The initial care people receive however, depends on the level of training and certification the emergency responders have and guidelines established by the state and local medical control authority.

In rural areas, like Alpena, where first responders may have to travel dozens of miles to get to a patient, every minute counts. The more highly trained a responder, the better the odds of positive outcomes.

That issue is especially pertinent in Alpena Township, where officials soon will decide whether to restructure the township’s existing fire department, which utilizes paid-on-call medical first responders and emergency medical technicians, or to contract with the Alpena Fire Department to provide response service with higher-trained paramedics and advanced life-support ambulances.

The final decision will dictate how quickly help arrives on the scene of a township emergency, and the quality of care received by residents.

News Photo by Steve Schulwitz Alpena firefighter/paramedic Todd Adrian trains on emergency airway procedures at the fire station on April 7.

Jeff Roberts, president of the Michigan Association of Fire Chiefs, said having more highly trained personnel show up at the scene first is advantageous. But, he added, whether a medical first responder, an EMT, or a paramedic arrives first, having anyone there quickly sets the wheels in motion for a good outcome.

“Well, the sooner you have an advanced intervention, the better the odds for a good outcome, but having someone who may be less specialized who can provide CPR or other basic lifesaving action is critical, too,” Roberts said. “The reality is one first responder is better than none.”

Over the last several months, residents in Northeast Michigan have heard the terms MFR, EMT, and paramedic as the city and township fire departments discussed a merger. Many, however, may know little about the differences between each.

To help inform the debate, here’s an explanation of those terms:

MEDICAL FIRST RESPONDERS

A medical first responder uses limited equipment and treatments to perform the initial assessment and care for sick, wounded, or otherwise incapacitated people. Medical first responders require about 60 hours of training and a license from the state, according to the Michigan Department of Health and Human Services.

They typically arrive first to the scene, especially in rural areas, and begin basic medical treatments, such as taking vital signs and treating wounds, until more highly trained help arrives. They can conduct basic airway management, CPR, and use an automated external defibrillator, which is a portable electronic device that automatically diagnoses life-threatening cardiac arrhythmias and treats them through defibrillation. Medical first responders also can immobilize a patient and assist EMTs or paramedics who arrive afterward.

Most of the township’s paid-on-call employees are medical first responders. Alpena has none on its force.

Alpena Fire Chief Bill Forbush said in the city’s recent proposal to the township that the city would maintain the township’s paid-on-call employees to respond from home to all township calls, and some emergencies in the city.

EMERGENCY MEDICAL TECHNICIAN

An EMT needs a minimum of 194 hours of training before getting licensed.

An EMT can apply CPR and perform defibrillation, bandaging, splinting, and bleeding control, and basic airway management. They can also stabilize a patient using a backboard. An EMT can use an automated external defibrillator during a cardiac arrest, but can’t perform any cardiac monitoring or rhythm analysis. They can’t inject medications or start an IV and can only administer medicines previously prescribed to a patient.

An EMT is critical in stabilizing patients until paramedics arrive and providing paramedics important patient data and assisting in more advanced care.

Currently, the township has four firefighter/paramedics on staff, but they can’t utilize their advanced medical training and act only as EMTs because the township department is licensed as a basic life support-non transfer entity. The township lowered its type of license because of questions about costs and run volume.

The city has no EMTs.

PARAMEDIC

A paramedic can administer dozens of drugs that address heart issues, breathing difficulties, seizures, and much more.They can start an IV and give medications or fluids intravenously. They may run 12-lead electrocardiograms that assess and diagnose patients with suspected heart and circulatory issues. A paramedic can conduct several intricate airway treatments, analyze blood, and perform other, more complex medical procedures before and while enroute to the hospital.

To become a paramedic, it takes a minimum of 1,000 to 1,200 hours of training.

The city utilizes a full staff of paramedics. In its proposal to the township, the city offered to provide a pair of paramedics at each of the township’s two fire stations, as well as advanced life support ambulances.

The Alpena Fire Department responds to all emergencies in the county, paid by a four-year, 1.5-mill countywide property tax for ambulance services. That tax costs the owner of a $100,000 house about $75 a year.

WORKING WITH ONE ANOTHER

Alpena Township Fire Chief Dave Robbins said he has four employees trained as paramedics, who legally can’t implement their skills because the township is not licensed to let them do so.

He said all three levels of medical first responders are key to getting to someone in trouble in a timely manner and providing appropriate care until they can get to the hospital. Robbins said people who live close to Alpena have short response times and quick trips to the hospital, but those who live miles out of town rely heavily on medical first responders to assist them until more advanced personnel arrives.

“As rural as Alpena County is, the greater the importance of having a first responder there in five minutes, so they can initiate basic life support treatment,” Robbins said. “That is the importance of having the medical first responders. Be there first and begin to help. All of our (emergency medical services) working together is paramount.”

There are differences in the ambulances the two municipalities use, too. The township has basic life support units, while the city has a full complement of advanced life support rigs.

An ALS unit is basically an emergency room on wheels that carries a host of medications and technology to treat people suffering from life-threatening health emergencies. A BLS ambulance is structurally the same as an ALS, but its medical gear is limited to items used for basic first aid.

The township has three BLS ambulances it uses on calls, while Alpena uses its ALS units for emergency responses and other types of transfers. If the city is hired by the township, it will provide an ALS ambulance at each of the two stations.

Emergency first responder training

Hours of training required for a person to get get licensed in Michigan for different types of medical responders:

Medical first responder: minimum of 60 hours

Emergency medical technician: minimum of 194 hours

Paramedic: minimum 1,000-1,200 hours

Source: Michigan Department of Health and Human Services

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