Concord EMS: A Big Bang for Your Buck

It’s funny how misunderstood EMS is with the general public.

People either don’t know it exists or have little understanding of how it works. Fire Departments years ago, like the name suggests, simply went to fires. However, as we have discussed in many other articles, the fire service has greatly expanded its role. The biggest expansion by far has been the addition of EMS to the fire service. In the early days, an ambulance was simply a station wagon which had no attendant in the back of the ambulance. It was all about getting patients to the hospital fast. It was there at the hospital that life saving measures were begun, with little if nothing being done on scene or in the ambulance. Believe it or not, it was the Concord Police department that first provided this service in Concord. Eventually, the Police determined that it was not wise to continue this service and Concord Fire took it over.

As time marched on, it was discovered that doing more on scene and in the back of those crowed ambulances would greatly reduce the amount of lives lost daily. Fire Departments started to give training to their firefighters in CPR and dealing with trauma. In these early years, it was all just stop gap measures to keep someone alive while getting them to the hospital. However, some progressive departments started to take things further. They started to get more in-depth with their training, teaching firefighters how to treat more advanced stages of trauma, as well as the far more common non trauma medical emergencies. This also began the idea of using different levels of what are now being called EMTs (emergency medical technicians).

Each EMT level required more tiers of training and allowed for more in-depth assessment of the emergency and how to treat it. The first responder, who was trained very minimally, could perform CPR and trauma support. The next tier was the EMT-B (Basic), who was the person trained to deal with all medical emergencies, stabilize them and get them to a hospital. EMT-Bs are by far the largest community of medical providers, as well as the national standard in most communities. Next, we have the more advanced tiers which require even further training. The EMT-A (Advanced) has all the skills of a basic with the additional training that allows them to add intravenous therapy to their repertoire. They have the ability to give more advanced drugs through these IVs pre-hospital. This changed everything because you’re now able to start truly treating someone in the field. Lastly, there is the highest tier or gold standard of pre-hospital care, which is the Paramedic. These folks are trained in all the levels previously mentioned, as well as a gamut of more advanced skills. These advanced skills and drugs allow our medics to truly take drastic steps in the field to save a life.

As the procedures and abilities in the field changed, we also saw a change in the ambulances on the road. Today’s ambulance is 3 times the size of the early versions. This allows for multiple people to do simultaneous procedures in the back of these units. This all becomes very necessary during a code or extreme call. The modern day unit brings most of the ER to you in the street. Fire based EMS also brings highly invested, highly trained employees who are able to bear any type of medical emergency you can dream up. We go to everything from heart attacks and strokes to toothaches and anxiety. Another great aspect to fire based EMS is that your rescuer will also be your EMT. This means the second we get to you, across a river, down a well, in a wrecked car, we will start providing medical treatment. A patient will not have to wait until they are rescued and brought to an ambulance to receive care. There is already a culture of teamwork in the fire service that predates the addition of EMS. Teamwork is essential in successful outcomes in medical emergencies. Lastly, fire based EMS is a better choice because of the command structure that is inherent to the fire service. This command structure has been widely used in the fire service for many years for both small scale and large scale incidences. Municipal departments are also publicly funded, so they are not beholden to changes in the economy or business downturns. These changes could cause private companies to cut cost with staffing and equipment. Less staffing leads to longer waits and time is precious in ems. Cuts are the last situation you want to see when it’s you or your child in peril.

The city of Concord has always been a leader in EMS and we work daily to stay as cutting edge as possible. In fact, Concord was one of the first cities in New England to have 24 hour paramedic ALS coverage. So, what are some of the situations that set us apart? First and foremost, we have 3 ALS units positioned around the city. These units arrive most often in 3 to 5 minutes of receiving a call for help. Every Concord Firefighter is at least an EMT, if not a Paramedic. On arrival, a Concord resident gets a Paramedic (the gold standard) on every call. Whether you have a stroke or a headache, you will receive the highest level of care every time. The Paramedics at Concord Fire attend a unique 72 hour program in conjunction with Concord Hospital. We are able to use the cutting edge technology at Concord Hospital’s simulation lab to practice on Pediatric Advanced Life Support and Cardiac Life Support. This year, our Medics will even participate in a pig cadaver lab that will allow them to practice surgical cricothyrotomy.
Concord Fire works very closely with the Medical Director Dr. Hirsch, who brings his experience from Boston. He strives to keep the service as cutting edge as possible in the ever changing world of E.M.S. A prime example is the use of cold water IV therapy to cool a body down when in the midst of a cardiac arrest. This rapid Hypothermia Therapy is showing some promising results in saving a person from long term damage caused by cardiac arrest. Our Paramedics can also perform an intervention that only a very few services can provide in the field. Most ALS services can provide advanced airway interventions like endotracheal tubes, but Concord performs RSI. This is a lifesaving procedure where we can give you a paralytic drug that stops your breathing and allows us to breathe for you while an ET tube is placed in your airway to save your life. We can send all your vitals and heart rhythms to the hospital via computer. This allows the doctor to see exactly what we see in the field. These doctors can then make the decision to avoid the E.R. all together and go straight to the cardiac catheterization lab or operating room. This time saving measure continues to save countless lives every day.

It is a reassuring feeling to know when you pick up the phone, you’re only a few moments away from getting an emergency room on wheels. Today’s EMS is light years ahead of the past and is a world of constant innovation. We constantly seek to better ourselves and our craft. From tooth aches to trauma, we handle everything.