Thank you to the residents of Medfield for your strong support of the Advanced Life Support funding decision at the 2018 Annual Town Meeting. The plan to hire 4 Firefighter / Paramedics also received a positive override vote at the town election on June 11th. This will allow the department to move forward with the proposal presented and ultimately to provide a higher level of fire and emergency medical service to the residents.
Advanced Life Support (ALS) is provided by paramedics who are trained and certified to provide a high level of pre-hospital care including medication administration, cardiac monitoring, airway management / intubation and other life saving skills.
For many years hospital based intercept paramedic teams were available from Norwood Hospital or Metrowest Medical Center to respond to Medfield and other towns when ALS/Paramedic level care was needed. When the hospitals discontinued these services by the early 2000's Medfield was able to obtain service from private EMS companies on a per-call charge. Those services or arrangements are no longer available as the latest private provider ceased operation.
Emergency Medical Technician's provide basic level care and patient assessment including splinting/bandaging injuries, CPR and Auto External Defibrillator (AED), c-spine management, glucose monitoring, and administration of a few medications such as epinephrine (allergic reaction), albuterol (asthma), narcan (overdose), and aspirin (for possible heart attack) under limited protocols. EMT-Basics have approximately 150 hours of initial training.
EMT-Paramedics have over 1100 hours additional classroom training plus 500 hours of clinical and field internship time. Paramedics administer dozens of medications for a variety of emergent conditions and perform cardiac monitoring via 12-lead EKG, intubate / provide advanced airways, establish IV access and more.
The Medfield Fire Department ambulance is currently licensed / staffed at the EMT-Basic level (i.e. Basic Life Support or BLS) and relies on outside agencies which can provide Advanced Life Support Intercept services for patients who require a higher level of pre-hospital care. Medfield Fire will be transitioning to ALS level service in FY 2019.
An Intercept is when our BLS ambulance begins transporting a patient to the hospital and stops en route to meet an ALS truck because the patient requires a higher level of care than our Basic EMT's can provide. Paramedics from that agency will then board the Medfield ambulance along with their specialized equipment and provide an enhanced level of care to the patient while the transport to the hospital resumes. In many cases the responding ALS service will arrive at the scene before transport is initiated.
While Medfield has been evaluating solutions to the service gap, neighboring fire departments such as Westwood, Walpole and Norfolk (which are already operating at the ALS / Paramedic level) have been responding to the scene or for an intercept with our ambulance upon request under a mutual aid agreement. This is not truly mutual aid, however, since Medfield is not able to provide paramedic level service back to those communities in their times of need. These neighboring towns indicated they would no longer provide non-reciprocal ALS support to Medfield as of July 1st unless our community made a financial committment and initiates a plan to provide our own service.
Since the end of the hospital based ALS services the following Norfolk County / Metrowest towns now provide fire department paramedic service: Ashland, Bellingham, Canton, Foxborough, Franklin, Hopkinton, Natick, Needham, Norfolk, Norwood, Sharon, Sudbury, Walpole, Wayland, Westwood and Wrentham. Millis and Medway are working to establish paramedic level service within their fire departments in 2018. Dover, Sherborn and Holliston do not have any full time firefighter/EMT's and are relying on fire department based or contracted private services from adjoining towns for ALS assistance.
The April 2018 Town Meeting and June 11th override election approved the recommendation to hire 4 firefighter/paramedics later in 2018 and to begin the transition to providing Advanced Life Support service through the Medfield Fire Department. This will effectively add 1 firefighter/paramedic to each shift, and increase the total on duty shift strength from 2 personnel to 3. On-call firefighters would continue to supplement the full time staff for fire and rescue incidents where needed as they do today.
While the majority vote of the ALS committee supported providing paramedic service within the fire department, along with the majority of the Warrant Committee and the Board of Selectmen - alternatives were evaluated.
Regional Solution: With concerns such as call volume, skills retention and cost - the committee did consider working with neighboring communities to secure ALS /paramedic coverage. 3 adjoining towns already provide fire department based paramedic service and 1 is upgrading to the ALS level in 2018. These communities have indicated they do not wish to engage as Medfield's service provider, even for an additional fee. The 2 other adjoining towns have a low call volume and no full time firefighter / EMT's and have indicated they cannot commit to the additional cost of a contracted shared service.
Private Service: a minority opinion of the committee supported hiring a private ambulance company to provide dedicated paramedic intercept service to the town. A Request For Information (RFI) was sent to c. 30 private ambulance companies and of those 2 companies provided written responses. The cost estimates from the RFI responses for such a multi-year contract were significantly higher than the proposal to hire firefighter/paramedics within the Medfield Fire Department. Additionally, the private service employees would only staff an SUV / intercept vehicle (not a transporting ambulance) and would only be utilized for medical calls which require Advanced Life Support. Conversely, paramedics hired for the Medfield Fire Department would be cross trained as firefighters and respond to hundreds of additional service calls in a year, as well as maintain department equipment and apparatus, and support fire prevention efforts.