County's medical protocols rankle some area fire chiefs


 
 

Robyn Rosenthal | | Tuesday, August 14, 2007


FENTON - Area fire chiefs say new protocols mandated by the county medical control authority could compromise patient care and will tax already budget-strapped departments.

Ten of the 19 fire departments in the county are first responders, meaning they are the first to be dispatched to a medical call. In rural areas, they often arrive before ambulances and paramedics.

But new county standards prohibit nonlicensed medical first responders from assisting with patient care.

"Do we take a chance and treat the person or take a chance and get suspended?" asked Gaines Township Fire Chief Bill Miller, a critic of the county regulations. "It's all because they're trying to protect themselves. The liability is ours, not theirs."

That's not how Bruce Trevithick, executive director of the medical control authority, sees it. And the authority regulates emergency medical services in the county.

"Fire medical first responders have a very narrow purpose and value," Trevithick said. "They're there to provide care before an ambulance gets there. They're primarily used in rural areas where response times are longer."

Fire chiefs say recent changes to the county protocols could compromise their care to patients by requiring that anyone assisting on a medical call be a medical first responder. Miller said although 25 of the 30 volunteer firefighters in the township are licensed first responders, it's often necessary to have a firefighter who isn't licensed assist one who is, such as grabbing bandages or helping to carry a backboard.

That creates a situation whereby a bystander could help emergency personnel, thanks to the state's good Samaritan law, but an unlicensed first responders could not.

"The bottom line is they came out with this protocol, and we are not providing a service to our community. I can get anyone to help to assist, but I have trained personnel I can't use," Miller said.

Trevithick said the protocols are regularly tweaked by a five-person group and are designed to protect patients and area agencies.

"What happens if you slip and fall with the patient and you're now unprotected," Trevithick said of prohibiting nonlicensed medical first responders from assisting with patient care.

Trevithick said the county is enforcing state regulations, and argued that there is no room for interpretation. Miller doesn't agree.

"They're taking the law and directing it to the system," Miller said. "They're not looking at the spirit of the law."

Robin Shivley, manager of the EMS/trauma section for the state, said the state protocols are only a guide. Many counties adopt the state protocols, others craft their own. She said Genesee County regularly submits their own protocols for approval from the state; however, she could not say when they last did.

Shivley said state protocols require that licensed medical first responder agencies dispatch around-the-clock, and that at least one person with medical first responder training be dispatched. She said the state doesn't prohibit nonmedical first responders from assisting first responders with patient care.

"That doesn't mean they can't assist in patient care, like assisting with backboards," she said.

Mundy Township Fire Chief Toney Romans said the protocols are costing budget-strapped departments more money. The county is requiring special identification badges for first responders - Shivley said it's their right to do so - and for personnel to take a test on the county protocols.

"How do you get 35 people through a protocol test when you're having to go down to the court and take off work," said Romans, adding that the department would have to pay firefighters for their time to take the test.

Miller said in Gaines Township the fire department operates on an annual budget of $132,000. He said even if the badges indentifying personnel as medical first responders cost about $5 apiece, it's money his department can't afford. He said the department responds to 300 calls a year, half of which are medical calls.

"I run pretty lean," Miller said, adding that unlike private ambulance companies, fire departments cannot pass along higher costs to patients and insurance companies. "It doesn't sound like a lot until you realize it's not budgeted. They can't abruptly throw this stuff on the table without looking at what it's going to cost us."

Joe Edgerton, executive secretary/treasurer of the Michigan State Firemen's Association, said cost is keeping more fire departments from becoming first responders. He said his organization does not get involved in medical issues.

"There isn't the cost benefit," he said. "In the out county, it takes longer for an ambulance."

Area departments also criticize a county protocol that requires inspection of all first-responder vehicles. Fire departments already have their vehicles inspected, which is required by the state. However, it cost Gaines Township another $500 to have a second set of paperwork filled out for the county medical control authority.

"Some things are costing this department $10,000 to $12,000 - without our input," Miller said.

Miller said so many issues would be resolved if the county would recognize that fire departments and ambulance agencies need different regulations.

"They need to start recognizing the difference between fire service and ambulance service," he said. "We're the ugly step-sister nobody wants to talk about."

The county medical control authority is made up of five people: representatives from the three area hospitals, a county health official and the county medical director. There also is an advisory board that meets bi-monthly and makes recommendations to the authority. The advisory board includes a representative from an area fire department.

Argentine Township Fire Chief William Harvey, who sits on the advisory board, would not comment on criticisms from area fire departments.

Trevithick said the issue comes down to fire departments adapting to oversight.

"It's hard to be monitored when you haven't been monitored for so long," he said. "From our perspective, we haven't regulated the way we should have. This type of change is difficult for some people."




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