California Fire Department to Dispatch Citizens to Cardiac Emergencies

[eze8923]

California Fire Department to Dispatch Citizens to Cardiac Emergencies

 

i realize there are a lot with an EMS background... your thoughts?

[EMEDPA]

not a big fan of volunteers, volunteer fire depts or paid fire depts doing ems at all for that matter....but you use what you have...and in backwater nowhere a volunteer fire dept is usually better than no ems at all...

[eze8923]

san ramon is a pretty suburban area, so i don't think it's a matter of staffing necessarily. the thing is that i can see it's usefulness if there happens to be an incident in a mall where i'm grocery shopping a few doors down for example... but of course, there is the downside of those who are just surfing the airways for action.

[Just Steve]

First thought was patient confidentiality. Second thought was security of the patient's personal property. Third thought was CISM for civilians. Folks associated with response services undergo a background check and attend classes that discuss confidentiality. They area also surrounded by people who they can talk with to help them cope with things that they may experience on calls. Letting any Iphone owner squirrel into a scene may bring unsavory people being around someone who is at their most vulnerable, it may allow folks with poor coping skills to witness events that are not easy to forget, you can suddenly hear the Barista at the coffee shops laying out the details of some scene, dropping names, with disregard with who may overhear. All this on top of the fact that sometimes too many cooks spoil the soup. I can appreciate early intervention and if properly done, then handed off as more trained people show up is great. But the last thing I really want to deal with on a scene is some Squirrel in overdrive trying to call the shots when the only medical training they have is watching Johnny and Roy on TVLand. (Emergency! reference for those who missed it)

[eze8923]

I can appreciate early intervention and if properly done, then handed off as more trained people show up is great.

good points all around, but one might argue that despite those negatives... is it worth the one or few that show up can perhaps make an impact?

 

person could always refuse the help of a bystander as well.

[Craigk]

I may be wrong but I didn't notice anything verifying the qualifications of the person downloading the app. To me it would seem necessary to verify the person using the app actually had the training and willingness to do so and not just somebody looking to watch the show and get in the way. In theory I believe it's a good idea but practically I feel it may cause problems unless they take measures to verify users.

[rev ronin]

"Cardiac arrest patients have an 8 percent chance of survival without immediate help. That jumps to 80 percent when CPR and AED are used in the first few minutes, he said."

 

Well, I'd say the article quoted an overly optimistic statistic, at the very least.

 

Ultimately, a 911 call is public record, with certain exceptions for private data that wouldn't be relevant to the app anyways. I don't think BIs, CISM, or the like are really issues, since all it does is effectively take a simple proces--crying for help--and amplify it to people who've chosen to listen. Fundamentally, it's a bit like a fire department scanner, only more targeted. The responders' actions, for good or ill, fall under the responders' own responsibility and/or good Samaritan laws. Their own insurance can pick up the cost of CISM, should the need arise.

[medic25]

I actually downloaded this app a few days ago when I first heard about it, and I like the idea in concept. The evidence supporting early CPR continues to grow, and one of the weakest links is bystander CPR. If this helps to find some interested citizens willing to perform early CPR, it can't help to give it a shot. I'm actually planning on passing this information along to our local dispatch centers and EMS agencies to see if anyone is interested in adapting it in our region.

[ventana]

I like it - but should be restricted to licensed medical providers - scenes are to crazy already and to add in every tom, dick and harry that has it on their Iphone is nuts - as well what a better time to steal something from the office????

 

I do think it is a great idea for medical people - I would have no issues with going to a code a short distance away if I knew about it - to do compression only CPR (unless I have a BVM)

[ohiovolffemtp]

I think that time will tell how well this works. I'm optimistic, though. Unlike EMEDPA, who I respect greatly, I've had great results with volunteers. My last 2 cardiac arrest saves (both neurologically intact) began with combinations of YMCA members & staff starting CPR and using an AED. In my 30 years in the fire service - always dual role fire and EMS - volunteers, including me, where the major providers.

 

I would like to see that department make successful completion of a CPR course and a background check a prereq for being dispatched via that app.

[medic25]

I like it - but should be restricted to licensed medical providers - scenes are to crazy already and to add in every tom, dick and harry that has it on their Iphone is nuts - as well what a better time to steal something from the office????

