Darien EMS-Post 53 should have a paramedic on duty at all times in town, contracted from an organization and based at Post 53 headquarters on Ledge Road, say the EMS consultants hired by the town.
The lack of a paramedic based in town increases average response time for paramedics (from the time dispatchers inform the ambulance service of an emergency to arrival time at the scene), the report from McGrath Consultants said.
It takes, on average, 5 minutes, 53 seconds for a Darien EMS-Post 53 ambulance to arrive at the scene after being dispatched. For the current paramedics coming in from Stamford, it takes 9 minutes, 21 seconds, according to the report. That’s a difference of 3 minutes, 28 seconds (9:21 — 5:53 = 3:28). (page 18 of the report)
(In addition to response time, it takes dispatchers an average of 2 minutes, 40 seconds to inform Darien EMS-Post 53 and police responders after someone calls 911 [page 48].)
According to the report (page 45):
Providing emergency services is all about response times. How long it takes the ambulance to get on location to begin patient treatment; along with the response time of paramedic intervention are the primal issue.
Defining an acceptable response time is subjective, depending on if you are the one in need or not. When a citizen makes a call to 9-1-1 for an ambulance, every second seems like minutes, and their anxiety will increase disproportionately as the severity of the incident worsens.
All EMS [emergency medical services] providers understand the importance of response time and many have lived with the results of not being there just a few seconds sooner.
On Friday afternoon, the town government website posted the full report from McGrath Consulting Group Inc. of Illinois, which was hired to look into both the overall quality of emergency medical service provided in town and in particular, see whether Darien needs a paramedic based in town or should continue to rely on contracted out-of-town service.
The McGrath report is on the agenda for presentation to the Board of Selectmen at Monday night’s meeting. Darien TV79 says the meeting will be broadcast live on Cablevision Channel 79 in Darien as well as online, here. Later, it is expected to be on TV79’s Vimeo channel.
The consultants’ report praised Darien EMS-Post 53 as an “excellent Basic Life Support organization” and made recommendations for improvements in several other areas, including different ways for dispatchers to get information to the ambulance service faster, quicker response to some highway emergency scenes, a different way to organize the vehicle-replacement schedule and record-keeping changes.
But On page 9, in the Executive Summary section of the report, the consultants say:
The consultants are recommending one on-duty 24/7/365 paramedic be placed in-town and provided with a vehicle/equipment (fly-car) to respond in conjunction with Post 53 BLS ambulance.
If paramedic intervention is needed, the paramedic will stay with the patient in the ambulance; if ALS is not needed the paramedic can return to his/her quarters and be available for the next EMS incident. The recommendation will include hiring the paramedics contractually versus Town employees.
The issue of whether paramedics should be based in town isn’t about the overall quality of what services Darien EMS-Post 53 provides, the McGrath report said, but a policy decision ultimately made by the Board of Selectmen on whether this additional service should be provided. On page 8 in the Executive Summary, the report said:
Again, the recommendations in this report are not about Post 53 being inadequate – they are an excellent Basic Life Support organization; rather, it’s about if Advance Life Support (paramedics) is in the patient’s best interest to have an in-town paramedic who can immediately respond or wait for the neighboring paramedic.
Nevertheless, the report said, the issue of whether or not Darien should have paramedics based in town “is the underlying issue pertaining to Darien’s Emergency Medical Services.” (page 17)
The report pointed out that there’s an in-town paramedic in New Canaan — which also has a volunteer EMS service (page 59) — as well as in every single city and town along Interstate 95 in Fairfield County. Darien is the only town in the area without one. Paramedics are onboard for 30.7 percent of all Darien ambulance rides to hospitals, according to the report (page 12).
Post 53 is independent, but Selectmen ultimately decide
The consultants reported they found some resistance to the idea of having paramedics based in town (page 58):
Some interviews were intense, just short of implying we “shouldn’t upset the apple cart”; suggesting that placing an in-town paramedic in Darien would cause harm to Post 53, especially the young adults. One needs to separate what is best for self from what is best for the patient needing emergency medical treatment. When providing emergency patient, care the emphasis must be focused on the patient’s needs and the safety of the provider.
Some resistance to the idea came from within Darien EMS-Post 53, but not adamant resistance (page 60):
Throughout our visits with Post 53, their concerns about having an in-town paramedic were voiced. The comment was made that they are not opposed to bringing paramedics into town, but they believe the current system is working. The consultants agree it is working well at the BLS [basic life support] level but not at the ALS [advanced life support] level; The current ALS arrangement in very inconsistent with the high level of services offered in the Town of Darien.
There was concern about where an in-town paramedic would be stationed, but during our exit interview shortly thereafter, the consultants were told by Post 53 leadership, that with some housing adjustments and policy revisions, “we could make it happen”. The consultants believe they can make it happen.
The report (page 15) defines “Basic Life Support” as “A basic level of EMS care to sustain life through CPR, defibrillation with an AED, bleeding control, shock management, and stabilization of injuries.”
“Advanced Life Support” is defined as “The highest level of pre-hospital care available includes manual defibrillation, advanced airway management, and the administration of drugs and medications. By a paramedic.”
Update: Medical director for Darien EMS-Post 53 opposes in-town paramedics
Updated 10:23 a.m., Sunday
The consultants reported the opinion of Dr. Douglas Gallo, medical director for both Stamford Emergency Medical Services and Darien EMS-Post 53. According to the report (pages 22-23):
Dr. Gallo was most adamant that in his opinion, which in summary, indicated he does not support the need for paramedics being housed in Darien. He indicated that Post 53 is a very well educated group of emergency service providers and articulated a series of beliefs that paramedics in Darien would not be beneficial, including they would provide no clinical benefit over the existing paramedic arrangement, it would not be cost-effective, and infrequency of paramedic skill usage would result in skill deterioration.
Cost for in-town paramedics
For paramedics based in Stamford, Darien currently spends a total of $177,301 ($105,000 base rate plus an average of $72,301 over the past five years for expenses when the contractual amount is exceeded — the reason for the exceeded amounts wasn’t clear in the report).
The consultants roughly estimate that having paramedics in town would cost an additional $270,000 to $345,000 a year, based on estimates from two organizations that might provide them.
At less expense (an estimated $270,000), the town could hire its own paramedic, or it could do nothing, but have Stamford Emergency Medical Services provide advanced EMS service along with the paramedic service that agency now provides.
One advantage of having a service provide a paramedic is that if the employee, for whatever reason, doesn’t work well with the Darien staff, the service can assign another employee to the job, the report said.
The paramedics should be based in the Post 53 building at the Noroton Heights Train Station, the consultants say. The report indicates that there seems to be adequate room in the building for paramedics to be based there if the uses of some rooms were changed.
An additional advantage of having in-town paramedics is that Darien EMS-Post 53 staff can learn from them, not only in formal settings negotiated in a contract, but also on an informal basis by working together with them, according to the report (page 58).
Editor’s note: This is the first of a number of articles Darienite.com will publish about the McGrath report on Darien EMS-Post 53. See also: