Let Peoria Fire Give Emergency Health Care

My comments in 2021---

1. This was the first of many JS opinion articles I would write over the course of the next 20 years. 

2. I had a very smart family member telling me that I did not want to submit the article below for publication. But I did it anyway.

3. I was drawing a line in the sand and didn't realize it. By questioning OSF and AMT, the business community in Peoria would not be happy with me. 

Let Peoria firefighters give emergency health care

November 17, 2002

By DR. JOHN CARROLL

Picture this: you're at home and your father grabs his chest, collapses and becomes unresponsive. You run to the phone and call 911.

A rescue truck from your local fire department arrives, and firefighters begin administering care. They work courageously but are only allowed to provide basic life support, which limits what they can do. The paramedics in the ambulance, which will arrive a few minutes later, are licensed to provide advanced life support, which is the most comprehensive pre-hospital emergency care available. The extra time your father has to wait is critical.

As your father deteriorates,.lt is obvious he needs to be transported to the hospital. However, the firefighters can't do that either; only the ambulance can transport.

Unfortunately, the above is not an uncommon scenario in central Illinois. The knowledge of this reality caused me to read with skepticism and dismay an advertisement touting Advanced Medical Transport's (AMT) perfect score from an accrediting commission. Central Illinoisans should not be deceived into thinking that we have ideal emergency response services. AMTs local monopoly does not serve us well.

In many other Illinois communities, such as Rockford, municipal fire departments, which frequently arrive before the private ambulance, are certified to begin advanced life support immediately. They are able to provide the critically ill patient with life-saving medications, airway management and treatments not available to units that are relegated to basic life support capability.

In Peoria paramedic advanced life support is provided exclusively by AMT. Precious minutes spent waiting for advanced life support to arrive may decrease the survival odds for the critically ill patient.

There are many unanswered questions regarding this dangerous situation. Why can't Peoria's firefighters be certified at a higher level? Why have obstacles been created when the Peoria Fire Department has attempted to upgrade its level of service during the last decade? Why don't the hospitals insist that the Peoria Fire Department advance its status? Why should a Peoria-area heart attack victim have to wait additional minutes for a private agency to arrive to receive advanced life support?

Some Peoria firefighters do have advanced life-support training but are not even permitted to use their training to help a fallen cOlleague at the scene of a fire. Does this make sense? Is "duplication of services" a valid argument against fire departments receiving advanced life-support training when it is, in most cases, AMT that would be doing the duplicating? The three local hospitals helped create AMT. Is there a conflict of interest here?

As a physician who worked at OSF St. Francis Medical Center for 20 years, I know that the AMT paramedics, municipal firefighters and volunteer fire departments do their very best under difficult circumstances in urban, suburban and rural areas. The many firefighters I have spoken to have been frustrated that they have not been permitted to attain and use these life-saving skills. Lives hang in the balance during these crucial minutes, and care that is late or sub-optimal contributes to poor outcomes. The Peoria firefighters know this all too well, as they have witnessed patients deteriorate when they couldn't even "load and go."

With the budgetary crisis in the city of Peoria, it would behoove all of us to take an unbiased look at another scenario. If the Peoria Fire Department were allowed to upgrade its pre-hospital care, a valuable service would occur and possibly a new source of revenue for the city. AMT says it took in $7 million in the year 2000.

Pre-hospital patients cared for by Peoria Fire Department paramedics would be billed in the same manner as AMT bills its patients - insurance, Medicare and Medicaid. If initial capital expenditures, mostly in ambulances, were deemed prohibitive, the Peoria Fire Department could provide advanced life support for the emergency victim at the scene, then turn to a private agency to transport the patient to the hospital. The cost-benefit ratio would be on the patient's side.

However, the will has to exist to implement change. The hospitals' boards of directors and the City Council need to be given accurate data to make the most prudent decision as to what is really best for the pre-hospital patient. Unfortunately, the majority of Peoria's medical community has no idea how and why important decisions have been made regarding these emergency medical services. They need to know.

Saving lives, not monopolizing emergency medical services, should be the goal.

Dr. John Carroll formerly worked in the emergency department at OSF St. Francis and is founder of the Haitian Hearts program.