Paramedic Capability Increased on SMFD Engine

San Marino firefighter Dominic Petta was in a local store last week when a woman walked up and showered him with gratitude.
Petta had recently responded to an emergency call and found this same woman in cardiac arrest. He and other San Marino Fire Department paramedics worked to restore her heartbeat, and here she was a short time later, up and around … and profoundly grateful that he had been there to minister to her.
Now the SMFD is even better positioned for such medical crises. Its fire engine has been newly equipped for advanced life-support situations, receiving approval from the Los Angeles Emergency Services Agency as a paramedic assessment engine.
That means it will carry equipment — and people trained to operate it — to deal more comprehensively with a wide array of medical emergencies, from heart attacks and blocked airways to spinal cord injuries and nerve-agent attacks.
San Marino Fire’s ambulance was already equipped in this way. Now the engine is similarly stocked. And since nearly all of the SMPD’s firefighters are also paramedics, the engine will be able to operate as a de facto ambulance. About 56% of the calls handled by the department are medical in nature, according to figures on file with the Verdugo Fire Communications Center.
“Often, the ambulance is at the hospital with a patient or on another call,” firefighter Dave Tannehill said. “This really does make us capable of delivering service faster to the community.”
“Now we carry the whole gamut of medicines,” added Capt. Nick Maza. “It’s not just one box of, say, epinephrine (adrenaline). We have the same cache as the ambulance. Since we’re SFTP-certified (standard field treatment protocols), we can get through the whole treatment algorithm without having to make a phone call to the hospital [for permission].”
The upgrades were made at a relatively modest cost — $1,500, according to City Manager John Schaefer. He commended paramedic coordinator Jeff Tsay for helping make it happen.
The engine’s enhanced features include:
• Advanced airway kit. The engine now carries an intubation device that is designed to minimize airway trauma. “A balloon blows up to the circumference of the trachea,” Tannehill said, “and the only air that moves in and out is through the tube. That way we’re in control of the airway. The patient can’t vomit and breathe it in.”
The paramedics also have tools to remove foreign-body obstructions.
Some of these methods typically are only conducted by Emergency Room physicians, but the paramedics are trained to use them in emergency situations.
The airway kit also includes end-tidal capnography capability, enabling paramedics to determine a patient’s cellular metabolism by measuring the expiration of carbon dioxide.
• A more comprehensive supply of pharmaceuticals. “It allows us to give the full suite of drugs in cardiac arrest that can be life-saving,” said Chief Mario Rueda. “And if someone has a very serious injury, the engine [paramedics] can now provide pain management. If there is a broken hip or a broken femur, it really doesn’t do the patient any good to be in that much pain. They can do themselves more harm.”
The expanded cache of medications also has remedies for prolonged or multiple seizures, which can be life-threatening if the patient is not getting sufficient air, Rueda said.
Other drugs can sedate people having dangerous psychotic events. Still others are in stock for organophosphate poisoning — nerve agent attacks.
• The engine’s heart monitor is now equipped for pediatric assessments, not just adult patients.
• San Marino firefighters got busy building a special storage box atop the engine to hold backboards — with Brian Campbell personally doing the welding. It will enable paramedics on the engine to immobilize patients with spinal injuries.
As a member of the Verdugo Fire Communications Center, the San Marino Fire Department can get ambulance help from San Gabriel or South Pasadena or Pasadena in the event its own ambulance is busy on another call and cannot respond to a medical emergency. But, Rueda said, “that takes a little longer. In that additional time that is spent when the ambulance isn’t here, we can now give the full therapeutic treatment modalities while waiting for the ambulance to come.”

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