The Stanford Department of Emergency Medicine is working with nine local fire departments to ensure that crews learn the latest protocols for treating community members during health emergencies.
June 5, 2019 - By Susan Coppa
Contrary to popular opinion and most television shows, the first responders to reach the scene of a medical emergency aren’t usually an ambulance crew but firefighter-paramedics. In fact, the majority of the calls fire departments respond to are medical.
Because of the crucial role that fire departments play in pre-hospital care, Stanford Health Care and the Stanford Department of Emergency Medicine have developed partnerships with nine local fire departments, including those in Palo Alto, Mountain View and Santa Clara, to ensure that first responders are trained in the latest emergency medical care.
Typically, a single fire department will contract with one physician to serve as its medical director. The Stanford approach is different: Several faculty members in the Department of Emergency Medicine serve as the collective medical director for multiple fire agencies. The approach has yielded significant benefits, said Marc Gautreau, MD, clinical associate professor of emergency medicine and director of pre-hospital care at Stanford.
Individually contracted medical directors rarely provided on-site training to the firefighters because of the time involved in traveling to and coordinating with multiple fire stations. However, with a team of physicians to draw from, Stanford has been able to provide frequent, consistent training and ensure quick dissemination of new protocols and emergency procedures to stations throughout the peninsula, said Peter D’Souza, MD, clinical assistant professor of emergency medicine.
“Fire departments are receiving hands-on training from Stanford physicians in advanced emergency medical services, and fire personnel can turn around and provide very high-level care to the populations they are serving,” Gautreau said. “We’ve already seen several great saves as a result of the advanced resuscitation skills implemented by local fire department paramedics. And we can provide training during shift hours, which means stations do not need to pay overtime for training, and resources can be directed toward offering the best care possible.”
A chance encounter
The idea for the partnership arose in 2016 when Kim Roderick, chief of emergency medical services for the Palo Alto Fire Department, stopped by the Stanford Hospital coffee cart. Roderick happened to see D’Souza, who had been involved with the fire department for many years and had collaborated with Roderick on a study in which first responders were taught a new method of delivering an anti-seizure medication.
As the two chatted, Roderick asked D’Souza whether he was interested in becoming the medical adviser for a number of fire departments in Santa Clara County, but D’Souza and his wife were expecting their first child and he felt the timing wasn’t right to take on additional work. However, D’Souza proposed an alternative: The collective resources at Stanford Emergency Medicine could provide medical support for Palo Alto and other Santa Clara County fire agencies.
The idea of having an institution take on the role of medical director was untested, so there were no road maps to follow. “We brainstormed about using the entire physician group, and it kind of went from there,” Roderick said. D’Souza discussed the possibility with Stanford emergency medicine leaders, and Roderick shared the idea with fire chiefs in the area. Two months later, they pitched the idea to the nine other emergency medical services chiefs in Santa Clara County. “They loved it,” Roderick said.
Following a formal proposal process, Stanford took on the role for the Palo Alto Fire Department in February 2017. Stanford signed similar agreements with eight other fire agencies in the ensuing months.
In one of the initial training sessions, Stanford faculty members instructed Palo Alto firefighters on high-performance CPR, which optimizes resuscitation during cardiac arrest. HP-CPR requires a team of trained individuals who rotate through different roles to minimize the downtime between chest compressions. The goal of HP-CPR is not simply to save the patient, but to minimize the loss of brain function, enabling patients to resume their lives with minimal lasting damage.
The Palo Alto Fire Department immediately implemented the techniques, with positive results. “We used to see a return of spontaneous circulation in 17% of the patients,” Roderick said, meaning that those patients were able to breathe and their hearts resumed pumping blood. “With HP-CPR we see spontaneous circulation in 20% to 25% of patients.”
This was not an isolated result. Stanford recently trained members of the Santa Clara Fire Department in using a video laryngoscope, which enables responders to quickly insert a breathing tube without stopping chest compressions. One week later, D’Souza received a text message from the department’s emergency medical services chief noting that crews had already successfully used the approach on three separate emergency calls.
Another benefit of the partnership is the ability to close the loop about critical patients or challenging emergency medical treatments. Roderick said 97% of the people the firefighter-paramedics transport end up at Stanford Hospital. But in her three decades on the job, she has rarely learned what happened to the patients once they passed through the hospital doors. “We didn’t really know if we were having an impact,” she said. “Most health care providers review cases and assess actions on a regular basis, but we didn’t have that opportunity. Now, we can share lessons learned. We can reinforce techniques that have the best result.”
Finding out how patients fared
The partnership has also given the fire departments access to experts including the four Stanford faculty members who are board certified in emergency medical services — only 600 or so are certified in the country, so they are a rarity in fire departments. In addition, Justin Lemieux, MD, a clinical assistant professor of emergency medicine who has had extensive training in combat casualty and tactical emergency operations, can provide training for a hostile situation such as a mass shooting.
We want to ensure our patients have the best odds of survival, even before they set foot in the emergency department.
The partnership with Stanford is also helping fire departments prepare for a new “community paramedicine” model that would enable first responders to undergo training on a wider range of treatments, possibly saving patients a trip to the emergency department. For example, the first responders could treat a bad asthma attack on-site. The state of California is developing a scope of practice that could enable paramedics to treat conditions that are now commonly handled in emergency departments. Having fire departments participate in the model makes sense, Roderick said. “We have the infrastructure already,” she said. “We respond to calls 24/7. Why not include options for the patients besides transports to an ED? Patients might prefer more options depending on the emergency.”
Stanford recently acquired an emergency response vehicle that is being retrofitted to serve as a mobile training unit. Between scheduled trainings, physicians will be able to travel to stations to provide short refresher courses to firefighters while they are on shift. D’Souza and Roderick also hope to incorporate timely, case-specific simulations in response to unusual medical scenarios that firefighters encounter.
“We want to ensure our patients have the best odds of survival, even before they set foot in the emergency department,” D’Souza said. “Our commitment is to serve our community and provide the best possible care at every stage. In order to do so, we have to reach beyond the walls of the hospital.”
Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children's Hospital Stanford. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu.