01/05/09 108 W, 1 I - + 16 - 16 Wake County EMS to Roll Out Advanced Practice Paramedic Program

FireNews has the first pictures of the Dodge Chargers to be used the Wake County Advanced Practice Paramedic (APP) program, as well a detailed summay of the new service that starts January 6. The APPs will operate as single providers and focus their activities in three areas: co-response with EMS ambulances to high-acuity calls, prevent and public health visits, and alternate destinations. Read the article and see more photos. The APP program will be the subject of a media meeting this morning at Wake County EMS Station 1, so watch for more coverage.     

FireNews Photo

The Chargers feature Battenburg markings, a checkered pattern developed in the mid-1990s in the United Kingdom. Read more: http://en.wikipedia.org/wiki/Battenburg_..
Legeros - 01/05/09 - 07:26

simply beautiful!
CFP 7021 (Email) - 01/05/09 - 09:21

Best of luck and a big congratulations to the Wake Co. EMS System for continuing to be (in my opinion) the nation’s EMS LEADER. We have a lot to be proud of here in Wake County and these folks are constantly making proactive advances that benefit all of us!! Hats off to Chief Kirkwood, Dr. Myers, and staff. (The car is really cool too!!)
A.Rich - 01/05/09 - 10:11

With the big concern about budget cuts in the county, is this the right time for a new program. Would the person driving the hot rod not be better suited to sit in an ambulance with a partner? Medics have handled sick patients for years with just 2 folks, seems like the “EMS Box” is costing money with no guarantee of a better outcome? Wake County Fire and EMS defined as: SPEND, SPEND, SPEND!
Budget Cuts - 01/05/09 - 12:18

Way to go Wake EMS. This seems like a great addition. I anticipate great results from this program.

Budget Cuts – Putting 1 person in an ambulance would require one more to have 2 people (more money). It appears that this unit will be much more flexible and able to “jump” from one call to another and in many cases, save taxpayer dollars by allowing ambulances to stay in service and not transport patients that simply need basic assistance. Seems like they’re trying to do all they can to minimize expenses, not “SPEND, SPEND, SPEND”
yfd482 - 01/05/09 - 13:59

Let’s make sure to enter Budget Cuts address into the CAD to ensure he gets an Alpha response…..
harkey (Email) (Web Site) - 01/05/09 - 14:22

Good financial stewardship is at the heart of the APP program. This was true in the planning for the program, AND it was subject to the intensive scrutiny of the Wake County administration, budget office, and the Board of County Commissioners.

Three of the underlying strategies of the APP program are to (a)reduce the number of patients requiring ambulance response and ambulance transportation, thereby keeping existing ambulances available for calls that need them; (b) allow us to move to a “paramedic + EMT” staffing model throughout the county, which will save money by using less costly personnel while making provision to have that extra, experienced paramedic available for critical emergencies, and© slowing the need for additional ambulances in the system over the next 10-15 years.

We also went with lower cost vehicles – Chargers instead of SUVs – and made numerous small internal decisions designed to assure the best value for the dollar spent.

The reason that this project got supported like it did, even in the face of tough economic times, was that it was examined closely and found to be fiscally sound.

CHIEF100 (Email) - 01/05/09 - 14:45

I think it’s a great idea.

Please tell me that the drivers are getting some training on driving the charger. It is very different from an ambulance or your “daily commuter”. Know the limits of the vehicle, but more importantly, know the limits of the driver. Wet roads also are of huge concern, especially doing emergency runs and rounding corners. The rear end LOVES to kick out not because of power, but being a rear wheel drive loaded with gear, our crown vics do the same thing.

Is driver training part of the training that these APP’s receive?
RPD (Email) - 01/05/09 - 15:01

Yes, they will get a car-oriented EVOC. We are trying to get this from the NCSHP, RPD, and Nash Community College BLET right now.

Until they do (which may take a couple of weeks, and it couldn’t be arranged during the holidays) there are some speed restrictions, which will be enforced via AVL monitoring.

Great point…thanks for thinking of our safety.

CHIEF100 (Email) - 01/05/09 - 15:39

Just checking. I don’t want to have to take any reports of preventable car accidents involving y’all.

