Friday, January 20, 2006
ALS: A medical emergency system that saves lives
Carlisle residents benefit from a two-tier emergency medical response system. The first tier is local and is town supported; the dispatcher routes incoming medical emergency calls to the Fire Department, which notifies local Emergency Medical Technicians (EMTs) who respond at the emergency scene within a few minutes. The second tier is provided by Advanced Life Support (ALS), created by Emerson Hospital in 1982 and still based at the hospital.
ALS paramedics are part of the regular hospital staff, and travel to the emergency scene in the now familiar red and white vehicles. ALS paramedics work under the direction of an Emerson Hospital emergency physician, through either radio or telephone. Carlisle Fire Chief Dave Flannery says there is a 13 - 15 minute response time for the Emerson-based paramedics. In fact, local and Emerson-based paramedic units work together, with local EMTs providing immediate care, ALS bringing needed special equipment to the scene, and the local ambulance providing transport to the hospital. In extreme condiditons, patients can be air-lifted from the emergency scene to the helipad at Emerson, with the ALS paramedic in attendance throughout.
While both EMTs and paramedics respond to medical emergencies, there are significant differences in both training and performance capability, and different requirements for state certification. EMTs usually have 120 to 130 hours of training and are authorized to provide only non-invasive care; paramedics have 1500 or more hours of training and are authorized to provide intravenous therapy, administer medications, intubate, and use both a 12-lead EKG and a defibrillator.
Money is the problem
As part of the regular hospital staff, ALS paramedics are paid by the hospital. Costs are either paid for by insurance, or patients are billed directly. The problem is that receipts do not cover costs and the program has been running with a steady shortfall, estimated at $180,000 a year by one source and $200,000 annually by another. Last year there was consideration of towns being assessed for services, but special outreach grant monies were obtained for this year to support the Emerson ALS program in the 13 communities it covers. ALS usage has grown from 129 calls annually in 1982 to over 1700 a year at this time, so that demands for service have increased along with the cost of providing the service.
The need for a firm and solvent plan to maintain ALS services for Carlisle and the other 12 towns using the Emerson ALS program is pressing. Alternatives might be a privatized or a regionalized response system. These might have fiscal advantages, but the ALS base might be farther from Carlisle, resulting in longer response times.
Emerson Hospital remains committed to the ALS program. Emerson administrator Christine Schuster, who came to the hospital just last year, called a meeting of the Emerson-area first responders, and expressed her support for the two-tier system which has, according to Flannery, "saved many, many lives." Glenn Smith, vice president of Clinical and Administrative Services at Emerson Hospital, says, "We have been working very hard to find additional funding resources to continue providing this valuable, regional service to the 13 communities in our service area. We are pleased to report that Emerson has recently received approval from the state. indicating that our local legislators have helped us successfully secure a grant that will enable Emerson to fully underwrite the cost of this service."
© 2006 The