EMS 2

• Document outlines procedures and guidelines for First Responder Companies (FRC) in Philadelphia Fire Department, revised October 2023

Definitions

• First Responder Company (FRC): designated firefighting company staffed with at least one Firefighter/EMT
• First Responder Company Member: any member assigned to an FRC
• Lead EMT (L-EMT): company member certified as EMT-B, taking lead in patient care
• Basic Life Support Unit (BLSU): medic unit staffed by two EMTs
• Advanced Life Support Unit (ALSU): medic unit staffed by two Paramedics, or one Paramedic and one EMT/EMT-A
• Intermediate Medic Unit (“I” Unit): medic unit where highest level of care is EMT-A provider

Responsibilities

• Each member must use control dictated by their rank when implementing procedures

Commanding Officers

• Designate an EMT as the L-EMT for each tour, CO's won't be L-EMT
• Ensure FRC equipment is checked, prepared, and deficiencies are reported/corrected
• Upon arrival at a medical emergency, the Commanding Officer receives patient condition assessment from L-EMT
• The Commanding Officer then makes the final decision to upgrade/downgrade level of response depending on the L-EMT report
  • Medic Unit Required - Proceed in at emergency speed
  • Obvious DOA (as specified in Section 322 of Pennsylvania Statewide Basic Life Support Protocol) – Have Medic Unit proceed in at reduced speed
  • No patient found – Recall Medic Unit
• FRC is unavailable until medical emergency is transferred to ALSU, BLSU, Intermediate Unit, Police Unit, determined no service is needed, or released by IC
• Engine Company Quota-Officer and three members, Ladder Company Quota-Officer and four members

Engine and Ladder Company Protocols

• If an FRC starts a tour with the set quotas and the L-EMT assists in transporting a patient, remaining members don't return to service
• After securing the scene, the Company notifies the Fire Communications Center (FCC) when en route to hospital
• They drive at reduced speed to the hospital where the Medic Unit transported the patient, even if outside Philadelphia's boundaries
• Any member retrievals from outside alarm territory, follow hospital radio protocols and alert FCC for return
• FRC will not return to service if the following complements cannot be met:
  • Engines- One Officer and three Firefighters
  • Ladders - One Officer and four Firefighters

First Responder Status After Emergencies

• The Commanding Officer decides when an FRC returns to First Responder status after emergencies
• FRC members should cleanse themselves and equipment when required, aiming to return to FRC status ASAP

Lead Emergency Medical Technician (L-EMT)

• Ensure all FRC medical equipment is restored and supplied to operational readiness at the start of each tour and after each incident, following equipment list
• Assess patient condition and situation upon arrival, informing the Commanding Officer
• A medical first-in bag goes to the patient's side on all medical dispatches
• The Semi-Automatic External Defibrillator (SAED) is used on all cardiac arrest scenarios
• Treatments and stabilizations will be based on patient assessment, e.g., oxygen administration, cervical collar application and bleeding control
• Provide report to Paramedic, EMT, or EMT-A attendant on transporting Medic Unit
• Responsible for completing the NFIRS report about the incident

First Responder Company Members

• Assist the L-EMT in performing medical assistance, providing equipment and supplies, family reassurance, and maintaining sanitary and safe working conditions
• When required, assist medic unit personnel that are transporting the patient to the hospital
• Completion of current certification in CPR

Battalion Chief

• Ensure that each FRC has an assigned EMT at all times

Deputy Chief

• Distribute EMT’s as required to ensure proper staffing of FRC's
• Ensure FRCs are following procedures when conducting respective divisions

Guidelines

• The first responders' top priority is the patient, to stabilize/improve the patient's condition until a transporting vehicle arrives

FRC Response Uniform

• Requires uniform for medical emergencies:
  • Approved Class C uniform
  • Fire Helmet (as situation dictates)
  • Department Work Jacket (Optional)
  • Approved Shoes
• Bunker gear/boots should safely be stored on appararatus when responding, not worn inside dwellings or buildings for EMS response

Necessary Activities

• All of the following activities may be necessary depending on the emergency condition:
  • Protect parties from approaching or passing traffic
  • Avoid unnecessary road blockage
  • Request more help, if needed
  • Patient access
  • Administer emergency medical care, utilizing universal precautions gloves, mask, goggles, etc.
  • Move patient if such movement is necessary.

EMS Dispatching Protocols

• Following FCC ADMINISTRATIVE ORDER #20, MEDIC RADIO DISPATCH PROTOCOLS when determining units to send
• Guidelines are used to determine when to send First Responder Companies (FRC), Advanced Life Support Units (ALS), and Basic Life Support Units (BLS)
• For units where highest level of care is an EMT-A provider the "I" identifier will be utilized
• FCC to continue using two dispatched incident categories: ALS and BLS
• Medic Units identified as "I" dispatch on all BLS and ALS calls except fire ground and cardiac arrest; dispatched as "B" units for fireground/cardiac arrest

Equipment

• Provided in list format on page 5

FCC Administrative Order #20 Appendix A

• Using Computer Aided Dispatch (CAD) to determine EMS priorities
• Global Positioning System/Automatic Vehicle Locator (GPS/AVL) determine dispatch recommendations; if unavailable, use static recommendation

