title: Is there a role for first responders in EMS responses to medical facilities?
abstract: OBJECTIVE
  Emergency medical dispatch (EMD) protocols should match response resources with patient needs. We tested a protocol sending only a commercial ambulance, without fire department first responders (FR), to all non-cardiac-arrest EMS calls at a physician-staffed HMO facility. Study objectives were to determine how often FR provided patient care at such facilities and whether EMD implementation could conserve FR resources without compromising patient care.
  
  
  METHODS
  All EMS dispatches to this facility in the 4 months before implementation of the EMD protocol and 4 months after implementation were identified through dispatch records, and all FR and ambulance patient care reports were reviewed. In the "after" phase, all cases needing ALS transport were reviewed to examine whether there would have been benefit to FR dispatch.
  
  
  RESULTS
  Of 242 dispatches in the "before" phase, BLS FR responded to 156 (64%), and ALS FR to 117 (48%). BLS FR provided patient care in 2 cases, and ALS FR in 17. Of 227 dispatches in the "after" phase, BLS FR responded to 10 (4%), and ALS FR to 10 (4%); all but one were protocol violations. BLS FR provided care in one case, and ALS FR in three. Review of the 93 "after" cases requiring ALS transport found none where FR presence would have been beneficial.
  
  
  CONCLUSIONS
  First responders rarely provided patient care when responding to EMS calls at a physician-staffed medical facility. Implementation of an EMD protocol can safely reduce the number of FR responses to unscheduled ambulance calls at such a facility.
authors.affiliation: Division of EMS, Section of Emergency Medicine, School of Medicine, Yale University, and Department of Emergency Medicine, Hospital of St. Raphael, New Haven, Connecticut 06519, USA. david.cone@yale.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Cone
authors.forename: Nicholas
authors.initials: N
authors.lastname: Galante
authors.forename: Donald S
authors.initials: DS
authors.lastname: MacMillan
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Perez
authors.forename: Vivek
authors.initials: V
authors.lastname: Parwani
mesh_terms: D022561:Advanced Cardiac Life Support; D003237:Connecticut; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians / Q000706:statistics & numerical data*; D006268:Health Facilities; D006801:Humans; D024382:Professional Role; D012189:Retrospective Studies