 

I do think it is a great idea for medical people - I would have no issues with going to a code a short distance away if I knew about it - to do compression only CPR (unless I have a BVM)

 

My worry with this is that you are drastically limiting the number of potential responders to initiate early CPR. It would be like sounding a fire alarm in a building but only letting licensed firefighters use the fire extinguisher on the wall. If this helps to encourage Joe Blow to began early CPR, I'd have no problem thanking him for his efforts on arrival and asking him to step aside. With the push towards compression-only CPR there are fewer things to push a citizen away from starting CPR, so I'd gladly get more of them involved in the chain.

[Just Steve]

good points all around, but one might argue that despite those negatives... is it worth the one or few that show up can perhaps make an impact?

 

person could always refuse the help of a bystander as well.

 

Is it worth it? Dunno...I come from a military background so the concept of "acceptable losses" has been in my lexicon for a very long time. I still don't like it a whole lot but I do understand that we break a few eggs when we make an omelet. As for the person refusing the help of a bystander...I was under the impression we were talking about folks in cardiac arrest. If the diagnoses is correct, the patient would fall into the "implied consent" realm.

[Just Steve]

Ultimately, a 911 call is public record, with certain exceptions for private data that wouldn't be relevant to the app anyways. I don't think BIs, CISM, or the like are really issues, since all it does is effectively take a simple proces--crying for help--and amplify it to people who've chosen to listen. Fundamentally, it's a bit like a fire department scanner, only more targeted. The responders' actions, for good or ill, fall under the responders' own responsibility and/or good Samaritan laws. Their own insurance can pick up the cost of CISM, should the need arise.

 

To be devil's advocate...the public record of 911 calls is not the same as having first hand information from being on scene. A 911 call simply tells you that an event happened. Being there gives intimate details that do not need to be shared with a bunch of nosy friends or bragged about. If people really want to chose to listen, they can join their local volunteer fire/rescue system. This App seems to be a free ticket for gawkers who want to "be in the know" but do not want to dedicate the time and energy to become a first responder/emt. Yes, it is like scanners which anyone can listen to, but those are signals not specifically sent to civilians. This App is a government supported plan which is targeted to untrained civilians. In essence, it's consenting their participation. A gun rights advocate may say this should be extended to "active shooter" incidents where early intervention may save innocent lives. Have a "shooter App" sent to concealed carry folks so they can rush in and be a hero. I know, slippery slope argument but it's an easy parallel

[haeriphos]

Great idea, but it should be limited to those that have provided proof of CPR/AED training, pass a background check, and sign a confidentiality agreement (HIPAA training). They should also configure the app so that it only sends out alerts that are within a short distance of your listed addresses. If I got CPR events across town every day I'm more likely to ignore it when my neighbor's address comes across.

 

But really an excellent start. I see an ambulance on my street every few months and wonder if it was something I could have helped with.

[Firemedic13]

Bad idea. First off, privacy issues already mentioned. Second, the fire department who made this app is asking for major liability. I can see the courtroom now: "So, Chief DHFISFDJI, you authorized anyone who downloaded this app to respond to a scene?"

"Um, well, they were supposed to be trained in CPR."

"But anyone who downloaded this app was authorized by you to respond to an emergency?"

"Yes, but we had them sign a waiver."

"But they were authorized once they signed the waiver?"

"Um, yes."

"I see, so when they stood there, filmed the deceased being molested and beaten... and then put that up on youtube, you authorized that then?"

"No!"

"Really, but you told them they could be there! You even gave them GPS directions to get there!"

"Wait, no!"

 

Two weeks later and that chief's county is filing bankruptcy. Easy Peasy.

[rev ronin]

Heh. Nice fictional scenarios, guys, but no, there is no liability.

 

1) 911 call information belongs to the public. It's broadcast over the airwaves ALREADY, so all the kooks can ALREADY listen in and show up. Most of them, do not. Those who do on a regular basis get attention from the media, mental health organizations, and/or the police.

2) There is (even absent sovereign immunity) no liability to an agency for making public information public. It is, in fact, required to do so.

