Fire Dept. to answer more 911 calls - Delayed responses prompt changes - By David Armstrong, Globe Staff, 4/22/2000
The Boston Fire Department will soon begin responding to more calls for medical emergencies, a move city officials hope will reduce potentially dangerous delays in getting help to injured and sick people. The change in the response system comes after another incident in which the city's bifurcated emergency medical system was criticized for a delayed response - this time to a man who eventually died of a heart attack.
Boston is one of only a handful of major cities in the country where two agencies - the Fire Department and the Emergency Medical Services department - respond to medical calls. In most cities, the calls are handled by one agency or the ambulance service is provided by a private company. The EMS responds to all medical calls, while the Fire Department currently responds to higher-priority medical calls.
A system of codes based on the description of the medical emergency by a caller automatically determines whether the Fire Department is dispatched. The coding system, and a history of competition and distrust between the Fire Department and EMS, has been blamed for several incidents in which medical care was delayed or compromised for people who eventually died from their injuries.
Under the new system, which will be instituted in mid-May, the Fire Department response will be increased by automatically sending fire units to four additional categories of medical emergencies, including seizures and internal bleeding. In addition, if an ambulance is delayed in responding to other calls that do not automatically trigger a Fire Department response, an engine company will be sent by a dispatcher.
The union representing EMS workers has historically opposed granting the Fire Department more of a role in medical emergencies, suggesting the larger agency is most interested in taking over all EMS functions. Perhaps as a compromise, the new system will institute a cancellation policy under which the EMS can call off fire units responding to the same scene if the ambulance has already arrived and determined no further assistance is necessary.
Dennis DiMarzio, who is the acting fire commissioner in addition to his job as the city's chief operating officer, said the medical response changes are being made to eliminate gaps in the system and to improve response times. ''If there is any doubt, we will send both'' agencies, he said. ''The last thing we want is a problem occurring because we are splitting hairs. We shouldn't put anyone's health at risk.'' He also said the cancellation policy makes sense because it will cut down on unnecessary runs and keep the streets clear of speeding emergency vehicles that are not needed on a call.
The Fire Department typically responds to about 30 percent of the estimated 100,000 calls for medical help in the city each year. As the number of fires has declined dramatically in the past 20 years, the availability of fire units to respond to medical calls has increased. Because it has more units and personnel, the Fire Department is often able to respond more quickly to medical calls than the more limited number of EMS ambulances.
In the most recent case pointing to flaws in the system, the Fire Department was never notified of a call reporting a man having a seizure outside the American Legion Hall on South Street in Jamaica Plain on March 25. The Fire Department was not asked to respond to the call because it was coded as a seizure, an event that does not trigger a fire response. Under the new system, the Fire Department will be sent to such calls.
At the time of the call, a nearby firehouse on Centre Street with four firefighters trained as emergency medical technicians on duty was available to respond and likely would have been on the scene within two to three minutes. The engine company is located 7/10ths of a mile from the scene. The lack of a fire response to the call on March 25 was critical because it turned out the man, Donald Milliken, was actually having a heart attack. All fire engine companies are equipped with defibrillators, a device that shocks the heart back into normal rhythm.
An EMS ambulance did not arrive on the scene until nearly eight minutes after the call. The response was delayed in part because the ambulance went the wrong way on South Street - a problem the agency said was caused by a mapping error in the city's 911 system. ''We couldn't understand why the Fire Department wasn't there,'' said Milliken's widow, Linda. ''They are usually there first.''
Under the new system, the Fire Department would have been sent to help Milliken. ''It would have helped in this case,'' said DiMarzio. DiMarzio said relations between the Fire Department and EMS have improved dramatically recently. ''The groups are working together a thousand percent better than before,'' he said. ''There is good communication and a lot of the biases of the past are gone ... This is a real positive step.''
This story ran on page B01 of the Boston Globe on 4/22/2000.