My advise, go to SHP for the training. They actually drive the chargers (we only have 2) so they can give a better instruction course on charger related driving. Plus, SHP has some of the best trainers in the country on driving. Those boys (and girls) know how to drive. It’s like watching a shark swim in water.
RPD (Email) - 01/05/09 - 16:16

Also, keep in mind that there is no longer a passenger to aid in directions, radio traffic, computer manipulation, intersection clearing, etc. All of these tasks are now up to the driver. I can’t tell if there are 1 or 2 siren speakers in the cars, but be aware that it will be A LOT harder for someone to see a car vs. the ambulance. It WILL take longer for people to recognize the vehicle, where it is coming from, and to react to it than what you may be used to in an ambulance or even a suburban.

I hate to sound like I am repeating myself, but it will be a change for sure in the way driving to calls will be done. Which ever place you go to for training, remember that the driving the instructors are used to is teaching COPS how to safely pursue and respond to calls. That means more aggressive techniques than strictly response oriented driving where the key is to just get there.

You have the V8’s so use them wisely. Clear traffic ahead and around you making sure it is done safely, and then use that V8 to make up time in the straight aways. Forget trying to haul tail through the corners. I would be willing to bet that due to the kinds of calls, a V6 could get me there just as fast as your V8’s. V8’s are oriented more towards police due to the fact of the need to catch up to a vehicle, a V6 would be just as fast getting to a place as the V8.
RPD (Email) - 01/05/09 - 16:42

Excellent advice RPD. Please be careful out there with those tiny cars. Too bad you couldn’t mount the lightbar about 4 feet higher and put a Q and air horns on it…lol. I drove an EMS unit with the backup camera the other day and that was great! Everything should have that on it. Our Engine at NH will have one soon, very helpful in assuring safe backing operations.
AB - 01/05/09 - 17:10

Is it to be expected that Wake County EMS will start using this scheme on all apparatus?
Adam Brown - 01/05/09 - 17:48

News & Observer article, with the dubious headline “EMS gets muscle cars to reach emergencies faster”, http://www.newsobserver.com/news/story/1..
Legeros - 01/05/09 - 19:59

...and the official media release, http://www.wakegov.com/news/66154.htm
Legeros - 01/05/09 - 20:06

Thanks again, RPD. “APP EVOC” has been on my office white board in big red letters for about six weeks now – it is definitely a concern.

One of the reasons we went with the V8 rather than the V6 was the shorter stopping distance for the V8. I’m not quite sure if the mechanics of the brake system are different, or if the weight is different. We spent a lot of time with the annual Michigan State Police evals before making our decision (actually, before making our recommendation to GSA Fleet Services, which had to approve the choice and provide the vehicles).

The difference in single vehicle operation is significant. Fortunately, most of those promoted APP were previously FTOs who served as relief District Chiefs, and thus had experience driving, talking, navigating, etc. by themselves. And they are all very experienced street medics, selected for having maturity and good judgment. We are trusting them with a lot of professional discretion, including these new and very capable vehicles.

Adam, the Battenburg color scheme is definitely a possibility for new additions to the fleet. We will do anything we can, within reason, to enhance the conspicuity of our vehicles and thus the safety of our personnel. But, we want to see how the community receives it. Right now, one of the most important aspects is that it is unlike anything used by the local law enforcement community. So we shall see.

Thanks to all of you for your your interest and support. So far, besides legeros.com and firenews.net, the best general media coverage was NBC-17. They seemed to have understood that its about the medics, the patients, and the program, not the cars.

