Ohio Debates ALS

COLUMBUS, Ohio — A committee charged with finding ways for Columbus to save money has recommended that the city return to a basic emergency medical system.

The last time the Columbus Division of Fire provided only basic-level care was in 1968.

Since then, Columbus has provided advanced life support to anyone who calls 911 for medical attention, whether a patient needs it or not.

Basic care mostly involves stabilizing injuries before a patient is transported. Paramedics trained in advanced support can administer lifesaving drugs and treat heart attacks on the way to a hospital.

The economic advisory committee, appointed by Mayor Michael B. Coleman and City Council President Michael C. Mentel, suggested comparing costs and benefits of the current system with basic life support.

The group cited a 2005 study published in the Journal of Prehospital and Disaster Medicine that found that patients fared about the same. The study examined 22 previous studies, 18 of them more than a decade old.

“The (2005) study would lead you to the conclusion that whether you have advanced life support or basic life support, you really don’t have much difference in the outcome,” said Robert F. Howarth, a lawyer who led the committee.

“If there’s no positive result or effect … and basic life support is cheaper, then in fact the Fire Division could reallocate those assets and use them elsewhere.”

Basic life support is provided by emergency medical technicians who, for example, can stabilize broken bones or use an automatic external defibrillator on cardiac-arrest patients.

With advanced life support, highly trained paramedics can administer lifesaving drugs, create airways in patients who can’t breathe and shock patients who have had heart attacks.

“A paramedic is vital in saving lives; there is a huge difference,” said Battalion Chief Doug Smith, spokesman for the Columbus Division of Fire. “I think (Howarth) is wrong.”

Dr. David Keseg, the Fire Division’s medical director, said the study did not take into account the benefits of drugs that paramedics administer. “This paper in and of itself is not a good defense of trying to promote” an all-basic emergency medical system, he said.

More than a decade ago, Columbus leaders moved from a two-tiered system to an advanced-only system in which every medic unit is made up of paramedics trained to use lifesaving equipment and drugs.

Many new firefighters are required to become paramedics. Of the 1,520 firefighters, about 640 are paramedics and are paid at a higher rate than firefighters.

Fire officials say the system works. For example, the national survival rate for cardiac arrest is 6.4 percent. In Columbus, it’s 12 percent.

“I can’t see the citizens of our community changing from an (advanced) system to a (basic) system in order to save 3 percent of the budget,” said Jack Reall, president of the Columbus Fire Fighters Union.

He questioned whether the committee considered the money the city could lose in switching. Columbus bills government agencies and private insurance companies at a higher rate for advanced emergency transports to hospitals than for basic care.

Last year, the city collected $12.4 million for emergency medical runs.

“If that’s their recommendation, you have to wonder what the rest of the report has in it,” Reall said.

Fire leaders have discussed returning to a tiered system so paramedics wouldn’t respond to basic calls.

Howarth said the committee did not recommend studying a two-level system.

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