Life support

Fairfax County Fire and Rescue Transitions from All Advanced Life Support Systems

Over the next few months, the Fairfax County Fire and Rescue Department will be making personnel changes to address staffing shortages beyond Covid concerns. Migrating from a fully advanced life support system to a two-tier emergency medical system system will enable countywide coverage that meets the current hiring situation.
Great Falls, Station 12 at Great Falls

On Feb. 8, Deputy Fire Chief Thomas Arnold said the county fire and rescue department saw no challenges or negative impacts on the 12 stations that converted units. The initial change will be followed by a review period of performance data acquisition and analysis.

The twelve fire stations are Annandale 8, Bailey’s Crossroads 10, Great Falls 12, Chantilly 15, Clifton 16, Gunston 20, Reston 25, West Springfield 27, Fox Mill 31, Fairfax Center 40, Crosspointe 41 and Scott’s Run 44. According to Arnold , the fire and rescue service would operate 43 transport units, 12 Basic Life Support and 31 Advanced Life Support.

While the Great Falls Citizens Association expressed concern over the plan, Supervisor John Foust said: “Chief Butler and his team are very conscientious and provide an excellent level of service to all county residents, including residents of Great Falls,” Foust said. “They wouldn’t adopt a service model that puts people’s lives at risk. They explained the difficulty of recruiting and retaining paramedics and how their plan makes adjustments that will maximize the use of paramedics. I believe this plan will be implemented without adversely affecting the service that is provided.

The degree of training and certification dictates the duties, with Advanced Life Support, Paramedic being the highest. Advanced life support providers can provide cardiac support, CPR, endotracheal intubation for airway management, intravenous catheters for administering medications and fluids, and more as prehospital emergency medical treatment.

Fire Chief John Butler, Fairfax County Fire and Rescue

Arnold wrote of the factors that went into determining which stations were Advanced Life Support/Basic Life Support percentage of sends, call volume, and proximity to hospitals. He cited that some averaged less than two hours of use per 24-hour shift due to the saturation of carrier units equipped with Advanced Life Support. Using a variety of data points and an equity lens avoided disproportionately impacting some areas of the county more than others.

The former Fire and Rescue Service advanced life support system prioritized the presence of an advanced life support provider, a trained paramedic, on all transport units. However, he added, “This move requires the abundant availability of advanced healthcare providers and comes with associated costs of personnel, equipment and training.” When the Fire and Rescue Department implemented the current staffing model in 2015, it was determined that the county needed to hire 48 new paramedics each year to meet the advanced care provider target goal and accommodate attrition. But the fire and rescue service has averaged just 20 new advanced care providers per year over the past eight years, which is 43% of the target goal.

The loss of advanced care providers and the inability to replace them left the fire and rescue service dependent on staff overtime and the use of “double hatters”, advanced care providers who filled two roles at the same time – as an Advanced Life Support provider and a device operator, or as an Advanced Life Support provider and a unit officer. A conflict can arise when both tasks are vital and time is of the essence.

Although the Fire and Rescue Service had used double hatters for over ten years which helped overcome staffing issues, it proved to be less than ideal due to the problems presented, according to Arnold. When double hatters have other primary responsibilities, their skills degrade when assigned to stations with lower call volumes. “Over time, this can negatively impact patient care,” Arnold said.

Arnold added that the overall impact of the change on staffing requirements would be a decrease in the number of advanced care providers per day and an increase in the number of basic care providers per day. The transition would be permanent and not part of staffing adjustments made in early January due to rising COVID cases among staff.

Regarding the procedures paramedics can perform, Arnold wrote, “The potential skills that our paramedics can perform have increased in recent years as the Virginia Office of Emergency Medical Services (VAOEMS) adds skills to the scope of practice of paramedics.” These include administration of oral glucose, Epi Rite, baby aspirin for chest pain, insertion of iGel airways, use of tourniquets, and hemostatic gauze for wound dressing. “Working with our Operational Medical Director, the Fire and Rescue Department has added skills to the EMT. This increased skill set will allow paramedics to practice skills that previously could only be completed by a vendor. ALS,” he said. Skills that will soon be implemented, according to Arnold, are oral administration of ondansetron for nausea/vomiting, acetaminophen/ibuprofen for pain, and other procedures.

The proposed unit cuts were officially unveiled on January 11, at the meeting of the Supervisory Board’s Public Safety Committee. According to Fire Chief Butler, it was about balancing the reduced staffing and health and safety department staff with service to the community.

“We’re going through tough times as you’ve seen and heard from me,” Butler said, referring to, among other things, vacancies, COVID cases and attrition.

“We estimated that we would have about 90 vacancies today (as of January 1, 2022), but we are currently at 105 with both rookie schools in session. … Then omicron came along, and it took a long time .gains that we had gained through new promotions and wiped out those gains…causing an increase in our vacancies,” Butler said.

The health and safety of fire and rescue service providers and frontline responders is a concern.

“Some have worked 60 straight hours at a time. That poses a risk to them at work and in commuting between home and family, the fatigue factor,” Butler said. “So we’re here to provide the highest quality service to our community and balance staffing.” The fire and rescue service has 1,260 career employees.

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