Hi, I’m a paramedic in a poor urban area with a high call volume.

The county’s EMS (Emergency Medical Service) agency has immediate local oversight of all of its different EMS providers. All of the fire departments in the county have ALS (Advanced Life Support) engine and truck companies. A few of them have ALS ambulances. The primary ambulance service provider operates the majority of the ALS ambulances in the county for the EMS system.

An ALS fire unit carries at least one firefighter-paramedic, and an ALS ambulance carries at least one paramedic. Firefighters trained as emergency medical technicians (EMTs) make up the rest of the fire unit, and one EMT works with the ambulance paramedic. Sometimes there are more than one firefighter-paramedic on a fire unit, just like there are dual-paramedic ambulances.

When a person dials 911 on a landline, the call is routed to a PSAP (Public Safety Answering Point). If the call is for medical assistance, the PSAP dispatcher transfers the call to an Emergency Medical Dispatch (EMD) center, where an EMD dispatcher obtains the nature of the call and other relevant information, provides pre-arrival instructions in certain situations such as CPR, bleeding control, etc., and dispatches the appropriate personnel and equipment. Fire units are “toned out” from their stations, station-based ambulances are called via landlines, and flexibly-deployed ambulances are dispatched via radio.

In general, a code 2 response simply consists of an ambulance response without lights and sirens. A handful of fire departments send a crew on these code 2 calls. A code 3 response consists of a fire apparatus and an ambulance, both lights and sirens. A fire crew is known as the first responder, and they turn over patient care to the arriving ambulance for transport. On more serious calls, the firefighter-paramedic accompanies the ambulance crew during transport. The Base Hospital is available to crews for medical consultation via telephone or radio. In some cases, air ambulances are utilized, usually in more remote parts of the county or during rush hour.

Most transports are code 2, no lights or sirens. The Emergency Department (ED) at the Receiving Hospitals is notified with a brief report prior to arrival. Patient care is transferred to the ED staff, and a Patient Care Report (PCR) is submitted if time allows.

Time to go available.

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