Echo (CD) Dispatch Priority - AVL/GPS Recommendation

• When There is no confirmation of CPR in progress:
  • Closest FRC OR BLS* (HOT) and
  • CLOSEST ALS (HOT) if less than 2 miles away or CLOSEST ALS or BLS (HOT) if ALS is greater than 2 miles away
• When There Is Confirmation of CPR in Progress
  • CLOSEST FRC OR BLS* (HOT) and
  • CLOSEST ALS (HOT) if less than 2 miles away or BOTH ALS AND BLS (HOT) if they are both greater than 2 miles away and the BLS is closer
• FRC prioritized over BLS if they are stationed together

Echo (CD) Dispatch Priority - Static Recommendation

• When There is no confirmation of CPR in progress:
  • CLOSEST FRC OR BLS* (HOT) and
    • ALS (HOT) If the ALS unit is first or second due ALS or CLOSEST ALS or BLS (HOT) if ALS is further than the second due ALS
• WHEN THERE IS CONFIRMATION OF CPR IN PROGRESS
  • CLOSEST FRC OR BLS* (HOT) and
    • ALS (HOT) If the ALS unit is first or second due ALS or BOTH ALS and BLS (HOT) if they are both further than the second due ALS but the BLS is closer
• If a BLS and FRC are stationed together, the FRC will be considered closest and have dispatch priority ahead of the BLS.

Echo (CD) Dispatch Priority - PFD Unit on Location

• ALS UNIT on location and requests a Code Blue:
  • If not already dispatched, dispatch a FRC or BLS unit, whichever is closest, and an EMCO.
• BLS UNIT on location and requests a Code Blue:
  • A FRC (if not already dispatched), the closest ALS unit, and an EMCO. When the ALS unit goes enroute we will ascertain their ETA to the assignment and give it to the FRC and BLS unit.

Delta / Charlie (A) Dispatch Priority – AVL - GPS Recommendation

• ALS ONLY (HOT) If the ALS Unit is less than 2 miles away.
• FRC* (HOT) and an ALS or BLS (HOT) whichever is closer, if the ALS Unit is greater than 2 miles away.
• If a BLS and FRC are stationed together, the FRC will be considered closest and have dispatch priority ahead of the BLS.

Delta / Charlie (A) Dispatch Priority – Static Recommendation

• ALS ONLY (HOT) if the ALS Unit is responding from the first or second in station.
• If the first due ALS Unit is not available, send the closest unit (FRC or BLS*) HOT and the second due ALS Unit (HOT).
• If the first and second due ALS Units are not available, send a FRC (HOT) (If Closest) and the closest ALS or BLS Unit (HOT).

Bravo (B) Dispatch Priority- AVL - GPS Recommendation

• If the BLS Unit is responding from less than 2 miles away – send the BLS Unit (HOT).
• If the BLS Unit is responding from greater than 2 miles away – send the closest available medic unit (HOT).

Bravo (B) Dispatch Priority - Static Recommendation

• If a BLS and ALS unit are recommended, dispatch the BLS unit (HOT) if the BLS unit is responding from the first four fire stations
• If the BLS unit is not responding from the first four fire stations dispatch the closest available medic unit (HOT)

Alpha (BC) Dispatch Priority- AVL-GPS Recommendation

• BLS (COLD) if less than 5 miles away
• If closest BLS is greater than 5 miles away, send the closest ALS or BLS (COLD)
• On all ALPHA BC incidents, FRC (COLD) only dispatches when no medics available

Alpha (BC) Dispatch Priority- Static Recommendation

• BLS (COLD) if BLS unit is responding from first 12 stations
• If closest BLS is greater than 12 stations away, send the closest ALS or BLS (COLD)
• If no medic unit is recommended, send a FRC (COLD) and closest ALS or BLS (COLD)

Trauma Dispatch Priority - AVL-GPS Recommendation

• If the unit is more than 2 miles away a FRC (HOT) will be sent

Trauma Dispatch Priority - Static Recommendation

• If the medic is responding from first or second-in Fire Station no FRC needed
• If the medic is responding from third in Fire Station or beyond a FRC (HOT) will be dispatched
• On a trauma response, CAD will recommend a FRC and closest medic unit ALS or BLS

Private Medical Facility Protocol 33

• Echo determinant be generated from case entry, even if incident at Medical Facility

No Confirmation of CPR

• CLOSEST FRC OR BLS (HOT)

If ALS greater than 2 miles

• CLOSEST ALS (HOT) if If less than 2 miles, or closest BLS (HOT)

Under Confirmation of CPR

• CLOSEST FRC OR BLS (HOT)

ALS not close

• CLOSEST ALS (HOT) if less than or BOTH ALS & BLS (HOT) if greater and BLS is closest

Dispatch Priority

• If choosing to send a BLS unit to a PMA, check with the caller to find out if any ALS measures have been taken

Code blue

• CD call-taker directs to a 33-D-1-or 33-D-2: follow procedures for static response

Charlie (PMA) Dispatch Priority - Static Recommendation

• Locate 1st or 2nd due to ALS (HOT) If either are absent, locate closest

Charlie (PMA) Dispatch Priority Gps Avl Recommendation

• ALS unit in service if less than 2 miles/ 3.2km
• If further, closest available or closest BLS (HOT)

Protocols

• There is be zero Bravo priority when it comes to protocol 3
• All listed priorites must be in Acuity 1 of protocol 33
• The D.M. is responsible for knowing protocol symtoms

Alpha (PMBC) Static/GPS REC

• The BLS is active if under 12 station/8km
• Activate ALS unit outside of it or nearest BLS (Cold only)

IMPORTANT Note

• Protocol 33 incidents only dispatch FRC if code blue is on location or requested by EMS on scene.