5-minute emergency response protocol evaluated in Mich.
By Sally York
Copyright 2007 Flint Journal
All Rights Reserved
GENESEE COUNTY, Mich. — About five years ago, a swarm of wasps stung Paul Fortino outside his home. He's severely allergic.
His wife administered an EpiPen shot, but the Gaines Township supervisor was failing fast. She called 911. Moments later, local firefighters - from a mile or so down the road - arrived to administer oxygen.
"I don't think I can tell you how glad I was to see them," Fortino said. "I was dying."
But is it possible to have too much of a good thing?
Until recently, up to 20 firefighters might respond to a single local medical call, followed by a paramedics unit and an ambulance. That sent costs skyrocketing.
A new rule has changed that in nearby Mundy Township, and other communities. Now, Mundy Township firefighters are dispatched to life-threatening medical emergencies only when a paramedic unit or ambulance is unable to reach the scene in five minutes.
And that's caused a strong debate about the right way to respond to area emergencies. It comes down to firefighters versus ambulances or paramedic unit.
Fortino said he would have been "in deep trouble" if he were stung in Mundy Township today.
"My situation shows why it's important to have (firefighter) medical responders," he said.
But other fire departments - Davison-Richfield and Atlas and Forest Townships - have used the so-called five-minute rule for many years to reduce the cost of firefighter calls and avoid duplicating services by paramedics and ambulance personnel.
Mundy Township adopted the rule about a month ago, slashing firefighter medical runs last month from 89 to 10, and generating opposition from on-call firefighters, whose wages have fallen commensurately, and the township supervisor.
Just how well does the rule work?
Davison City Manager Pete Auger — also chairman of the Davison-Richfield Fire Authority — said his residents receive high-quality, quick responses to medical emergencies, aided by two ambulance companies in the area.
"I'd say the service is good," said Tony Nguyen, an attendant at a Shell station in Davison Township. Ambulances from Patriot Ambulance Service "sit up here a lot until they get a call. Then they run out of here and go."
But what about in cases where an ambulance is delayed and fails to arrive at the scene in five minutes? Fortino said he waited 20 minutes for one.
"I don't know of any situations in our community where that's happened, but it's always a concern," Auger said.
The five-minute rule is "working good for us," said Forest Township Fire Chief Dave Upthegrove. "Do firefighters need to be called if there's an ambulance right there?"
However, since the only ambulance service in Forest Township recently closed, his firefighters are getting called on more medical runs than ever, Upthegrove said.
Until the rule change, Mundy Township firefighters were dispatched to every life-threatening medical call, a policy used in such other communities as Gaines Township, Montrose, and Montrose Township.
"It's good for when somebody's in a severe wreck, or has heart or lung trouble or diabetes," said Montrose Township Fire Chief Albert Rush. "We can stabilize them, especially if it's a heart problem."
Other fire departments — often in more populous areas — don't perform any medical runs, relying exclusively on county paramedics and ambulance companies. They include Burton, Clio, Flushing, Grand Blanc, Swartz Creek, and Grand Blanc and Flint townships.
In Mundy Township, which has two local ambulance companies, the five-minute rule was adopted to reduce expenses and avoid having too many emergency personnel trip over each other at the scene.
"I don't see anything wrong it as long as they don't ignore the issue of health — it saves money," said Mundy Township resident Bruce Lanning. "But if it proves to be ineffective, they'll have to revisit it."
But some authorities aren't happy with the policy.
"How much money does it really save?" asked Supervisor Karen Bond, adding that figures aren't in yet. "I don't think people's lives are worth it."
Local firefighters recently were dispatched to the scene of a collision at the corner of Grand Blanc and Torrey roads, Fire Chief Toney Romans said. Their assignment was to wash car fluids off the street.
"It took 19 minutes for the ambulance to arrive," Romans said. "We did initiate medical treatment."
And Bond is worried about what could happen.
"The longer we let this go on, I'm sure we're going to hit some family who needs help during those first three minutes," she said. "What if you're choking or having a heart attack or drowning in a pool? And we have many elderly people (in the township)."
Here's how the five-minute rule works: When a medical call comes in, two dispatchers in the 911 center work together to contact county paramedics and the closest ambulance, said Lloyd Fayling, director of the Genesee County dispatch center.
The system works but isn't perfect, he said. Dispatchers call ambulance bases, not vehicles. It's not always possible to find an ambulance on the first call, and dispatchers don't know with certainty how close the vehicle is to the emergency.
"It's not unusual for us to have to call more than three (ambulance) bases to get an ambulance, especially during the day," Fayling said.
Fayling said he trusts his dispatchers, but they often have to make a judgment call on whether to contact firefighters.
"Traffic could cause the ambulance to take longer than five minutes," he said. "Those kinds of things can happen."