3) HIPAA doesn't apply to bystanders. Not current ones, and not ones who might additionally show up to help if they knew about it.

4) CPR training is not the same as current certification. In case no one has bothered to read the 2010 guidelines for bystander CPR, they've been dumbed down to "Call 911, push hard and fast in the center of the chest". Why has the AHA does that? Why, because the mire of complicated instructions were causing people to die or lose brain function needlessly.

5) If a person takes the initiative to go to an uncontrolled medical scene, then they are either a) trespassing, and subject to arrest, or b) on public property or on private property with appropriate permission, and entirely entitled to be there. If they misrepresent themselves in order to gain entry, that's itself a crime.

 

And the term isn't "civillians" unless you're military, Just Steve. It's "taxpayer" or "citizen" or "constituent" or "sir/ma'am".

 

Fundamentally, all public sector services are facing grave cutbacks in many, many cities, and Fire/EMS are not immune. If we're going to serve and protect the public, we're going to need the help of every willing volunteer who's willing to walk across the street and start bystander CPR.

[Firemedic13]

Heh. Nice fictional scenarios, guys, but no, there is no liability.

 

1) 911 call information belongs to the public. It's broadcast over the airwaves ALREADY, so all the kooks can ALREADY listen in and show up. Most of them, do not. Those who do on a regular basis get attention from the media, mental health organizations, and/or the police.

2) There is (even absent sovereign immunity) no liability to an agency for making public information public. It is, in fact, required to do so.

3) HIPAA doesn't apply to bystanders. Not current ones, and not ones who might additionally show up to help if they knew about it.

4) CPR training is not the same as current certification. In case no one has bothered to read the 2010 guidelines for bystander CPR, they've been dumbed down to "Call 911, push hard and fast in the center of the chest". Why has the AHA does that? Why, because the mire of complicated instructions were causing people to die or lose brain function needlessly.

5) If a person takes the initiative to go to an uncontrolled medical scene, then they are either a) trespassing, and subject to arrest, or b) on public property or on private property with appropriate permission, and entirely entitled to be there. If they misrepresent themselves in order to gain entry, that's itself a crime.

 

And the term isn't "civillians" unless you're military, Just Steve. It's "taxpayer" or "citizen" or "constituent" or "sir/ma'am".

 

Fundamentally, all public sector services are facing grave cutbacks in many, many cities, and Fire/EMS are not immune. If we're going to serve and protect the public, we're going to need the help of every willing volunteer who's willing to walk across the street and start bystander CPR.

 

1) & 2) There is a difference between making information public, and dispatching responders. A fire department is liable for the actions of the people it sends to a scene.

 

3) HIPPA does apply to any medical personnel dispatched to a scene. A lawyer will make the argument in front of a poorly educated jury that someone trained in CPR and sent to the scene counts as medical personnel.

 

4) strawman

 

5) either they are allowed to be there, or they aren't.... well, either way, doesn't effect the liability the fire department has just gained

 

FYI, I am not saying this is right, I am just saying that given the current litigious environment in this country that I can totally see it playing out this way.

[rudypa]

not a big fan of volunteers, volunteer fire depts or paid fire depts doing ems at all for that matter....but you use what you have...and in backwater nowhere a volunteer fire dept is usually better than no ems at all...

 

You do realize that volunteer depts out number career departments, right? If municipal budgets could handle more career/fulltime, tons of people would be happy. The fact of the matter is, without volunteers, several small communities would be in trouble. I understand where your concern comes in with regards to "quality" volunteers, but, I don't need to tell you early CPR & AED is critical.

 

Im not entirely certain what the "lay citizen" is going to accomplish w/o the proper equipment.

[EMEDPA]

I'm actually not a fan of fire ems at all. I think the places that do ems best have dedicated ems medics who don't do fire at all. doing fire + ems divides your focus and draws wanna bees who do ems to become firemen for the pay/ benefits.

[rudypa]

I'm actually not a fan of fire ems at all. I think the places that do ems best have dedicated ems medics who don't do fire at all. doing fire + ems divides your focus and draws wanna bees who do ems to become firemen for the pay/ benefits.

 

I can agree with the wanna bees.

