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June 18, 2014
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Nevada County to see major upgrade in emergency medical care


Nevada County residents are about to experience one of the biggest upgrades in emergency medical services in decades.

Nevada County Consolidated Fire District and Nevada City and Grass Valley fire departments are awaiting word this month on approval of their application to upgrade to an Advanced Emergency Medical Technician license status, up from the agencies’ current basic EMT license.

If their application is approved as expected, Nevada County will become the first in the lower Sierra foothills to move to that level.

“This will fundamentally change the way we do business,” said Nevada County Consolidated Fire Capt. Patrick Sullivan, one of six firefighters in the three districts who are already trained as paramedics but who are unable to use their skills in an emergency due to the current license status. “We’ll be able to provide a higher level of care for our constituents.”

Advanced EMT certification means that firefighters with paramedic skills who arrive at the scene of a heart attack, drug overdose or diabetic emergency won’t have to wait for an ambulance and paramedics to arrive to start an IV, open blocked airways or begin other vital interventions.

With the three fire districts’ current basic EMT license level, even trained paramedic firefighters like Sullivan are barred from using those skills. The exception in Nevada County is Penn Valley and Truckee fire protection districts, which have their own ambulances that offer paramedic-level care to people in emergencies in the back country or Yuba River areas. The need for the upgrade to Advanced EMT is only within the areas covered by Consolidated Fire, Nevada City and Grass Valley.

“I live in the community that I work for,” said Nevada City Fire Engineer Kevin Cartzdafner, also trained as a paramedic. “I would love to be able to provide the best level of service that I can.

”A lot of us put ourselves through paramedic school,” Cartzdafner added. “It will be a huge benefit not only for the community, but for me personally to be able to use those skills.”

Besides Sullivan and Cartzdafner, the following fire personnel are already trained as paramedics and would be able to start work at the Advanced EMT level immediately upon license approval or soon thereafter: Consolidated Fire Capt. Jim Smith; Consolidated Fire Engineers Robert Tellam and Brock Benton; and Grass Valley Firefighter Chris Gregory. In addition, Consolidated Firefighter Cameron Foley and Grass Valley Firefighter Roque Barrera are currently enrolled in paramedic training and would be eligible to operate at the Advanced EMT level upon graduation.

“This will ultimately benefit our patients,” said Benton, noting that he and others have worked part-time for ambulance companies to keep their skills fresh. “I live two minutes from the fire station, so I’ll be able to help my family, my patients.

“As far as our jobs go, it will make it easier because there will be more hands on (in an emergency interventions),” Benton added. “And I will be able to use skills that I’m not now able to do.”

The program won’t be universally adopted immediately because only the fire engine crews that have trained paramedics on board will be able to operate on the Advanced EMT level, Sullivan said. But that will change.

“We see this as the beginning,” Sullivan said. “Our goal is that, over the next five years, all our engines are going to AEMT.”

According to Sullivan, 73 percent of fire calls in the three-district area are for medical aids and car accidents.

“Firefighters are ordinarily the first to arrive to assess the patients and provide initial medical interventions,” he said.

The fire agencies now have to rely on the arrival of Sierra Nevada Ambulances, which have paramedics on board, to administer life-saving interventions, such as opening up breathing passages or reversing diabetic shock.

But if the ambulances are busy, or, as in the case of an incident at a remote location, a person could die while awaiting what is called Advanced Life Support that a paramedic would supply. Also, in the case of a mass casualty such as a bus crash, the ambulances and paramedics may be flooded with patients and need the extra hands and vehicles

Sullivan said he and others relied on advice from Penn Valley Fire Protection District in writing the 60-page application for the Advanced EMT level.

The application, which took about eight months to complete, is currently under review by the Sierra Sacramento Valley EMS Authority.

Penn Valley fire ambulance services started in 1978 at the basic EMT level. The level of care was upgraded to a more advanced EMT level in the early 1980s. After that, the care was upgraded to paramedic level, which now offers Advanced Life Support on a 24-hour, seven-days-per-week basis.

While the Advanced EMT level does not include all the elements of the paramedic level, it is a big step up from basic EMT, Sullivan said.

In addition to all the basic non-invasive EMT skills such as CPR, wound dressing, splinting, or use of the automated external defibrillator, the Advanced EMT level allows for:

King Tube airways; tracheal suctioning of intubated patients; peripheral IV access, saline locks, needles; IV administering of glucose solutions, isotonic solutions, naxalone, dextrose.

Also: Obtaining blood samples, measuring blood glucose levels, administering drugs other than in an IV, such as aspirin, sublingual nitroglycerine, glucagon, inhaled bronchodilators, activated charcoal, naxalone and epinephrine.

As to the cost of the upgrade, Sullivan said there was a $500 application fee. In addition, each engine with Advanced EMT will carry a new bag of catheters, IVs and other equipment that costs $800. There is no extra cost to patients who receive the higher level of care.

Sullivan said there are plans to offer a “bridge” course for firefighters to move from basic EMT to Advanced EMT at Sierra College in Grass Valley. The Northern California Training Institute in Roseville already offers the AEMT training, he said.

“If we have snow on Highway 20 and there’s limited access for ambulances, we’ll be able to give care to people,” Sullivan said of the move to AEMT.

“Also, if a fellow firefighter goes down when we’re out of the county or on a strike team, we’ll be able to help one of our own.”

To contact Staff Writer Keri Brenner, email kbrenner@theunion.com or call 530-477-4239.

This story was updated on Wednesday, June 18, 2014 to clarify the role of ambulance and paramedic care within the Penn Valley and Truckee fire protection districts.

“I live in the community that I work for. I would love to be able to provide the best level of service that I can.”
Nevada City Fire Engineer Kevin Cartzdafner


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The Union Updated Jun 20, 2014 06:58PM Published Jun 18, 2014 01:01AM Copyright 2014 The Union. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.