AED Automated External Defibrillator and Rural Fire Departments

[Branchchipper]

Txdon- in my part of the world, (and in most of the rest of the western US) a fire engine without any EMS capability whatsoever would be unheard of. What if one of your own members suffers a cardiac event requiring CPR (and an AED)? What if one of you gets injured? I assume your community has some sort of EMS response capability (hospital or private provider?) Have you considered their response times and capabilities for the above scenarios?
After you do, think about how much more integral a part of your community you would become if you were responding to EMS calls (at least the more critical ones). Could you beat the ambulance to your neighbor's house by many minutes?
I'm betting you could. There's where some real lifesaving could happen!
I'd bet that right now, every time your local ambulance flies by your fire station Code 3 (and your rig just sits there behind a closed bay door) you're earning bad PR for the department. I realize you're all volunteer, but so are many of the agencies around here, and every one of them is part of a tiered EMS response system. They may be EMTs, or just advanced first aiders, but they all respond, and all have AEDs.
I know you can't personally change the whole system, but one of the reasons that many US fire departments run into funding and other public support problems is that the citizens they serve don't see enough of them, or and/or they don't consider them an integral part of the community, except when they gather occasionally to watch another barn burn down. You can be a lot more!
(I'm speaking from a few decades of experience in this issue)

 

[WM75Guy]

Several questions:
1. With this type of response time would it be useless buying one?
2. Is anyone a member of a rural Volunteer FD that has an AED and has used it?
3. If one has been used, what is the time frame in which it was used. and was the life saved?

Don,

I have 37 years in EMS, 32 as a paramedic and instructor, and and still respond with my local VFD. For last 4 1/2 years I have worked as an ED RN and Advanced Cardiac Life Support instructor/coordinator for my hospital. My ED sees apprx. 35,000 patients a year and I respond to several codes or rapid respnse team calls inhouse every week. The American Heart Association 2010 Guidelines place the increased chance for survival on high-quality CPR and early difibrillation. Drugs and advanced airway skills are a distant third for increasing survival. The 2009 statitics show out of hospital survival rates of 2-6.7% from cardiac arrest.

To answer your questions:
1. Yes, I have seen many patients have Return of Spontaneous Circulation (ROSC) and survive to discharge with long response times.
2. Yes, with some good results.
3. A good first responder program can start with CPR and an AED. The person is already dead, you cannot make them deader. Even a long or delayed response is better than no response.

The Texas Department of State Health Services has training grant money for training first responders. Last I heard recently they were begging to give it away. You can have as few as 3 people in the class.

ECA Training Funding - Texas Department of State Health Services, EMS & Trauma Systems

For equipment try local industry, just remember it's PR for them so write it up in the paper. The local Walmart manager can assist with basic supplies and perhaps funding. A Plano tackle box makes a good trauma box. The one with the fish on the lid was $50, the one with the blue Star of Life medical box was $150, same exact box. The local welding supply probably carries medical oxygen and can help. Check with railroad or pipeline companies that pass thru your district, they like to help first responders to their events. Ag suppliers can help. The Texas Farm Bureau funds people to go to the A&M Fire School each year.

If you need more info feel free to PM me.

 

[txdon]

Branchchipper and repowell, thank you so much for your detailed response. I want to make a Keynote (powerpoint) presentation to inform our VFD of the capabilities of the AED and training requirements and our need and expectations to do more. I hope I can show them the need to take on the extra responsibilities. I will use the information you have provided. Our next meeting is in January so I have enough time. Since I started this thread I found out that the reason they wanted to get the AED was the concern for the older firefighters with heart problems. I'll see if they are willing to look a little wider and start making severe medical calls.

 

[RobertN]

I'm teaching AHA BLS CPR tomorrow and Thursday eve's. A BLS CPR class is doable on a Saturday. I have assisted with BLS CPR/AED for Search and Rescue; that sounds more along the lines of what your needs are, unless you are going to put bag valve masks on your rigs.

