There are three things you can generally expect from emergency medical calls in central Contra Costa County: 1) A fire truck, with three firefighters, will be dispatched to the scene; 2) a two-person American Medical Response team will arrive in an ambulance; and 3) neighbors will watch intently, wondering why both units are necessary.

Of all the proposed solutions to cut Contra Costa Fire District staffing costs, the most frequent is to eliminate medical response. Critics say leave it to AMR, the company the county contracts with.

Um ... it's not that simple.

Firefighter staffing needs are dictated by the manpower required to fight a major fire -- often units from several stations at once. Medical calls are a bonus, not the reason firefighters are on the clock. Besides, medical calls often require more than two sets of hands.

"If you respond to a cardiac arrest," said AMR General Manager Leslie Mueller, "it takes a large number of people to handle it."

She explained that one person applies the airway (forced breathing apparatus), while another administers CPR, a third reads the heart monitor and a fourth hooks up an intravenous drip. When a victim needs more treatment en route to the hospital, a firefighter climbs into the ambulance to help the AMR paramedic while his partner drives.

Similar teamwork is required for setting broken bones, preparing splints, administering pain medication, lifting and transporting victims. "We train together, we work together, we follow the same protocols," Mueller said. "It's a ... team of coordinated efforts."


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Different communities have different first-response models, she said, with varying responsibilities falling on public and private entities. The ConFire model anticipates the most extreme cases. If a victim is unable to open the door, firefighters can make a forced entry. If he's trapped under a structure or inside a car, they perform extrication. If hazardous materials are involved, they know what to do. If bystanders are too close, they're trained in crowd control.

"There's some overkill for sure," said fire Capt. Vince Wells, president of local firefighters union Local 1230, "and efforts are being made to minimize it, but the system is designed to handle the worst-case scenario."

Another question is why firefighters arrive in fire trucks. It's the same reason police wear guns while directing traffic -- so they're prepared for other developments.

"If we go on a medical call, and it's under control, and there's a fire," Wells said, "we don't have to drive back to the fire station to get another vehicle."

Medical emergencies are automatically relayed to one of 24 strategically located district fire stations and any of 35 to 40 mobile units that AMR typically has on call. "We move the ambulances throughout the day, based on traffic patterns, supply and demand and where we anticipate volume," Mueller said.

Sometimes an ambulance crew is first on the scene. Sometimes firefighters are. Each team has a paramedic, so the order doesn't matter.

"The system is designed to get the appropriate resources where they belong in a timely manner," Wells said.

The recurring question is whether a less costly approach can achieve the same results. Mueller said new models are being explored, but one thing is certain not to change.

When callers dial 911, they can't afford to wait.

Contact Tom Barnidge at tbarnidge@bayareanewsgroup.com.