Well, this is a simple and yet complicated answer. First of all, the apparatus are not both ambulances. One is a rescue truck used to extricate victims from vehicles, machinery, etc. The other is indeed an ambulance. Understanding why both are showing up requires a little knowledge about emergency medical service laws and rules in Ohio and a little history of Quad Ambulance.
The State of Ohio has for the most part, four levels of EMS providers:
EMR – Emergency Medical Responder
EMT – Emergency Medical Technician
EMT Advanced (Intermediate) – An EMT with more training, particularly in regards to trauma. The name for this certification has changed the most over the years, not that it really matters in this conversation
Paramedic – Highest level of EMS provider. There are some specialty certifications for flight paramedics and mobile intensive care units, but for everyday EMS response, this is the top.
Ohio requires that paid departments provide at least two personnel trained to the level of EMT when transporting patients, one of which can be the driver.
When Quad began operations personnel were not paid, they were volunteer. The station was not staffed. This model can be successful with a low call volume and a healthy roster of volunteers. Call volume increased, training hours and requirements increased, volunteer numbers diminished. In 2006 Quad began staffing the station twelve hours a day. This was an immediate success. A tax levy was passed, by the second quarter of 2007 Quad was staffing the station, not with just the minimum of two providers, but three, twenty-four hours a day, seven days a week. Even though most agencies the size of Quad only staff with two, Quad has always set the bar high, providing the best service while being financially responsible.
Quad is at another transition. As call volume has increased over the years more and more calls have gone unanswered. Why? When there are more calls for service, there are more chances that these calls occur simultaneously. Mutual aid departments have been requested in these situations, but always at the cost of a delayed response.
So… the question now is: How can Quad answer simultaneous calls more often rather than relying on mutual aid?
One solution would be to increase staffing. This does not fit into the current budget, so more tax levy money will need generated. This is a tall order considering that additional personnel are only needed a few hours a day while transports are being made. It doesn’t seem responsible to always put the burden on taxpayers either.
Another solution is to implement a recall system. Meaning that every time a transport takes place a request is made for off-duty personnel to come in and staff the station for a minimum number of hours. This fits in the budget and became policy a few years ago. However, it only had limited success and is dependent on the availability of off-duty staff.
Which brings us to another solution. Splitting the three person crew. Why? Over the years the expectations and use of EMS has changed. A larger percentage of calls for service are stable patients or, not even resulting in transport. Improvements in technology has streamlined the work being done, like heart monitors that continuously monitor the patient and communicate with hospitals, electronic patient care reports that can be completed once back at the station, power stretchers, etc. But with all this technology, the deployment model hasn’t changed. More than any other time in Quad’s history it is reasonable to expect two providers to be able to manage a stable patient while transporting to the hospital. However, responding with three personnel creates flexibility. The bulk of the work is done on scene which requires more providers and if a patient is unstable, the third person can transport.
What does the third person do if they don’t transport? They remain in the district, ready to respond to a simultaneous call for service. Provide immediate lifesaving interventions. Request appropriate resources. Or, if only one off-duty provider responds to the recall request, the minimum required number of providers have been met to transport a patient in the reserve ambulance.
How does the third person get to the scene if not in the ambulance? Quad doesn’t own a utility vehicle. Considerations have been made to purchase a used one, or a new one. Where to park it? Considerations have been made to build an addition. Is all that worth it for a solution that isn’t even proven to work? Likely not. What about that rescue truck?
Before considering using the rescue truck, why does Quad even have a rescue truck? Well… before the current make-up of fire and EMS departments and leaders were in place a set of hydraulic tools were purchased and placed on an old ambulance. These tools were used in the entire district. Auto extrication is an extremely technical and cost intensive part of public safety. Not that agencies don’t respond to many traffic accidents, but there are very few victims that actually need extricated. In fact, in 2021 that number was three. This number is important for a couple reasons. One, the current rescue layout Quad deploys cost in excess of $250,000. Is it reasonable to ask the districts taxpayers to provide multiple rescue trucks and tools for every fire department in the district? Not for three calls a year. This is why the departments (Quad, Magnolia, and Mohawk Valley) have continued to work together to provide this mission in the most financially responsible manner.
Seems like a no brainer, use the rescue truck. Not quite. Occasionally, the vehicle used to get the third person to the scene needs left on scene if that provider is needed for transport. This is where the three actual extrications comes into play again. Based on the call volume of Quad and making reasonable predictions based on years of data, there is about a 1 in 200 chance that the rescue truck will be left on scene, making it unavailable, and a traffic accident occurring that requires extrication. Mutual aid requests will be made to mitigate the incident if needed. However, off-duty personnel retrieve the rescue from the scene as much as possible returning it to an in-service state. This decreases those odds even further.
Back to the original question:
Why are two ambulances showing up when I call for assistance?
To do more. To be flexible. To provide the right staffing, at the right time, for the right patient, rather than a one size fits all approach.
If you call for service and one person shows up, don’t be offended, don’t be upset, your emergency just happened to occur the same time as someone else. Rest assured this one provider has called for the appropriate resources and can make the difference between a positive or negative outcome in an emergency. Prior to these policy changes, no one was showing up unless another agency was available resulting in delayed response at best.
Is it working?
The first four months of 2022 has been arguably the busiest first four months in Quad’s history. Call volume has increased by 20% since this time last year. Despite these numbers, a Quad provider has been available to respond to every single call. Not one patient has been transported by another agency. The rescue truck has been available to respond to every traffic accident.
Yes. It is working. It is effective, cost efficient, and responsible. Services have not diminished, in fact care to the district as a whole has increased. Quad’s providers and administrative staff are working harder than ever to accomplish the mission:
To provide efficient and professional pre-hospital emergency medical care, 24 hours a day – 7 days a week, with an emphasis on sensitivity, compassion, and professionalism, to the residents and visitors of the communities comprising the Quad Ambulance District.