EagleTribune.com, North Andover, MA

March 6, 2013

Town considers adding ambulance service

LGH says medics wouldn't get enough patient experience

By Dustin Luca
dluca@eagletribune.com

---- — ANDOVER — Fire Chief Mike Mansfield is looking to upgrade the town’s ambulance fleet from providing basic life support services to handle advanced life support needs, but it’s a plan that Lawrence General Hospital officials oppose.

Town Manager Reginald “Buzz” Stapczynski is looking to increase a few specific line items in the fire department’s budget this year to begin the process towards increasing the town’s ambulance service qualifications.

Two town ambulances — with the purchase of a third going to annual Town Meeting in May — currently provide “basic life services,” which includes a variety of tasks that town ambulances carry out today when transporting a patient to the hospital, Mansfield said.

Upgrading the town’s BLS abilities to ALS will, in short, give the town the ability to bring the hospital to a patient’s front door quicker.

“Advanced life support is patient care that’s provided by EMT paramedics that are trained at a higher level to begin fluid therapy and do other invasive skills,” Mansfield said.

The town currently relies on crews from Lawrence General Hospital to provide ALS services as needed. If the town is “allowed to move forward with the program, we’ll be able to reduce response times by about 20 to 25 percent,” Mansfield said.

One example of a task provided by ALS paramedics would be the intubation — the process through which breathing tubes are inserted into a patient who can’t breathe.

Another service provided by advanced life support is the use of the 12-lead EKG, conventionally known as a heart monitor.

“Medics are taught how to read the heart algorithms that are on the screen,” he said. “They’re also trained to be able to utilize different narcotics and medications on the field as well.”

The department is looking for a “first-year start-up cost of just under $146,000,” Mansfield said. The cost would increase slightly year by year, but “the projected revenue for each and every year going through 2017 covers the entire cost of program implementation.”

After spending about eight minutes to talk to his proposal with the Board of Selectmen Monday night, officials from Lawrence General Hospital responded with a presentation that went on for roughly another 30 minutes.

In the presentation, LGH Advanced Life Support Services Director Paul Brennan said the hospital would “take a hit of roughly 500 patient interactions a year. Would it put us out of business? No. Would we look to augment that some way? Possibly, maybe redeploy our units in other communities.”

But the affect it would have on Andover would be more drastic, he said.

“We believe medicine is competency based, and you get that at every single level, from physicians and anesthesiologists, all the way down,” Brennan said. “There is solid evidence, there is solid studies, that more experience — not the number of years necessarily as a paramedic, but the more patient interactions you have — patients have a better outcome.”

Brennan said the hospital, which responds to thousands of ALS calls a year for the towns it serves, has a 98 percent success rate with procedures like intubations. Nationally, the success rate is around 80 percent.

“There’s one study, a very large study out of Pennsylvania, that says one in five intubations actually goes in the stomach, which means no one’s getting any oxygen at all, so it either leads to death or brain injury,” he said.

With Andover having 16 paramedics, each paramedic would see an average of 1.4 intubations per year, according to Brennan. That would lead to a lower success rate from town paramedics, he explained.

George Kondylis, LGH chief of Emergency Medicine, said town officials should ask, “what does this mean to the patient?”

“If I have a daughter who needs a cancer specialist, you know I’m finding the guy that does it 3,000 times a year, and not three times a year,” he said.

Mansfield said he rejected the claim. In Andover’s case, the town currently has five staff trained as paramedics who would be underutilized until the town added ALS services. When they’re not working for the town, they’re still building up experience by working elsewhere.

“Those five paramedics would be doing it not only working as paramedics at Andover Fire, but I’m sure they’d be retaining their other paramedic jobs where they work for other ambulance companies,” he said. They will “also maintain their skills by providing them to other areas of the Commonwealth as well.”

If the town were to move forward with the proposal, officials would have to become licensed to provide the ALS service and roll out a number of new programs over a two- or three-year period.