Andover Townsman, Andover, MA

March 7, 2013

Fire Dept. wants to take over advanced ambulance services

Lawrence General says its people have necessary experience

By Dustin Luca
Staff Writer

---- — The Andover Fire Department is pushing for its town ambulances and its paramedics to provide advanced life support services, but current provider Lawrence General Hospital argues that the town’s EMTs have less experience than their people.

A $146,000 bump in the town fire department’s budget for the coming year would seek to begin turning the town’s ambulances — which provide basic life support services to patients en route to a hospital — into something closer to hospitals on wheels.

“Advanced life support is patient care that’s provided by EMT paramedics that are trained at a higher level to begin fluid therapy and do other invasive skills,” Fire Chief Mike Mansfield said.

Should the town’s ambulances be upgraded to handle ALS services, Andover EMTs could perform procedures like intubations — inserting breathing tubes into patients — or 12-lead EKG heart monitoring, according to Mansfield.

“Medics (providing ALS) are taught how to read the heart algorithms that are on the screen,” Mansfield said. “They’re also trained to be able to utilize different narcotics and medications in the field as well.”

ALS services currently come from Lawrence General Hospital, so upgrading the town’s own abilities will “reduce response times by about 20 to 25 percent,” Mansfield said.

The increased cost would be $146,000 the first year, he said. While the cost would increase slightly each year, the program would pay for itself through increasing revenue, according to Mansfield.

“The projected revenue for each and every year going through 2017 covers the entire cost of program implementation,” he said.

Mansfield spoke to the Board of Selectmen about the proposal at itsr meeting this week. In response, officials with Lawrence General Hospital weighed in on the proposal afterwards.

In their presentation, LGH Advanced Life Support Services Director Paul Brennan said the hospital would “take a hit of roughly 500 patient interactions a year. Would that put us out of business? No. Would we look to augment that some way? Possibly, maybe redeploy our units in other communities.”

But he was concerned for how it would affect Andover residents, he said.

“We believe medicine is competency-based, and you get that at every single level, from physicians and anesthesiologists, all the way down,” he said. “There is solid evidence, there [are] solid studies, that more experience — not the number of years necessarily as a paramedic, but the more patient interactions you have — patients have a better outcome.”

While the hospital responds to several thousand ALS calls a year for all of the communities it serves, Brennan said it has a 98 percent success rate with procedures like intubations. Nationally, the success rate is lower — 80 percent, meaning one out of five attempts at intubating a patient fail on average.

“There’s one study, a very large study out of Pennsylvania, that says one in five intubations actually goes in the stomach,” he said, “which means no one’s getting any oxygen at all, so it either leads to death or brain injury.”

Assuming Andover had 16 paramedics on the job, each paramedic would see an average of 1.4 intubations per year, according to Brennan. He said that would lead to a lower success rate from town paramedics.

George Kondylis, chief of emergency medicine at LGH, said the question should be, “what does this mean to the patient?”

“If I have a daughter who needs a cancer specialist, you know I’m finding the guy that does it 3,000 times a year, and not three times a year,” he said.

But Chief Mansfield said Andover has five staff currently trained to be paramedics, and they would carry out ALS operations for both the town and other providers.

“Those five paramedics would be doing it not only working as paramedics at Andover Fire, but I’m sure they’d be retaining their other paramedic jobs where they work for other ambulance companies,” he said.

One of the paramedics “actually works part-time for Lawrence General Hospital on his days off,” Mansfield said.

The first step to adding ALS services to Andover’s ambulance fleet would be to become licensed to provide the services, Mansfield said. With that, and the other programs that would need to roll out, the process would take up to three years.