Dispatching multiple units necessary for quality service

There are reasons for sending two or three fire units to a traffic accident or residential medical emergency. To some it may seem excessive, but for a person in distress, the help is their lifeline. They will certainly appreciate the multiple flashing lights and sirens that bring the needed support.

"Fire engines have two to three people and ambulances have a paramedic and an EMT," said Captain John Choi of the North County Fire District. "Are five people needed? Absolutely! It's like bringing a hospital to your residence. Everyone has a job to do, from treatment, traffic, administering medicine, CPR and many other duties."

They work as a team, each with individual responsibilities, and there is an extreme number of possible "team" combinations because Fallbrook has five fire stations in the district – but only three have an ambulance.

"We provide the full package, but if it's a minor incident we do less," Choi said. "We want to provide the best possible service. Our purpose is to keep everyone safe. We're their lifeline."

With approximately 70% of the district's emergency responses being for medical situations, there are multiple opportunities for different "teams." For example, if the closest ambulance is in service elsewhere, it may be two fire engines that are the initial responders. Or perhaps an ambulance from another fire department will be the "taxi." The Fallbrook district has a "drop boundary" agreement, meaning the ambulance may be dispatched from Oceanside, Vista, Escondido, or one of several private services.

When someone in North County places a 911 call, it is first answered by the County's Public Safety Answering Point operated by the San Diego Sheriff facility in Kearny Mesa. If the request is for fire or emergency medical, the call is transferred to North County Dispatch, also known as North Comm, the regional fire and EMS dispatch center located in Rancho Santa Fe.

Dispatchers then contact the closest available units.

The dispatcher will give instructions to the appropriate agency and station – where to roll, extent of injury, etc. The closest available unit is dispatched, regardless of its "patch."

North Comm answers approximately 200 emergency calls per day to most of the fire districts and cities in North County.

"Time is of essence," said Choi. "When you dial 911, you don't expect to wait 20 minutes for an ambulance. That's why engines usually go first."

If an ambulance is sent to transport a person, it is essentially out of service for 1.5 hours, Choi said, since they are dispatched to the "Golden Three" hospitals – Temecula Valley, Palomar in Escondido, and Tri-City in Oceanside.

About half of transports are sent to Temecula Valley, but it's a decision that needs to be discussed with the person in distress or and his/her family.

Choi said the county policy is if a person wants something other than the closest hospital, they must sign a written statement, for liability reasons. An exception is a situation like a person with Kaiser insurance being able to go to Palomar Hospital since that's the closest hospital with a relationship with Kaiser.

Another exception is for a special need injury or condition that may mean a trip to UCSD Hospital or Children's Hospital in San Diego.

A helicopter – known as airship – is available through two services contracted with North Comm. The benefit is the speed but the use is rare. "We're conservative in using it," Choi said. "And it does come with an expense."

"If you choose a hospital further than the closest one, be prepared for a larger cost" he added. "It's something an insurance company may not cover."

"Our goal is to provide good information for the party to make a good decision," he explained. "We'll let the injured person make the decision. If there is hesitancy, the captain might respond with sharing what he would do if it was his spouse, for instance."

That includes the situation of an ambulance possibly not being needed.

"Often the person will be able to be taken to the hospital by a family member if the injury isn't too serious," Choi said.

He noted that there are studies showing that with a gang stabbing or shooting, the "homeboy delivery" by private vehicle has shown to be the best life-saving option.

The fire district is responsible for operating ambulances staffed with single-role paramedics and EMTs. Since the ambulances must often leave the district to transport patients to the hospital, firefighter/paramedics, with full paramedic-level equipment, are also assigned on every fire engine. This two-tiered EMS delivery system assures that the highest level of prehospital care is provided to patients in the area.

Station 1 is located in the downtown area at 315 N. Ivy St. The ambulance is staffed by a paramedic and EMT. The fire engine is staffed by a captain, engineer, and two firefighter/paramedics. The battalion chief is also assigned there, as well as a brush fire truck.

Station 1 has the most calls and the largest staff.

Station Four on Pala Mesa Drive and Station Five in Bonsall are the others with an ambulance, each staffed the same: a paramedic and EMT for the ambulance, plus the captain, engineer and firefighter/paramedic for the fire engine.

The fire Station Two on Winterwarm Drive has an engine and brush fire truck manned by a captain, engineer and firefighter/paramedic.

Station Three in Rainbow has an engine, medic squad and water tender, staffed by a captain and engineer, and paramedic/EMT.

The captain oversees each call and is in charge of crew safety. He also handles training and works on coordination with other stations.

Choi said that in instances where there may be a danger or hazard to the firefighters or paramedics, the Sheriff's Department takes command and creates a "warm zone" where the fire personnel wait until it's safe – unless there's a school shooting. "If there's an active shooter at a school, we'll go right in, not doing the staging," he said.

Dispatching duties at North Comm are shared by a staff of 16 full-time dispatchers and three shift supervisors who work 12 or 24 hour shift schedules. Additionally, there are five part-time dispatchers to help cover sick leaves, vacations, and provide support during emergencies. Dispatch personnel are supported by IT specialists, technicians, a support team, and administrators.

Part Two: New "Tier Dispatch" program coming in July will mean even better emergency service.