The Carlisle Mosquito Online

Friday, January 11, 2008


Carlisle's Emergency Medical Services are ready to help

You probably avoid thinking about it, but what would happen if you had a medical

Carlisle's ambulance. (Courtesy photo)

emergency? The Emergency Medical Service (EMS) Zone Plan submitted by Fire Chief David Flannery and EMS Coordinator Burt Rubenstein to the Metropolitan Boston Emergency Medical Services Council details the provisions for medical emergencies occurring in Carlisle. The plan sets minimum requirements for response time, staffing, backup, and training, and designates medical oversight and facilities.

Carlisle's EMTs

According to the plan, Carlisle has one ambulance and 17 Emergency Medical Technicians (EMTs) available, divided into four companies. The EMTs are part of the on-call fire department, and when a call is received, the automated dispatch system chooses the companies to dispatch based on a roster of available resources. A minimum of two EMTs and an EMT officer are sent for any medical call. Police units are dispatched simultaneously.

Emerson Hospital provides Advanced Life Support (ALS) staffed by two paramedics at all times, and is called in by the dispatcher in cardiac and other cases requiring specialized medication or equipment.

Police help with rapid response

Response time for EMTs averages six to seven minutes from dispatch, though police are usually on-scene within three or four. It takes time to get the ambulance on the road, whereas police are in cruisers ready to go. The Carlisle Police Department has two patrol officers and one shift officer on duty at all times. According to Rubenstein, the police typically act as first responders and from the emergency location radio the EMTs regarding status. Police are trained in CPR and have defibrillators, so they can start emergency procedures if necessary.

Rubenstein says the emergency department has set a goal of less than nine minutes to respond, at least 95% of the time. This percentage is hard to surpass because weather delays are inevitable.

Transport to hospitals

The primary destination is Emerson Hospital, which receives 95% of Carlisle ambulance deliveries, although Lahey Clinic serves as the primary destination for trauma cases and an alternate for other medical emergencies. The attending emergency physician at Emerson is available by radio to make recommendations regarding destinations for unusual emergencies.

Medflight is available and, depending on weather, can have a patient at a Boston hospital in six or seven minutes. Rubenstein says this is used very rarely, "once every two or three years."

Other hospitals could be used for pediatric, burn, smoke or water inhalation, or other emergencies where specialized services are required. Emergency transport can be provided as needed to Lowell General, Saints Memorial Lowell, and major Boston hospitals, but these trips are rarely made because the ambulance would be unavailable for other calls for a longer period of time.

Mutual aid

When the ambulance is tied up, mutual aid can be provided by the Bedford, Acton, and Concord Fire Departments. In addition, from 8 a.m. to 5 p.m. weekdays, Emerson has a second ALS transport unit available for backup. One advantage of Carlisle's call EMS service staffed with local volunteers is that all companies can be called on in a major emergency requiring multiple EMTs. Clinical oversight

Medical supervision is a state requirement, and Carlisle contracts with Dr. Thomas Lareau, emergency department physician at Emerson Hospital. He provides clinical oversight of EMS systems and quality, and receives monthly reports of calls and patient care records. He also approves the training curriculum.


Training of Carlisle EMTs "far exceeds state requirements," according to Flannery. Carlisle provides monthly three-hour sessions that cover drug administration, trauma management, and other specific areas. "We feel it's necessary," says Flannery, because Carlisle's part-time force does not get the same exposure as would full-time EMTs. Rubenstein notes that 28 hours of training are required per year, and Carlisle EMTs typically log 55 or 60, "about double what we need."

To become an EMT is a commitment of 120 hours of training. A course paid for by the volunteer prepares him or her for the state certification exam. In-service training can take one or two years before an EMT progresses to a lead position. EMTs must remain available for a minimum of 25 hours a week.

Staying on top of trends

With Carlisle's growing over-65 population, provisions for medical emergencies may be of increasing importance over the next decade. But so far, looking over the past ten years, Rubenstein sees "the mix of calls has been the same" and trends have stayed "pretty steady" with some increases attributable to population growth. He notes the Carlisle department is "very proactive" in monitoring trends and making needed changes. Often new state procedures and protocols are enacted here first because "we're small and can implement quickly," says Rubenstein. He adds, "We're not just getting by. We take emergency services very, very seriously." Says Flannery, "We are very fortunate to have the dedicated and caring EMT staff that we do. They are an awesome force in an emergency, and I am very proud of our department and the service we provide to the community."

2008 The Carlisle Mosquito