After several stutters and stumbles, the City of Chicago is close to launching its much anticipated–and, many say, long overdue–program to make fire engine crews better able to deliver advanced emergency medical care.
Under the controversial plan, the city will equip a quarter of its fire engines with ambulance gear–such as a defibrillator and IV drugs–and staff each one with a paramedic and three medically trained firefighters. The engine companies will respond like ambulances, except they will not transport patients to the hospital.
While some experts say the new program, known as advanced life support, puts Chicago at the cutting edge among big cities, it would not have been possible without a special waiver from the state.
And it is that waiver some paramedics say will lead to poor patient care–and in the worst cases, unnecessary deaths.
The Illinois Department of Public Health requires at least one paramedic and one emergency medical technician be aboard every advanced life support engine. The city, however, does not have enough EMTs to meet that requirement.
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So, after three months of negotiations, the Illinois Department of Public Health agreed earlier this month to let the city run the engines for one year with one paramedic and three first responders–firefighters who have about one-fourth the medical training of EMTs. By the end of the 12-month waiver period, the city must meet state regulations.
The ruling makes Chicago the first municipality in the state allowed to delay meeting the legal requirement for this new breed of combination fire engine/ambulance, said Leslie Stein-Spencer, chief of the Division of Emergency Medical Services for the health department.
“We have some concerns allowing them a standard that is not in our rules and regulations,” Stein-Spencer said. “But our regulations allow for new systems to be granted a one-year waiver, and we don’t want to hinder a provider from improving themselves.”
Still, some Chicago paramedics warn that staffing the engines with ill-trained medical personnel could prove disastrous.
“You are only as good as your partner,” said one high ranking, 20-year paramedic veteran who asked his name not be used. “If you’ve got to spend half your time explaining a medical procedure to first responders, a medical procedure an EMT would know, then you are going to be in serious trouble and so is your patient.”
But fire department officials, and the doctors who oversee the city’s emergency medical service, disagree. They say the program will improve the medical training of all firefighters and will speed up delivery of life-saving medical care to city residents.
“Optimum care would be two paramedics, but we strongly agree with the fire department that this current program is sufficient for advanced-life support care,” said Dr. Max Koenigsberg of Illinois Masonic Medical Center, one of four doctors who oversee the city’s EMS program.
Fire Commissioner Edward Altman said the new advanced life-support program will be up and running by Nov. 1–a month later than city officials initially had promised.
The delay continues Chicago’s decade-old struggle to upgrade its emergency medical system in the face of financial concerns from city officials.
Some national experts say Chicago has been slow to react to a decade-old national trend to train firefighters as EMTs or paramedics.
“As the number of fires across the nation decrease, and the number of ambulance-related calls increase, a lot of cities have seen the need to cross-train their personnel,” said Tim Elliott, spokesman for the International Fire Chiefs Association. “But there have been some larger cities, with very traditional fire departments, who have not followed that trend.”
Despite the fire department’s delayed efforts to cross-train firefighters, one national expert said Chicago is “ahead of the curve” in implementing advanced life support. “There is no major city within the top 30 that is even coming close to making all their fire engines advanced life support,” said Gary Ludwig, chief paramedic for the St. Louis Fire Department, who sits on the executive board of the International Fire Chiefs Association.
But the city’s efforts to create a top-of-the-line advanced life-support program has not been without its troubles.
After years of resisting calls for more ambulances, city officials in July announced a $600,000 plan to immediately upgrade 24 fire engines to advanced life support and eventually upgrade all 99. The decision was, some observers say, an attempt to combat growing complaints about lengthy ambulance response times.
State officials, however, initially rejected the plan’s request for a waiver. “They liked our plan, but they had problems with the level of training with our first responders,” Altman said.
Stein-Spencer said the state granted the waiver only after the city agreed to staff the new fire engines with state-licensed first responders.
Since the majority of firefighters do not have the proper training to gain the state license, the city has spent the last few months pushing dozens of them through the advanced medical training.
Still, some paramedics call this approach a “Band-Aid on a Band-Aid.”
“The bottom line is we need more ambulances,” said a 22-year veteran paramedic. “Residents of Chicago are getting shortchanged.”