At the Board of Selectmen last night Chef Kingsbury handed out the attached estimate of what it would cost the town to hire eight new paramedics, such that the Medfield Fire Department would be staffed by four full time firefighters on duty, 24/7.  Under this scenario, the Medfield Fire Department staffing would double from eight full time firefighters to sixteen firefighters, with half of the employees being paramedics, and half EMT’s.

Since 2000 we have provided EMT intermediate ambulance services, and we employ eight full time EMT’s to do so.  We are staffed by two EMT’s per shift, 24/7.

I believe that the major treatment difference between EMT and paramedic services is the ability of the latter to administer medication and insert IV’s.  I also understand that paramedics have about 1,640 hours of training beyond EMT’s.

At the meeting, ALS services were estimated to be used on 80% of the current runs, needed on maybe 60%, and currently ALS services are provided by ALS intercepts, if available, as the result of a ten year old agreement with the towns of Westwood, Walpole, and Norfolk.  We split any fees received for runs with ALS intercepts with the other towns on a 50/50 basis.

The data that especially interested me was that the Medfield Fire Department does about 650 ambulance runs per year, or about two per day on average, and that each run takes up to an hour and a half.  That would appear to mean that there is a lot of capacity for which we are staffed, to do more runs.  When figured on a yearly average, if the two runs take about three hours, there is about twenty hours per day of non-run time.  If all the departments in surrounding towns have the same issue, it seems that it cries out for a regional solution by which all departments are using more of that currently underutilized capacity.

There were several comments made about the safety issues of being properly staffed with employees who have the proper training, both for the safety of the firefighters themselves and for the safety of the public.  One call firefighter assured that no apparatus ever leaves the station without being fully and properly staffed.

Alternatives that were also mentioned included:

• converting to a paramedic service slowly over time by requiring any new hire to be a paramedic
• hiring a company to provide the ALS service on an intercept basis, which was estimated to cost $600,000/year,plus a charge per run, for three towns;
• starting a regional ALS service shared with other towns that do not currently have ALS (i.e. Millis, Dover, Sherborn, and one other, Holliston maybe), but it was reported that there appears to be no interest in those other towns per the Chief in doing a regional service; and
• NB, it was stated that there was felt to be little interest among our current EMT’s in their becoming paramedics.

Another alternative, that was not discussed, is whether the Medfield Fire Department could just be converted to an all paramedic service by requiring current employees to become paramedics within a set amount of time, say within the next three years.  In the past the Chief has opined that was not possible.

The more I learn about ALS services, the more uncertain of the right solution I become.  What is the proper balance between services and costs?  I still need a lot of education, so I hope the selectmen get a lot more input.  Today in follow up discussions with one of the meeting participants I was provided the Massachusetts EMERGENCY MEDICAL SERVICES PRE-HOSPITAL STATEWIDE TREATMENT PROTOCOLS, all 176 pages of it – so I have some homework to get me started.