BEND FIRE DEPARTMENT'S EMS DIVISION

ALS Ambulance

BEND FIRE DEPARTMENTS EMERGENCY MEDICAL SERVICES DIVISION

EMS COORDINATOR: TOM WRIGHT

LEAD PHYSICIAN ADVISOR: DR. HELENKA MARCINEK

SECONDARY PHYSICIAN ADVISOR: DR. BRYCE YERMAN

NUMBER OF ALS AMBULANCES: 5

NUMBER OF ALS ENGINES: 5

NUMBER OF EMT BASICS: 11

NUMBER OF EMT INTERMEDIATES: 3

NUMBER OF EMT PARAMEDICS: 61

NUMBER OF EMS CALLS IN 2004: 4171

NUMBER OF EMS CALLS TRANSPORTED IN 2004: 2849

PERCENTAGE OF EMS CALLS TRANSPORTED IN 2004: 68.3

OVERVIEW
By Tom Wright
EMS Coordinator

The Bend Fire Department responds to EMS calls over a 1600 square mile area of Deschutes County, Oregon. To put this in perspective, Rhode Island is just over 1000 square miles in size. From our stations in Bend we respond north to Gift Road, east about 70 miles to the Deschutes/Lake County border, south to Lava Butte, and to the west to the Cascade Ridge at the Deschutes/Lane County border.

Because of this large distance, we interface with EMS partners in our Ambulance Service Area. Oregon Department of Transportation workers who are first responders assist us in the far east communities of Millican, Brothers, and Hampton. At the Mt. Bachelor Ski Resort we work with the Ski Patrol and with the Mountain Medical Clinic. We depend on the assistance of the Deschutes County Search and Rescue with wilderness extrications and for the use of snowmobiles. We also use Air Life of Oregon to assist us with urgent transport of critical patients.

Each of our five stations have crews that have at least one paramedic per station. Every one of our paid crew members is an EMT at the Basic, Intermediate or at the Paramedic level. Inside each station are vehicles that have equipment and medications to provide Advanced Life Support. This equipment is found on our five engines, five ambulances. This allows us to bring Advanced Life Support to your home faster, as a fire engine may be closer than the ambulance that is responding to your medical emergency.

It is very common for loved ones to have a puzzled look on their face when a fire engine pulls up to the house instead of an ambulance. If the engine arrives first, the crew can provide Advanced Life Support Care until the ambulance arrives for the transport to the hospital.

Since our crews are cross-trained (firefighters and medics), the three-person crew will take the proper piece of equipment, depending on if the call is medical, rescue or fire in nature. Fighting a fire takes a large number of resources, so it is not uncommon that we can become short on ambulances if a large fire is burning.

To keep us from having a shortage of ambulances available for medical calls during a fire, we have several procedures in place.

1) The time that most of our calls come in is between 7:00 am to 5:00 PM. on all days except Sunday. This is known as our "Time of Peak Demand". To combat this load of heavy call volume, we have one ambulance that is know as the "Peak Demand Unit" (PDU). Two paramedics staff it every day (except Sunday) during 7:00 am to 5:00 PM. The goal of the PDU is take as many of the medical calls that they can during the Peak Demand Time. On critical EMS calls both the PDU and an engine responds to the emergency. If the engine gets there first they will start the treatment and will hand over care to the PDU paramedics.

The impact of this PDU has been wonderful since it started on December 31^st, 2001. The PDU takes about 56% of all of the EMS calls during their 10-hour shift. This means that the crew members that use to take the medical call, now can be in the station 56% more as they wait for the next alarm. Because the PDU allows more crews to remain in their district, it means that emergency response times improve.

In the first three months that the PDU was in operation, the average response time in the entire department was reduced by 45 seconds per call. This is a significant amount of time when a person considers how fast a fire can grow or how fast heart muscle can die in those 45 seconds.

2) When the PDU is off duty, the number of emergency calls is less. During this time the East, West, North and South stations have an ambulance in the station. When a call comes in, the closest ambulance is sent with three crew members.

