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No Ambulance for Toothache: Virginia Departments Switching to Need-Based Response

Chesapeake - Paramedics on a quarter-million-dollar medic unit sounded sirens as they raced to the scene of a toothache this spring.

They answered with similar zeal when a woman dialed 911 after spritzing herself in the eyes with perfume and when a kid got a fish hook jammed in a finger.

The Chesapeake Fire Department's protocol has been the same regardless of the circumstances. Come July 1, how quickly help gets to your door will depend on the nature of the complaint.

"If it's a true life-threatening emergency, you'll get a medic unit with a paramedic," fire Chief Edmund Elliott said.

Call with a toothache or a back strain or a pierced finger, and you might get a van with a part-time EMT.

It might take them an hour to get there.

Just as police calls are prioritized - a robbery in progress will pre-empt a bicycle theft - so will calls for medical attention. And the number of medics and firefighters on duty will depend on the hour of the day.

Chesapeake is among the first cities to switch from a traditional model driven by response time to one that is need-based, said Charles Werner, president of the Virginia Fire Chiefs Association.

"The realization is we really have to be more effective and efficient," Werner said. "With the challenges we all have economically ... I think this is a trend you're going to see really begin to happen and unfold across the country."

The Charlottesville Fire Department, of which Werner is chief, used to send three fire engines and a ladder truck to all fire alarms even though less than 0.5 percent turned out to be emergencies, he said.

"It makes you think outside the box, just as Chesapeake has done."

Now Charlottesville sends one fire engine and a ladder truck.

Chesapeake dispatchers will consult a list to rank the urgency of calls; a supervisor can upgrade or downgrade a call.

The department tested the new model for six months in 2007. It was meant to meet the demands of an aging population without expanding the department, Elliott said. "Little did we know that in just two years, we'd be facing a recession" - and an $887,000 spending cut in fiscal year 2011.

They'll lose a dozen vacant positions and two $230,000 medic units equipped to handle heart attacks and major traumas. A pair of $20,000 SUVs and a pair of $60,000 vans with part-time EMTs will help pick up the slack and extend the life of pricey equipment.

"It will create some problems," Werner said. "It will create problems because everyone has an expectation when they call 911 to have a vehicle there within 10 minutes. In this case it may be longer. It might be half an hour. But if you look at it, it's saying we're going to send the resources, and we're going to send them as quickly as needed."

It's also safer for folks out on the road, Werner said.

"It will take a good marketing campaign," said Bruce Nedelka, EMS division chief in Virginia Beach.

There, medics are often diverted from smashed fingers and lingering fevers for life-threatening emergencies.

"I'm sure issues will come up that they will have to deal with," Nedelka sai d. "People are pretty crafty. If they call for a stubbed toe and they don't say the right buzz words to get help fast, the next time they call, they're going to say the right buzz words."

Less than a third of all emergency calls in Chesapeake involve life-and-death situations. More than half require only basic care.

Ambulances back up five, six and seven deep at Chesapeake General Hospital. Medic units are shifted from one part of the city to another to cover the resulting gaps. Sometimes, they are borrowed from other cities.

"The calls manage the department," Elliott said. "We need to draw the line in the sand, and let's control how we respond."

Kristin Davis, (757) 222-5208,

kristin.davis@pilotonline.com



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