[rev ronin]

I'm actually not a fan of fire ems at all. I think the places that do ems best have dedicated ems medics who don't do fire at all. doing fire + ems divides your focus and draws wanna bees who do ems to become firemen for the pay/ benefits.

I'd be less surprised at you having this take on it if you were from the East Coast.

 

Here on the West Coast, I think there's been a real and substantial transition in the fire service. It's no longer purely a blue-collar trade occupation, but actively transitioning to a professional field EMS organization who also fight fires. Seattle Fire prefers to hire kids with a bachelor's degree, EMT-B, and zero fire experience. Society needs firefighters... but really not to the extent that they need EMS providers. Making Firefighting an adjunct function of EMS agencies, which is how the transition is going, is a good solution. Firefighting divorced from EMS is horribly expensive and an inefficient use of society's resources.

[Firemedic13]

I'm actually not a fan of fire ems at all. I think the places that do ems best have dedicated ems medics who don't do fire at all. doing fire + ems divides your focus and draws wanna bees who do ems to become firemen for the pay/ benefits.

 

I agree with you that the fire service draws a lot of people who only got their EMT-B so they could apply for their firefighter job. And it can lead to a situation, like the one in a nearby department, where the fire service simply sends a bunch of people they pick every year to paramedic school. So then you get bad medics too.

 

On the other hand, Rev has a point: fire service is vital, but expensive without a secondary function... and EMS is a perfect fit. I think that, with time, this will become obvious to the people in charge, and the culture will change.

 

Also, frankly, a well trained chimp could be a firefighter. But paramedic actually requires a human mind. It think, personally, this is why half the old guard firefighters hate the paramedics in their own departments so much. That and their dependency on the paramedics ("not real firefighters" they all claim) for about 80% of their funding. Funding which disproportionately goes to the fire side instead of the EMS side.

[EMEDPA]

Also, frankly, a well trained chimp could be a firefighter. But paramedic actually requires a human mind. It think, personally, this is why half the old guard firefighters hate the paramedics in their own departments so much. That and their dependency on the paramedics ("not real firefighters" they all claim) for about 80% of their funding. Funding which disproportionately goes to the fire side instead of the EMS side.

AGREE WITH ABOVE. firefighters on scene for me were handy as someone to do cpr, carry heavy pts, and do heavy labor. we used to do mutual response with la county fire and for the most part I wasn't impressed with their medics. ALL their firefighters are medics. they do medic school as part of the fire academy( and these guys are aiming for C's just to pass). the last big mci I worked with them( included 11 pts in the back of a pickup truck that flipped when it hit another oncoming car not to mention internal passengers in both vehicles) they triaged a guy with a huge and obvious midshaft femur fx as minor and set him to the side with no tx and as 3rd unit on scene I ended up transporting him much later than he should have gone.

I have no problem with medics sharing space with firefighters in a common quarters and receiving a pay check from the fire dept. I just don't like to see medics wasting valuable training time carrying hoses and doing fire related education instead of MEDICAL TRAINING.

LA city fire medics used to use a good model like this. they were basically a third service that lived at the fire quarters. medic 1 in seattle is similar in that these guys are dedicated medics although they work administratively for the fire dept.

[Firemedic13]

Yeah, EMEDPA, I can totally see where you are coming from. If we had the funding, I would split our department. Medics respond to medical calls and to fires as medical support. Firefighters respond to critical calls as an extra pair of hands, and to fires.

 

On the other hand we have a private transport service which means we are already kind of doing this.

 

Frankly, I am just glad I don't have to continue to live in my current situation come August. I am in charge on medical calls technically, but only realistically to the extent that some EMT-B lieutenant won't *****, whine, moan, or passive-aggressively get back at me later. Also, despite their inferior training, they are in charge of scene safety and triage. Whatever. I look forward to defending my department later in court when this bites them in the butt AGAIN.

[EMEDPA]

I'd be less surprised at you having this take on it if you were from the East Coast.

 

.

 

3 yrs as a medic in philly was enough for me.....16 yr old emt-b's with blue lights and rescue gear in their trunk just waiting for the big one so they can ditch out of their high school english class....delaware county, pennsylvania...most volunteer ems members in the u.s......working ems in philly was like stepping 10 years into the past after working as a medic on the west coast....