3) When we get multiple calls and all five of our stations are responding we can call for a "personnel callback". This is when off duty firefighters/medics are paged and are asked to respond to the stations to cover the next calls that may come in. We also have mutual aid agreements in place. With just a few phone calls we can get ambulances or firefighting equipment responding at once to Bend from Burns, La pine, Sunriver, Crescent, Sisters, Black Butte Ranch, Redmond, Crooked River Ranch, Jefferson County EMS and from Warm Springs Fire and Safety.

4) To help keep the paid crews available for emergency calls, some of the non-emergency calls are taken by the Medical Transport Team (MTT). Examples of non-emergency calls include transports from hospitals to nursing homes. They also include long distance inter-hospital transports from St. Charles Medical Center to hospitals in John Day, Burns, Prineville, Madras, Redmond, Portland, Salem, Eugene, Springfield, Medford, Lakeview, and Klamath Falls. The MTT members are part-time employees who schedule their time when they can work for us.

All medical care provided by the City of Bend Fire Department is done under the license of Dr. Helenka Marcinek who is a well respected Emergency Room physician at St. Charles Medical Center. Dr. Marcinek is also the physician advisor for Air Life of Oregon and was awarded the Physician Advisor of the Year award from the Oregon Health Division just prior to becoming our advisor.

Dr. Bryce Yerman, also an Emergency Room Physician, assists Dr. Marcinek in her work in evaluating the care that we provide to patients. Each month each of them reads about 160 pre-hospital care reports as they prepare to meet with the crews. They both then meet with the medics at a medical case review.

It is a chance to learn what we are doing well and a chance for us to learn what areas we need to improve upon. All case reviews are confidential by law and thus this allows the doctors and the medics the ability to have open and frank discussions about the practice of medicine.

The City of Bend medics are able to perform medical care in the field without direct medical contact on each call. We are able to do this as we follow medical care protocols that are written and approved by all of the physician advisors in Central Oregon. The East Cascade Emergency Medical Services Council (ECEMS) through the work of many EMS providers and doctors in Central Oregon, established a common set of Protocols for the entire region. Medical care under these protocols are similar, regardless of which ambulance agency cares for the patient.

AMBULANCE RATES

Advanced Life Support (ALS)(Skills that an EMT Basic can not perform) $567 + $12.55/mile

Basic Life Support (BLS) $530 + $12.55/mile

Local MTT transport (pre-arranged)(Not covered by FireMed) $168.00 + $7.35/mile

MTT transports outside of the Ambulance Service Area = BLS rate or ALS rate depending on level of care

As you can see, using an ambulance is a very expensive medical procedure. Members of a household can help protect themselves from a high ambulance bill when they need emergency medical transport. The FireMed program will protect an individual from having any out of pocket expense if they or a member of their household needs an emergency ambulance. Under the FireMed program, we will bill your insurance. We accept what the insurance pays as payment in full, thus you will never get a bill for an emergency ambulance call. If you have no insurance you are still covered as your $45 membership covers you in full.

FireMed does not cover the cost of non-emergency transports such as trips from the hospital to a nursing home. The FireMed program covers all persons who reside in a single household and includes coverage if a family member must live in a nursing home or a foster care home. FireMed can be purchased anytime during the year.

Call Peggy Kirkpatrick at 322-6306 or Kindra Harms at 322-6318 to have an application sent to you. Applications can also be found in most doctor offices, banks, and other public buildings.

Kindra Harms at the City Hall does the Bend Fire Department Ambulance Billing.

(541-322-6318). All non-emergency Oregon Health Plan transports that take place during business hours must be pre-approved and assigned by the Cascades East Ride Center by a caseworker before the transport can take place. The City of Bend will be happy to bill your insurance if a waiver was signed by the patient or by an individual who is authorized to sign for the patient.

Please realize that most private insurance companies will not pay 100% of the ambulance bill. Using the rates above as examples, please contact your private insurance company to see how much they will pay on an ambulance transport. If a large balance will be left, the FireMed program may be worth purchasing for the members of your household.

Burning Information: 322-6335
Fire Prevention Office: 322-6309
Fire Department Business Line: 322-6300