CHIEF100 (Email) - 01/05/09 - 22:37

I think that it was a mistake to get away from the “Traditional Wake County EMS Scheme” was a mistake…now ya’ll have changed it again…
Code Blue - 01/06/09 - 00:58

“it is unlike anything used by the local law enforcement community” c’mon Chief 100, it is what every english police car looks like. the Battenburg color scheme should be green not blue regardless of the locality.
Green Wouldn't Do - 01/06/09 - 01:54

How many of these APPīs will operate?
Dennis (Email) - 01/06/09 - 08:39

Sorry, guys. Wake County went away from green years ago because acceptable green reflexive material was not available (it may be now, but at the time the change was made only a really light green could be found, or so I’m told). Now, to go back to it, we’d have had to change too much stuff. Since England is not “local,” and we’re really the first battenburg looking EMS operation that we know of in the US, we’re OK with the blue and gold. See also the new “safety concept ambulance” being worked on by AMR and others in the industry (http://www.amr.net/news/media/images/_DSC2114.jpg) which uses blue and gold, so we’re consistent with that too. We discussed consistency with UK and European Standards, but ultimately it was deemed not that important. Also – we like change – it works with “continuous striving to deliver world-class EMS to the citizens of Wake County.”

Phase 1 of this project rollout (this year) has 5 APP units staffed in staggered shifts (peak load based) during the daytime, and 2 at night. Full rollout, if funding is provided, will see roughly 14 APP units serving the whole county.

CHIEF100 (Email) - 01/06/09 - 12:21

With these muscle cars I hope you are monitoring speed via AVL. Wouldn’t EMS be better suited with a utility vehicle that can carry extra boards etc. I know thats what the field supervisors are for but still aren’t these folks replacing the field supervisors on field response. Looking at your current units you obviously have a thing for British theme. Admit it. Even along the lines of bike uniforms your crew now wears. I understand how this program will decrease ambulance and hospital utilization but how does it decrease cost. You still have the same number of medics. You still need to hire more to staff your current units. So YFD482 how does this cut fees you still need to add more medics to fill the position these folks are vacating. Serious budgets…new tv’s in the training room. have to admit the vehicles are cool and very agressive looking. Glad to hear that you guys post poned the rollout to allow EVOC training
Really (Email) - 01/06/09 - 12:25

Ok, time for inside baseball behind a screen name again. For those who have serious questions about this exciting new program, I apologize.

Needs analysis established that a lighter, less costly vehicle was the most appropriate for the job. Trying to be more “green” than a suburban or an F-series utility truck (and a decision that was made when fuel was >$3 per gallon).

If the British have a better idea, we’ll be more than happy to adopt it. In this case, safety through conspicuity. Always open to better ideas.

The Mocean shirts are “west coast” if anything, not British. Medics in the UK wear yellow and green, and orange jumpsuits whle at MVCs. More comfortable in summer, more professional than t-shirts.

Cost savings are easy. Single medic APP units will reduce the need for additional ambulances. So (it was a complex analysis, but putting it in a single sentence), they will slow the rate of growth of cost of delivering the service.

The decision to go or not go without EVOC was well considered and it is what it is. We will get EVOC as soon as we can, and work to be safe through speed restrictions in the meantime.

I hope that this information is helpful. We really are trying to advance in a positive direction, and to continue to deliver world class EMS to the citizens we serve. If you have suggestions for improvement, bring ‘em on! They’ll be considered and tested, just like everyone else’s>

CHIEF100 (Email) - 01/06/09 - 14:08

green won’t do – blue and yellow combo’s more visible to the colorblind – see: http://www.dartmouth.edu/~sullivan/bike/.. and then the following page: http://www.vischeck.com/vischeck/

the vehicle looks great!
cornerhydrant - 01/06/09 - 15:45

You know, all this talk of cost and vehicle graphics is getting away from the real issue: What is best for the patient and for the providers?

I know, I have a somewhat dislike of the alpha-response sick call, or the "well-person checks", or other calls. This program serves to help in two important ways:
1) It keeps my ambulance in service to go to a call which may be of higher acuity or concern, and still allows the person to get the evaluation and help they need and deserve. Also, with the ability to transport to places which an ambulance cannot, like Wake County Crisis and Assessment, it will cut down on some of the overcrowding at WakeMed or other hospitals, as when ambulances only transported psychiatric or alcoholic patients.
2) It give the ability for one of these APPs to go to a high acuity call, which may need an extra set of hands. I know that I’ve been running and 4 or 5 supervisor level calls come out, and then another one happens. With these units in place, you get the extra sets of hands in the system to keep the system running smoothly.

