A 911 call for medical assistance within the City of Santa Barbara is answered by the Santa Barbara Police Dept. The call is interrogated and prioritized as non-emergency or emergency. Emergency calls are deemed life threatening and require dispatch of a fire engine while non-emergency calls only require ambulance response. If an emergency call is received, the computer (CAD- Computer Aided Dispatch) recommends the closest available city fire station. In addition, the closest AMR ambulance is sent. AMR is dispatched by the County Sheriff’s Dept with a separate CAD system. AMR units are placed in different areas of the City based on number of units available and time of day.

 

Typical calls for emergency medical assistance include: heart attacks, shortness of breath, falls, seizures, diabetic emergencies, drowning and trauma. The EMS system is set up to deal with all the aforementioned emergencies. In addition, because patients can deteriorate during a given EMS call, responders are trained to continually assess and treat a patient through a variety of medical conditions.

 

Levels of Training.

 

City fire firefighters are trained to the EMT-Basic level only. This means that they are allowed to assess patients, administer oxygen, perform CPR and automatic external defibrillation (AED). While all other fire agencies on the south coast of Santa Barbara (Carpinteria, Montecito and Santa Barbara County) provide paramedics on fire engines, the City of Santa Barbara only provides this lowest level of care. With that said, the City and its residents rely on AMR to provide all paramedic services in the City.

 

 

The City Fire Department strives to meet a four-minute response time for its “first-in” fire engines. This time begins with the receipt of the 911 call and ends upon engine company arrival. This four-minute time has a proven direct correlation to successful patient outcomes. This desire to arrive within four minutes is partially derived from American Heart Association Standards that suggest that BLS care be initiated within four minutes.

 

 

The fire stations in Santa Barbara are strategically placed to provide optimum coverage utilizing the four-minute response criteria. Although in place since 1962, this model continues to allow fire engines to respond effectively in the City. Due to the varied terrain including narrow, winding roads; the fire stations provide outstanding response times in all area of the City.

 

 

American Medical Response has the sole contract in the County of Santa Barbara to provide emergency and non-emergency ambulance transport. This contract, known as an Exclusive Operating Agreement (EOA) is overseen and administered by the County of Santa Barbara. The County has the latitude to award one or more ambulance contracts however, for the past two decades, the ambulance contract has been awarded to only one company. Currently AMR is in the middle of a thirteen year contract for service.  The City of Santa Barbara receives ambulance service through a Joint Powers Agreement (JPA) with the County.

 

 

AMR’s contract stipulates that ambulances must arrive to calls in the City in less than eight minutes (7:59), 90% of the time. This is the only requirement and they do not get credit for arriving in less than eight minutes. This obligation is typical for a contracted ambulance company in California. This eight minute response is partially derived from American Heart Association Standards that suggest that ALS (advanced life support, paramedic) care be initiated within eight minutes.

 

 

The American Heart Association sets the standard for emergency cardiac resuscitation. They have extensively studied cardiac arrest outcomes and have formulated the following Chain of Survival. The Chain of Survival shows the “link” between early access (911), early CPR (citizen via training or EMD), early defibrillation (by SBFD) and early advanced care (by AMR).

 

Any break in the chain, significantly hampers successful patient outcome. The Chain of Survival illustrates the point that all players (from the reporting party to the paramedic) are integral players in the successful resuscitation of a patient. Again, any “link” broken will be detrimental to patient outcome.

 

 

 Seconds Count

 

 

 

 

For a look at the new standards for cardiac care, reference: http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-206

 

 

This document was designed to provide the reader with a brief overview of your City Fire Department’s role and response to medical emergencies. Although tasked with much more than medical response, the focus was to provide the reader with qualitative data to analyze EMS response in the City.