Branchchipper made a good point; if they need CPR/AED, they are dead. Anything you can do to bring them back is a positive.

Unfortunately, your firefighters concern about the older firefighters having a heart attack is too real. And not just for the older guys. It is unfortunate, that too many of the national emails I see passed down, include LODD from heart attack after training or during/after a call.

My concern, would be what level do you train for for medical emergency....? Any idea what other similar departments EMS levels are? Remember 85%+ of calls are typically medical calls.

Branchchipper and repowell, thank you so much for your detailed response. I want to make a Keynote (powerpoint) presentation to inform our VFD of the capabilities of the AED and training requirements and our need and expectations to do more. I hope I can show them the need to take on the extra responsibilities. I will use the information you have provided. Our next meeting is in January so I have enough time. Since I started this thread I found out that the reason they wanted to get the AED was the concern for the older firefighters with heart problems. I'll see if they are willing to look a little wider and start making severe medical calls.

 

[MBTRAC]

This is a very interesting thread, & as a volunteer RFS (Rural Fire Service) firefighter from the other side of the world (Australia), I find it interesting how much we share common challenges (like funding, medical first responder queries, equipment shortfalls, protocols ....etc.)

In our state NSW, all RFS vehicles carry an AED & comprehesive First Aid Kits, primarily because of the risk to firefighters in demanding operating environments (heat, stress, physical demands, injury/ trauma...etc.), with most of our RFS brigade crew qualified/certified in First Aid - whilst we are not designated medical first responders, because of distance & remoteness of incidents quite often the RFS brigade crew will be first on the scene for quite sometime & therefore need to initiate proactive care in a critical medical situation (often trauma from vehicle or farm accidents) including where required the use of a AED.

'BranchChipper' raises extremely valid points, however our local operating protocols/relationships allow us to work closer, rather than 'compete' with other agencies to improve response, & we actively deploy initiatives to develop our skills, inter-agency harmony & also raise our 'profile' to increase awareness/capability/funding in our area:-
1. Working with other local emergency services (EMS/Ambulance/Police & other paid fulltime agencies, & other emergency volunteer organisations like our SES - State Emergency Services) in training exercises/contingency emergency planning (fire/flood/evacuation..etc), convening joint incident debreifs & regularly supporting each others meetings/individual organisations training exercises
2. Community Engagement/Awareness
- Convening street meetings for community education (held on landowners properties for near neighbours to develop their 'plan')
- Assisting with individual property risk assessments/fire plans/hazard reductions..etc
- Activities in local schools, some brigades have 'cadet' programmes (for future recruits)
- Representation, displays & fund raising at all local fairs, fetes & elections..& a Xmas Santa fire truck run through the town...etc (a strategically placed fire truck draws attention anywhere !! ), & bi-annual RFS station open days
- Educating on what we do/how we can serve the community (e.g Fire, Flood, Disaster planning/recovery/Communications)
- Of our RFS skills/training: from the general public knowledge of Bush/Village firefighting to MVA/Incident & rescue response/Chainsaw use & Tree Felling/First Aid/BA qualifications to Communication/Mapping/Catering & Logistics .......etc
- Local Business: supporting their activities/trade days & public acknowledgment of their funding support & pledges..etc

All probably sounds like a lot, but somehow from our brigades c.20 members of which maybe 13 are regularly active, it gets done.

I'm unsure of how volunteer rural firefighting works in the US & other countries. Over here in NSW it is a state based organisation (currently funded fom state govenrment & insurance company contributions) that supplies the basic standard equipment like trucks/PPE/basic truck fitout & develops training competencies (deployed at a local zone level), there's also paid fulltime zone managers/coordinators/admin (whom I'm sure would like to think they add value....) , historically stations are mostly tin sheds having been funded locally (albiet with varying degrees of state contribution), & individual brigades raise funds for additional/ specific equipment locally.

