QAS INSIGHT | Summer 2017-18 edition

Right ■ Ladder Company response at a primary care centre, with the paramedic vehicle behind. Photo: Tony Hucker

Seattle ride along The first patient we attended demonstrated how their system works. First response was the local engine company with four firefighter/ EMTs. The two paramedic crew I was riding with arrived soon after. Three FF/EMTs were inside looking after the elderly male patient who was unwell with rapid atrial fibrillation. One of the team was waiting outside to direct us to the patient and assist bringing in the gear and stretcher (Stryker electric). When we walked in all the vital signs had been completed minus BGL. I am used to working in a two-tiered system, but what struck me with their system was some of the best teamwork I have seen in action. I am sure it has something to do with having six people on scene. This is a standard approach. We went to a family care centre (GP clinic) in one of Seattle’s leafy suburbs where there was a report of a young child having a seizure. The child was fine and was referred to a private ambulance company that is contracted to Seattle Fire to provide transport for low acuity cases. American Medical Response (AMR) is one of the biggest private ambulance companies in the USA and has the Seattle contract. They provide a basic EMT service and a very fast response. Every time we referred, they were arriving as we were walking out. The FF/EMTs stay with low acuity patients and provide the handover to AMR allowing the paramedics to clear early. Interestingly, the first responding FF/EMTs to this case were a Ladder Company. Their response vehicle was a semi-trailer ladder fire truck with one FF/EMT sitting in a rear cabin steering the back wheels of the truck. This is a very popular role, referred to as “the tiller” – it is massive!

We assessed a lady downtown who had overdosed. She collapsed on the street and got a spectacular response: two Engine Companies, a Ladder Company, paramedics and AMR. The Ladder Company did not stay, freeing up the street. To be fair, everyone cleared quickly and left the patient in the care of AMR. You can tell there is a very strong commitment to improving cardiac arrest outcomes. Their mantra is BLS owns CPR . The BLS response time target is six minutes and the ALS target is nine minutes. They get out of the station very fast and FF/EMTs drill to a very high level of performance. Paramedics back up and provide all the standard invasive care we are familiar with. The only differences I noted was the adult adrenaline dose is 0.5 mg and all cardiac arrests get intubated early. LMAs are only used after failed intubation at this point. I suspect this will change. One paramedic poked a bit of fun my way: “it’s because of you Aussies we have to now use a bougie to intubate.” I did get to see a cardiac arrest managed. The person power on scene was amazing – two engine companies, a supervisor (just passing by), paramedic crew, two paramedic students and me! This is not normal. There are usually fewer on scene. The lieutenant from the first responding engine company supervised the quality of CPR. This role is not hands-on and stands back with a laptop monitoring and making notes. They time the two-minute change over to the second. Their attention to CPR performance was first class. The resuscitation was stopped early as family called with a ‘do not resuscitate’ order. I have spoken about how their tiered system is quite different, being BLS and ALS, compared to the Australian model of ALS and ICP.

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Summer 2017–18