Why does the Grand Island Fire Department send both a fire engine and ambulance to medical emergencies within the city limits?

As fire chief for the Grand Island Fire Department (GIFD) I often get asked this very question.
The GIFD strives to provide the best service possible with the resources entrusted to us.  The practice of responding to medical emergencies with both an ambulance and a fire engine has been used for many years by the GIFD, as have many other fire departments across the country.

There are several key reasons this concept of emergency care is used in Grand Island.  It is my hope the explanation below will help educate and raise awareness as to why a fire engine and ambulance both respond to medical emergencies.

Rest assured, the next time you see a fire engine at the scene of a medical emergency know the decision was made with the best interest of the patient in mind.

Cory Schmidt
Grand Island Fire Chief
Dispatch information: Calls to 911 are received by highly trained dispatchers who work in the emergency dispatch center. Dispatchers ask a series of questions to determine the nature and complexity of the medical emergency.  Depending on the severity of the call, dispatchers send the appropriate number of responders using a tiered system.  Less severe calls receive fewer resources while more severe calls receive additional resources.  Some calls such as a sprained ankle, broken arm, and minor cuts receive only an ambulance.  More severe calls like chest pain, stroke, and unconscious patients will be handled by both a fire engine and ambulance.

Patient care: The GIFD operates under the license of a medical director.  The medical director is a licensed physician who provides the fire department personnel with a series of medical protocols. These protocols require specific medical procedures to be performed in a timely manner. Serious medical emergencies such as chest pain or someone not breathing require many procedures that must take place as soon as possible to ensure the best patient outcome.  These procedures simply cannot be accomplished effectively by the two people assigned to an ambulance and require additional personnel on a fire engine.  There is a national standard that requires at least two paramedics and two EMTs to respond to all advanced life support (ALS) calls.  In Grand Island approximately 76 percent of all the medical calls are ALS in nature.  These are the more serious medical emergencies mentioned earlier and require the personnel from the fire engine and ambulance for proper patient care.

Time:  Grand Island is a growing city that covers approximately 28 square miles.  There are four fire stations strategically located throughout the city.  Station placement was based on response times, population demographics, and expected growth.  A national standard allows fire departments four minutes or less of drive time to arrive at the scene of a medical emergency.  Four minutes is a critical time for someone experiencing a serious medical condition such as a heart attack.  The heart and brain have a better chance of full recovery if they receive oxygen in four minutes or less.

The GIFD currently staffs two ambulances on a daily basis which are located at Fire Station 1 and Fire Station 2.  If a medical emergency is dispatched and the ambulance is on another call or not in the general vicinity of the incoming call, a fire engine assigned to that response area will respond regardless of the severity of the call.  Each shift member of the fire department is trained to the emergency medical technician (EMT) or paramedic level. Because of this training, even when an ambulance is delayed, medical care is started and the patient receives emergency treatment as soon as possible.

Readiness: Think of a fire engine as a multi-use vehicle for fires, rescues, hazardous materials, and emergency medical calls just to name a few. The fire engine is typically staffed with three, highly trained professionals. The fire engine crew normally consists of at least one paramedic and two EMTs.  The crew must be ready to respond to not only medical emergencies but also all types of other calls. Often a fire engine goes from one emergency call to another without returning to the fire station.  In 2014 GIFD responded to 437 calls within two minutes of completing an earlier one.  This means fire department personnel most likely didn’t have time to return to the station to switch vehicles or resupply.  If the department were to respond in an alternative type of vehicle such as a suburban, crew members may not have the proper equipment to address the next call. Although fire engines are expensive, these vehicles allow the department to always be ready for the next call without a reduction in service or capability as the GIFD must always be prepared.

Discretion:  Emergencies are unpredictable and the situation is never fully known until crews arrive on scene.  The ambulance crew at times will request a fire engine due to the call being more complex than what was reported.  Things such as location of patient (in a basement, upstairs, etc.), patient size, condition of patient, and even weather may warrant additional help to safely take care of the person involved.