As for the RFS volunteers, we're all unpaid/no oncall retainer/no tax concessions for out of pocket expenses...etc... so we do it free for community service.......& volunteer recruitment & retention is as challenging a securing sufficent regular funding(except after a major disaster when all the politicians try to cover their past oversights with "one off" cash injections...)

Apologies if some of this was a little off the subject, but hopefully of interest to others engaged in volunteer fire/emergency services

 

[txdon]

My concern, would be what level do you train for for medical emergency....? Any idea what other similar departments EMS levels are? Remember 85%+ of calls are typically medical calls.

We have a VFD ambulance 9 miles north They are EMT (might be paramedic, I'll have to check) and two paid paramedic ambulances 14 miles south. One VFD 5 miles to the NW - also no medical and one VFD 8 miles to the SE has 1 first responder who responds from his house with equipment. Closest ER is 40 miles away. It is a small hospital that has a helicopter that will transfer the serious cases to Austin 80 miles away from the hospital. Austin Heart hospital, which can handle anything cardiovascular, is 60 miles from here.

MBTRAC Interesting post from the other side of the world. Our volunteer system for rural areas in the US varies differently with each county and each community and each state. Some get money from taxing some from grants almost all have fund raisers, meal and an auction. We get ours from an annual fish fry/auction and we apply for grants for partial payment of our trucks. Here the volunteers receive no compensation in some other states they receive property tax breaks for participation/training/response incentive. In Texas there are no minimum training standards for volunteer fire fighting.

 

[MBTRAC]

TXDon -
Wow, I'm really surprised Texas has no min standards for volunteer firefighting, particularly with your fire loads/risk in rural areas, sounds like you guys are doing it tough (your 'system' is somewhat akin to where we were at c.25yrs ago...before a disaster with a tragic loss of volunteer firefirefighters prompted change)
Over here there's min state standards/training/competencies for all levels, including:
- Initial BF/AF (Bush Firefighter/Village Firefighter) prerequisites for a fireground)
- CABA (Breathing Apparatus)
- Advanced Firefighter/Crew Leader/Capt/Officer ..etc
- Rural Fire Driver
- RAF (Remote Area Firefighter)
& heaps of sumplementary electives (like Preserve & Protect Incident Scene, Asbestos Risk/Containment/Control.....)

 

[wedge40]

I have not read all of these, but I'm the recipient of an ICD and would like to know if during your AED training you're taught to look for these before admistration?
I use the acronyms intential, cause if you're about to use AED you should know what an ICD is.

Wedge

 

[MBTRAC]

I have not read all of these, but I'm the recipient of an ICD and would like to know if during your AED training you're taught to look for these before admistration?
I use the acronyms intential, cause if you're about to use AED you should know what an ICD is.

Wedge

Great question as unskilled AED use can cause additional trauma & worse in ICD recipients-

Yes, with the number of people "running" with ICD's for arrythmia treatment increasing it's definitely part of our AED training/awareness....& if you're needing to use an AED the patient's ICD must be malfunctioning/failed...& placement of the AED pads remotely from the ICD location is critical (min. 6")...but I'm only speaking for our local training in 1 State "Down Under" ..........

 

[wedge40]

Great question as unskilled AED use can cause additional trauma & worse in ICD recipients-

Yes, with the number of people "running" with ICD's for arrythmia treatment increasing it's definitely part of our AED training/awareness....& if you're needing to use an AED the patient's ICD must be malfunctioning/failed...& placement of the AED pads remotely from the ICD location is critical (min. 6")...but I'm only speaking for our local training in 1 State "Down Under" ..........

I feel better now. Hope the US is training the same way. From my understanding AED shouldn't hurt the ICD, just shut it down. And you're correct, if you have an ICD and it looks like you need AED, you're having a really bad day.
Oh.. And I dont run to much anymore. LOL

Wedge