather, and also on warm summer evenings when the city's "knife and gun club" starts up, and fills the hospital trauma bays with battered and bleeding individuals.

Philly is planning to “fix” their EMS system by hiring a whole bunch of EMS-only EMT’s to ride ambulances, paired with Paramedics, allowing them to return to a all-ALS deployment with more units. That’s the stated goal, anyway. That isn’t going to happen overnight, though. The City should use the resources it has available to cover it’s requirement to provide EMS until PFD*EMS is on a better footing.

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