Having worked in the Wake EMS system for the better part or 4 years, and having friends who still do, I’m glad to see this program roll out. Having family in Wake County, I will rest a little easier knowing that these guys are out there and serving to protect the public.
CJS - 01/06/09 - 16:17

Maybe I miseed it, but, will they constantly be on the street, roving around, or actually assigned a station throughout the county?
Silver - 01/06/09 - 16:44

In between dispatched calls, the APPs will be handling a variety of non-response community health matters. They will be handling these while still available for critical calls – much like police officers and “self-initiated activity.” You will also see them checking in on ALPHA calls, to assist with possible alternative destinations, refusals, etc. So they will be “out and about,” but different from “roving” for system status management.

CHIEF100 (Email) - 01/06/09 - 19:00

I believe Orange County (NC) runs a similar program. I read an article about it while I was at UNC. It saves money all around. Saves EMS money on lost revenue from uncollected ambulance fees, saves patients money when the paramedic in the car determines they don’t have to go to the hospital or that they can have a friend or family member drive them rather than an ambulance. I know in some cases, an ambulance wasn’t even dispatched. While I lived there a few years ago they only ran 3-4 staffed ambulances a day. It seems to really work.
Native Charlottean - 01/06/09 - 21:43

Just ask the parents of the Chapel Hill Highschool football player who died after being refused by Orange Co EMS how well it works.
Preston Edwards - 01/07/09 - 05:30

Not the same program at all, Mr. Edwards. The word “refused” is not part of the vocabulary.
CHIEF100 (Email) - 01/07/09 - 08:44

As one who completed the program, 100 is right. We do not refuse anyone. Period. If you want to go to the ED, for any reason, we are going to take you, whether it is for congestive heart failure or athlete’s foot. Part of the program is ‘alternate destinations’. If somewhere else can meet your needs, and you are WILLING to go there, then we will make it happen. But if you still want to go to the ED, well, that’s where you will go. When you get to the point you are telling people “You don’t need to go” (and some probably don’t) you are setting yourself up for a lot of badness. The emergency is in the eyes of the caller, not the responder.
DJ (Email) - 01/07/09 - 09:56

Do these cars have a cage in the back? I can see one of these APP’s transporting someone to ATC and the guy going crazy and beating the heck out of the medic.
Mike - 01/07/09 - 13:24

By alternatives do you mean taxis, public transportation vouchers, family, or POV transport right? I didn’t think NC OEMS would certifiy a one-person transport unit, such as a Charger QRV.
Steven (Email) - 01/07/09 - 15:59

It sounds like Locution doesn’t know how to say that really complicated callsign: “Medic”. Go figure.
rfburns - 01/08/09 - 19:51

Locution doesn’t know how to say anything she hasn’t been programmed to say, hence the spelling of works, etc.
McAdams - 01/09/09 - 09:20

Skip, I was passed this AM by an undercover (non-battenburged) APP and they were driving quite responsibly running Emergency traffic. Best of luck with the program!
yfd482 - 01/09/09 - 12:11

Letter to editor of News & Observer, by myself: http://www.newsobserver.com/print/saturd..
Legeros - 01/10/09 - 08:59

Way to go Mike. I read some rather uneducated comments in the editorial pages of N&O. After election and their bias on alot of different issues I am going to cancel my paper subscription. If the reporters and the ones that wrote editorials were having a cardiac emergency they wouldn’t care if medics were driving a Charger, Ambulance or Yugo.
Apex BattChief - 01/10/09 - 14:15

DJ (Email) - 01/10/09 - 16:42

Is there a fire service equivalent of an APP program? Say, roving personnel for tactical use, who are also charged with aggressive prevention and safety initiatives? Or is that the mission of any engine/ladder/rescue company? When not deployed for fighting fire, engage in prevention/safety activities?
Legeros - 01/10/09 - 16:53

Guilford County has a group of firefighters that respond to the county fire dept’s calls to assist with fires during the day. This is because of the lack of vol. firefighters avail. due to their full time jobs etc. Not sure if they do any community awareness or other activities? Their unit number is SQUAD 50. I had heard that Guilford County was going to possibly ad more of these in the future.
Travis Loy (Email) - 01/11/09 - 14:00

Richmond. VA used to have what they called a “Flying Squad”, that provided extra hands on working fires. I really do not think there is an equivalent in the fire service. I guess you could say the APP program combines the flying squad approach (albeit a single medic with a knowledge set) and finally brings the prevention aspect to EMS, which is long overdue.
DJ (Email) - 01/11/09 - 15:12

Interesting discussion these last few posts.

