North County Fire personnel gets advanced training in resuscitation

Residents of Fallbrook, which lost its hospital in 2014, should take comfort in knowing that when they call 911 for a medical emergency and personnel from North County Fire Protection District arrives, they're practically getting a hospital delivered to their door.

All firefighters with North County Fire are paramedics, and they are constantly working to improve their medical skills through training and classes. An example: on Jan. 25 firefighters attended an Advanced Resuscitation Training program conducted by Dr. Daniel Davis, a Fallbrook resident who served as an emergency room physician at UCSD for 20 years.

Davis developed the ART program while at UCSD, which sent the doctor out "to train the world." Davis has been teaching the program for 10 years and has tutored people in 40 countries. He recently returned from China and will soon be heading to Dubai and Saudi Arabia.

"In the hospital, a lot of BART (basic resuscitation training) focuses on when the patient is getting sicker but isn't in cardiac arrest, and recognizing the signs that they're getting sicker and trying to intervene so they never have a cardiac arrest," said Davis. "The advanced training starts to bring in – once they've had cardiac arrest – how do you integrate your advanced equipment, some of the medications, some of the more innovative therapies, that sort of thing."

Davis said that by attending the ART program, North County Fire firefighters are gaining knowledge that will help them save more lives.

"Part of the reason that UCSD sent me out is because it's been kind of eerily consistent," said Davis of the results delivered by the ART program. "Everywhere we've gone, after a single round of training, survival from cardiac arrest doubles."

Davis, who has been teaching North County Fire personnel for 1 1/2 years on a quarterly basis, said he aims to give firefighters an advanced education.

"The things that I bring to them are concepts that would have been reserved for emergency physicians or critical care physicians and nurses," said Davis. "And I'm bringing it to them and presenting it in away that it's understandable and they can apply it."

Davis stresses the knowledge the firefighters are garnering should bolster their confidence.

"I tell them constantly, you couldn't find a critical care physician in San Diego County who understands this as well as you now understand it, and so be proud of that," said Davis. "Be confident that you're learning stuff that even physicians and nurses don't know."

Davis said residents in North County Fire's coverage zone can feel good about the fact that their emergency medical service providers "are better trained and more confident."

Davis added the better training really comes into play in areas like Fallbrook.

"In general, in a more urban environment, the transport time to the hospital is five or 10 minutes," said Davis. "I know that in Fallbrook, now that we've lost the hospital, that they (firefighters) may be with the patient for 30, 45 minutes or longer. So, they need to learn critical care in a way that perhaps the medics down in San Diego city don't have to because they're not with them as long."

North County Fire, according to Davis, is the only fire agency in San Diego County that is enrolled in his ART program. John Choi, captain paramedic with North County Fire, said Davis' classes are invaluable.

"Dr. Davis has been a great partner with us," said Choi. "He's a great trainer and he holds us at such a high standard. We already have the skills for advance life support, but what he wants us to do is start critically thinking calls through as a physician would. We want to take the bigger picture of what's going on with this patient so we can treat them appropriately."

Treating patients appropriately requires having the right equipment and sufficient personnel, and that is why an engine often accompanies an ambulance to a medical call.

"People always ask, 'I only called for an ambulance, why did you bring an engine and an ambulance?'" said Choi. "Well, one of the big components of that is we have to bring the hospital to you. Whereas, if you drove to a fixed building, they have an EKG there, they have the drug cart, they have a pharmacist, they have a respiratory therapist, they have an admin check in – they have all these people infrastructured to provide all the services.

"Well, we have to bring everything in," continued Choi. "We have to bring the drug box in, the EKG, the airway bag. We have to bring in somebody who is going to figure out the administration part – who is this, what's their name, how old are they, all their medical history. On top of that, if this is a working call like a CPR, we need a lot of hands."

Choi said the firefighters work as a team on the patient, performing different duties.

"You have the airway person, someone who is going to manage that critical airway; you've got somebody who is going to manage that monitor and report what they see on that heart monitor; somebody to start up the IV bag; somebody to draw up the medication; somebody to administer the medication; you need somebody to do CPR, we need somebody to do a time recorder, which they have in a hospital, a nurse that's time-stamping everything that they are doing," said Choi.

Choi added that if a house or building has no lighting or poor lighting, firefighters bring in portable lighting. Someone also has to bring in a gurney for transport.

Choi, who noted that 70 percent of the calls North County Fire responds to are medical in nature, said ART is just one of several training programs for its firefighters.

"We are an all rescue, all risk provider here, so we not only provide the fire, we also provide the emergency medical services," said Choi. "So this is part of that diverse training that we receive – medical, fire, technical rescue, hazmat. We do it all at North County Fire and we're always trying to be a better, proficient rescue team."