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Maine's Urban Firefighters No Longer Just Fighting Fires
12/21/2012   Reported By: Samantha Fields

If you live in a city and call 911 for a medical emergency, chances are that the fire department will show up. Virtually all firefighters in Portland now are trained in EMS, and responding to medical calls is an ever-increasing part of the job. Because of that, the Portland Fire Department has been focusing heavily on improving outcomes for medical emergencies in the field. One notable success: The survival rate for patients in cardiac arrest has jumped from 3 percent to 17 percent in the last two years. As Samantha Fields reports, it's all part of the changing role of urban fire departments.

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It's mid-morning on a Tuesday, and a group of guys from the Portland Fire Department is gathered at the Stevens Avenue Armory. Lt. John Kooistra is taking them through recent cases - high level medical emergencies that the fire department responded to. Many of them are cardiac arrests.

"Called to above address for a male patient unconscious," he says. "En route, advised by fire alarm the patient was in cardiac arrest and CPR was in progress."

The Fire Department does case reviews like this about once a month. David Carter is a firefighter and paramedic, who's been with the Portland Fire Department for 10 years. He says that recently, the reviews have included a lot more positive outcomes.

"Over the years that I've been doing this, typically when you'd get a call for a cardiac arrest, you kind of knew the outcome even before you got there - it was very rare that you had a save," Carter says. "It was great when you had one but you just kind of knew it wasn't going to happen. Now, just in the past few months, you hear people left and right, 'Oh, we had a code save yesterday!' And it's so rare - or was so rare. And now it's becoming fairly common."

The fire department attributes that to a mix of things: better technology that enables firefighters and paramedics to monitor, in real time, how they're doing with CPR; and new protocols, including keeping patients in place for a solid 20 minutes, to administer care in the field, rather than transporting them immediately to the hospital.

"So, it's not like the old days when I started, when you'd pick a patient up and just take them to the hospital. We're now providing that level of care in the street that's equivalent to what goes on in the emergency room," says Terry Walsh, the deputy fire chief in charge of EMS for the city of Portland.

Walsh has been with the department for 35 years. In that time, he's seen an enormous shift in what it means to be a firefighter, and in the kinds of calls the department is responding to.

"Probably at one time it was 50-50 when I first started, maybe EMS was even a little less than that," Walsh says. "I know since '77, our calls on the EMS side have doubled."

These days, the percentage of calls that are medical emergencies is closer to 70 percent. David Carter says that makes firefighting a very different job than it once was.

"Previously, years ago, there were a lot more fires. So firefighter's primary job was obviously to be a firefighter," Carter says. "Things have changed. There's fire prevention, sprinkler systems, even smoke detectors make a big difference. And now what we're seeing is there's a shift towards a lot more medical calls. And they're giving firefighters a lot more responsibility on those medical calls."

Deputy Fire Chief Terry Walsh says he expects that trend to continue. "Society's getting older, society's getting sicker. We're seeing more and more cardiac and respiratory and diabetic type calls out there. And we're changing to meet the needs of the public."

Generally, though, the public's perception of what the fire department does has not quite caught up to the reality. Walsh says that often, when firefighters arrive on scene, someone will say, "I called for an ambulance, not a fire truck." But in cities like Portland, the men and women who pull up in that truck are equally prepared to deal with a medical emergency as they are to put out a fire.


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