Advanced Life Support (ALS) is provided by paramedics who are trained and certified to provide a higher level of 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.
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 have indicated they will no longer provide non-reciprocal ALS support to Medfield as of July 1st unless our community makes 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.
A committee appointed by the Board of Selectmen has evaluated a variety of potential solutions and will present their proposal at the annual town meeting on April 30th.
The majority of the committee voted to recommend that the town hire 4 firefighter/paramedics in the next fiscal year and provide Advanced Life Support service through the Medfield Fire Department. This would 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. Considering the additional revenue the town will collect operating at the ALS/Paramedic level, the expected net annual cost increase to the town is $250,000. The majority of the Warrant Committee voted to support this proposal.
A public information session is planned for April 25th at 7:30pm at the Public Safety Building.
While the majority vote of the ALS committee supports providing paramedic service within the fire department, 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 neighboring 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. 2 private services responded to the Request For Information by the stated deadline and the cost estimates 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.
After careful consideration of the alternatives, the majority of the ALS Study Commmittee recommends hiring 4 firefighter / paramedics and providing Advanced Life Support service through the Medfield Fire Department. The recently retired, interim, and incoming new fire chief all support this model as well.