Several years ago (about the time NFPA 1710 was appearing) there was a bit of discussion about 4-person staffing and whether the fourth person had to ride on the same vehicle with the rest of the crew, or could come in a different vehicle. My recollection is that the IAFF felt strongly that the whole crew had to come on the same vehicle. In the Wake County APP model, if the “whole crew” includes the APP for critical patients, we’re saying that it doesn’t matter HOW they arrive, just THAT they arrive.

You wonder, though – let’s say you wanted to have a 5 person ladder company. Could it work with an officer and a driver at the station with the vehicle, and three firefighters in cars out around the first-due area doing inspections, etc? When the pager goes off, you go to the scene and form up the full company?

CHIEF100 (Email) - 01/11/09 - 19:39

Chief Kirkwood, Congratulations from NYC on the new program. The Charger looks great. I’ve become a big fan of the Battenburg livery that past few years. Lenox Hill Hospital EMS in Manhattan has used a similar scheme on their buses the past few year, though I don’t believe the markings are reflective, unfortunately. What I’m most curious about is what sort of training (and prerequisite requirements for the course) your department used to implement the APP program. To be totally honest, as a young medic, I’m rather inspired by your program. If you don’t mind I’d like to drop you an email to discuss the program a little further. Congratulations, again, and thanks for the work you’ve been doing on behalf of all EMS providers to improve the field. -bill (Bill Murphy NREMT-P murphquake@gmail.com )
Bill Murphy NREMT-P (Email) - 01/11/09 - 22:32

A city in Tennessee (Oak Ridge I think) had something back in the 80s called the “Fire Specialists”. As I remember, the engines were staffed with 3, while two additional personnel were assigned to two Ford Couriers pick-ups equipped with SCBA, basic forcible entry, extinguishers (dry chem and pressurized water), basic first aid gear, etc. Those guys were out doing inspections (prevention and pre-plan), hydrant maintenance, etc. I read about it in one of the journals (can’t remember which one). I don’t know if they are still doing it or not.
DJ (Email) - 01/12/09 - 12:43

The police version of the APP program is called “the police” :)
RPD - 01/13/09 - 22:05

Durham admin. disbanded Rescue 1 (big mistake and morale killer in my opinion) back in 98/99 and started the “squad” program; you had two firemen on a Parks and Rec surplus pick-up that was painted red, and equipped with lightbar and siren. The truck also had a fiberglass bed cover and sliding “pack-rat” tray. In it were 2 airpacks, a hook, can, set of irons, EMS equipment and turnout gear. The “squads” were put in place to run the EMS calls in a certain area, taking “wear and tear” off of the engine companies. But, is 2,000 calls a year enough to justify throwing 2 people on a ragged out pick-up? I think it’s a ridiculous and dangerous concept. Now that their squad program has “grown-up”, I think it’s great (getting EMT-I’s on engines to improve the level of care). I heard it’s going away from the QRV’s though, can anyone from DFD verify that? They’re supposedly going to go to an ALS Engine comapny concept??? I like the mindset of a certain Chief, in a certain city, in this area; “if the engine’s break, we’ll buy more”.

Don’t get me wrong, the “squad” in Durham was fun. You were supposed to answer to the ladder company captain at the scene of a fire, and usually either grabbed the primary or a second line. You could get places fast, and if you had a cool partner it was even better. O’ the good ol’ days…

Skip, as far as your concept of a 5-man ladder but the crew being split in cars doing inspections….you’re joking right? I’ve never wondered; don’t break up the crew, company unity and integrity is muy importante to be more effective!!
Silver - 01/14/09 - 22:00

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