Dublin Fire Brigade Paramedics- Insight into a Pre-hospital Emergency Care Service

• Brief history of DFB - Oldest uniform body in the state Since 1862(Oldest Ambulance service provider in Ireland) Since 1898

• Benefits of combined Fire/Emergency Medical service (EMS) for patients

• Our areas of operations

• Statistics/ type and numbers of calls

• Information on range of pre-hospital treatment protocols using generic case details

• Some footage with real on scene experiences with DFB staff.

Dublin Fire Brigade Paramedics- Insight into a Pre-hospital Emergency Care Service

D/O Martin O’ReillyS/O Paul Lambert

Dublin Fire and Ambulance Service

• Oldest uniform body in the state Since 1862

• Oldest Ambulance service in Ireland - 1898

DFB-RCSI Training Institute

• Educational Partnership with RCSI

• PHECC accredited – Institution– Programmes– Tutors

• 2011 Education & Training Standards

• Cardiac First Response to Paramedic

2011

Practitioner Level required for Emergency Ambulance

Paramedic2 year diploma program

Advanced Paramedic 2 year Graduate Diploma

Population served 1.2 million

464,749 Households

Provide a fully integrated Fire based Ambulance and EMS service

In 2011 we responded to 90,000 Ambulance/EMS calls

72,000 Ambulance/EMS incidents

93,000 Ambulance/EMS mobilisations 12,000 Paramedic Fire Appliance responses

Eastern Regional Control Centre

• Receipt of 999/112 calls for assistance– Determine the location and nature of the emergency– Determine the priority– Pre-arrival instructions

• Provide an appropriate Response– The “Right” response for the patient ? – Nearest appropriate resource

Benefits of combined Fire/Emergency Medical service (EMS) for patients

• Strategically located- rapid response

• 24/7 Availability of ambulance resources

• Resources reduce time on scene

• Equipment available - early Extrication

• Enhances safety on scene

• Highline Rescuesfrom tower cranes

• Immediate Medicalassessment and treatment

Swift Water Rescue

• SRT technicians

• Hypothermia• Submersion Incidents

Road Traffic Collisions

Reduce on scene time

• Spinal Immobilisation/Patient handling

• Rapid Extrication

• Safety/Fend off

• Fire Risk

Medical• Basic Life support• Advanced Life support• Acute coronary

syndromes• Glycaemic Emergencies• Seizures • Inadequate

Respirations• Stroke

Medical

• Septic shock• Poisons/ OD• Hypothermia• Altered Level of

consciousness

Trauma

• External Haemorrhage• Shock-Blood loss• Spinal• Burns• Limb Fractures• Crush injury

• Head Injury• Traumatic Cardiac

Arrest

Intubation

Vascular Access

DFB-RCSI Training Institute

• Morphine• Epinephrine 1:10 000• Amiodarone• Benzopenecillin• Lasix• Atropine

Oxygen (INH)

Nitrous Oxide (INH)

Salbutamol (INH)

Aspirin (PO)

GTN (SL)

Glucose Gel (BU)

Glucagon (IM)

Epinephrine 1:1000 (IM)

Naloxone (IM)

Paracetamol (PO)

Clopidogrel (PO)

Obstetric Emergencies

• Neo natal resus• Haemorrhage in

pregnancy• Breech birth• Umbilical cord

complications

The Right Response

• Immediately Life threatening incidents

• The nature of these incidents require a rapid response and more responders on scene– Paramedic Fire Appliance– Paramedic Ambulance – Advanced Paramedic

Fire Appliance Paramedics 60%

Ambulance Paramedics36%

Arrive together4%

Mater Hospital Out of hospital cardiac Arrest study 2003-2008

Mater Study

• Improvements in the pre hospital care management of cardiac arrests over the period of the study where;

– DFB fire appliance Paramedic equipped with Defibrillators and life saving medications

– ERCC began providing telephone assisted CPR– Advanced Paramedics provide pre hospital

Advanced Life Support on Fire appliances and Ambulances

Mater Study

Conclusions: •The improved quality of Emergency Pre Hospital Care has impacted on survival from Out Of Hospital Cardiac Arrest, particularly from Ventricular Fibrillation

Video of Cardiac Arrest

Thank you for your attention !

Questions ????