While fighting fires may be the No. 1 function of the Clovis Fire Department, its ultimate goal is to save lives and as a first responder to thousands of medical calls each year. Fire Chief John Binaski said the survivability of patients in distress increases when paramedics arrive on the scene along with the fire truck, which often gets there before an ambulance.
Currently, the Clovis Fire Department responds to calls for medical aid with the three-person fire engine with one Emergency Medical Technician, Binaski said. These EMTs have 120 hours of training and are able to provide life-saving CPR, oxygen, oral glucose and assess trauma. However, they are unable to provide life-saving medication injections, with the exception of an EPI pen if the patient has one, and cannot perform advanced airway innovations with a defibrillator—things that a paramedic with 1,500 hours of training can provide.
By outfitting the Clovis Fire Department with firefighter paramedics, Binaski said, they may be able to save as many as 100 additional lives each year, just by having a paramedic arrive on the scene of a medical aid call within the department’s 6-minute, 30-second time frame.
In 2016, Binaski said the department responded to 5,925 medical aid calls deemed high priority, while 10,000 calls for assistance total were received, with just an ambulance responding to the lower priority calls. It’s unknown how many lives were saved because the fire department responded promptly with an EMT, but Binaski said studies show even more lives can be saved when a paramedic is on the engine.
According to an American Heart Association study, early access to EMS, CPR, defibrillation and in extreme cases, life support, dramatically increase a person’s chances of surviving. More specifically, a South Carolina study showed an increase of 59 percent in patient survivability when they are treated immediately by a paramedic, as compared to just an EMT and trauma patients specifically had an increase in survivability from 27 percent with just the EMT to 73 percent with a paramedic.
While paramedics do arrive with an ambulance, Binaski said timing also has a lot to do with survivability and unfortunately local ambulance services are unable to rush to a 9-1-1 call in Clovis as quickly as the fire department. American Ambulance, for example, takes nine minutes, Binaksi said, and there is a huge gap in survivability between the six-minute and nine-minute mark.
Clovis Fire, Binaski said, reaches a patient right at the peak of their survivability because after the seven minutes, the odds of surviving a medical trauma begin to significantly decrease, and after nine to 10 minutes, the survivability dips even lower.
Binaski said he doesn’t fault local ambulance services for this time gap. In fact, he commended them for doing so well given socio-economic circumstances—there are a high number of Medicare covered calls in the Central Valley, which only reimburse ambulance companies $180 a call, meaning an ambulance company often loses money on those calls—and given that ambulance services serve a wider area. American Ambulance, for example, services all of Fresno County.
While there are many factors that account for the time gap of ambulance services, given that Clovis Fire doesn’t have those complications and can respond more quickly, Binaski said the fire department is in the best position to add life-saving paramedics to its staff to provide better medical aid to Clovis citizens.
And it’s not in just those three minutes that the extra paramedic would be useful because for many trauma patients, having two paramedics once the ambulance arrives rather than one can dramatically increase survivability as well.
“Survivability increases when you have two paramedics, one able to draw medication and another to administer just like when you go into the emergency room and there are multiple nurses and one doctor,” Binaski said. “In some places, two paramedics arriving is standard, but here in the Central Valley our socio-economic status is such that that is not feasible so we typically have one paramedic and an EMT.”
Adding paramedics, Binaski said, in obviously a win-win, however there is a cost to the city involved.
The intent, he said, is for Clovis Fire to apply for the 2017-2018 Assistance to Firefighter Grant, which he is hopeful the department will receive. If the grant is awarded, it does require a 20 percent match which he said the fire department can absorb if necessary into its budget. Already, Binaski said four or five employees are expected to retire this year, and the department plans to fill those vacancies by hiring firefighter paramedics in place of firefighters.
In fiscal year 2018-2019, the cost for the new firefighter paramedics is anticipated to be $42,885 for the additional salaries and benefits. To outfit and restock the engines for medications and other items, the total cost becomes $62,885.
If the department were to add additional firefighter paramedics to ensure one goes out on every high priority medical call, Binaski said the full build out of the program would take five years and cost $217,000.