What’s Up With That? Training, manpower drive fire trucks’ response to medical calls

One question we have always been asked, and continue to be asked every week, is “Why did you bring that big, red truck for a medical call?” People expect an ambulance when they call 911 for a heart attack, a diabetic problem, or a broken leg and are routinely surprised to see a fire engine or ladder truck also pull up. They often feel it is very inefficient. But there are actually really good reasons for the practice, and once folks have it explained to them, it makes sense.

— Jay Getsfrid, Sifton station captain, Vancouver Fire Department

It’s a great and common question. The floor is all yours, Jay:

“When you call 911 for a medical emergency, several things happen,” Getsfrid wrote in an e-mail. “Your address automatically appears on the 911 dispatcher’s computer screen along with the nearest ambulance and fire engine. The dispatcher is trained to ask a few questions to determine the severity of the problem. People often misjudge the severity of a problem, and this process identifies potentially serious symptoms very quickly.

“The dispatcher then sends the nearest ambulance and the nearest fire engine (staffed with medically trained firefighters) if the system identifies the potential for a serious problem. Many low-severity calls only get an ambulance, but if a symptom raises concerns from a medical standpoint, both units are dispatched.”

OK, that’s the how. But what about the why?

An ambulance has a crew of two, Getsfrid said. “One of them is always a paramedic, and the other has to drive. If a patient has a critical problem (cardiac arrest, heart attack, stroke, respiratory problem, something serious), more than one person is needed in the back of the ambulance to treat the patient. The fire engine provides another paramedic and additional manpower. Sometimes just moving a person downstairs to the ambulance takes a lot of people.”

All Vancouver firefighters are also trained Emergency Medical Technicians — that’s a basic level of training — and about 70 are more advanced paramedics, Getsfrid said. Ambulance and firefighter paramedics train together every month, he said.

So medical training and manpower are primary reasons for that big, red truck turning up for your heart attack. Availability is another.

“Often an ambulance is not the closest unit to an emergency. Fire engines are sent so that people who need help can get it as quickly as possible. If the ambulance arrives first and does not need the fire truck, they cancel it. If the fire truck arrives first, they can prepare the patient for transport, or cancel the ambulance if it is not really needed.”

Why a ladder truck or engine? Why send your biggest firefighting vehicle when you already know it’s not a fire call?

“While a smaller medical unit is more efficient for basic medical calls, it’s a one-trick pony. It doesn’t carry enough equipment or manpower for any other kind of emergency such as a motor vehicle accident or a rescue situation. The type of unit that can handle any kind of emergency is a fire engine. It carries hose, water, ladders, saws, extrication equipment and medical gear. It can do it all. A fire truck that clears one call is immediately ready for whatever comes in next without having to return to a fire station. No matter where it is, it’s ready to go and has everything it needs.”

Getsfrid estimated that 75 to 80 percent of all calls to fire departments everywhere — including Vancouver — are medical calls. “People get sick more often than they burn something down,” he said.

“Fire departments got into the medical response side of things in the 1960s and 1970s when …war-style field medical response was proposed for civilians as a means of saving lives. Fire departments had a standing army of equipment and personnel for fire response that was ideal for integrating into the medical-response system.”

— Scott Hewitt