Should fire stations be used as neighborhood health clinics?

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The fire chief of my old department has ventured forward with a new mission for the fire service. He is trying out a notion of using fire stations and firefighters as neighborhood health clinics.

 

The idea is that in some neighborhoods during specific and limited hours citizens can come by their local firehouse and have some simple health checks preformed by a combination of firefighters and volunteer health providers.

 

So if you live in one of these neighborhoods and suffer from perhaps a chronic health problem like diabetes, high blood pressure or maybe a heart condition, you can drop by the ole FD and get checked out.

 

These firefighters are already trained to the minimum standard of EMT basic and go all the way up the EMS food chain to the level of paramedic. They have all the latest technology in emergency medical care that is available to man. Fire trucks anymore are virtual mobile emergency rooms.

 

So this idea I think is very progressive and admirable. My experience with citizens with persistent chronic medical conditions tend use our services regularly anyway. When they are having difficulties with their health they call 911. So why not give them and us the opportunity to intervene early?

 

Well for me it would take away the excitement of riding around on the BRT with all the bells and whistles blaring and who wants to do that? Boring. Secondly it’s a firehouse, our house it’s where we live and we don’t care for visitors most of the time. If you need us let us know and we will come to you, it is what we do.

 

It is an inconvenience and that I believe is one of the problems with acceptance of the concept.

 

The idea isn’t without controversy. As far as I know it has never been tried before and anything unknown can cause anxiety and apprehension. The detractors I have heard are in two camps it seems.

 

The first is the firefighters themselves. Many in my former department have a feeling that they are already doing one hell of a job and that this additional service will increase their burden. I agree they are doing one hell of a job, just look at the apartment fire they fought this weekend, great job. http://www.gazette.com/articles/fire-138120-three-alarm.html

 

They also feel underappreciated; there hasn’t been a raise in their pay for many years now, with a steady increase in their out of pocket expenses for health care and retirement costs. In essence they are not only not gaining in salary they are losing real net income. They are doing more than ever and getting paid less than ever and now comes this.

 

The new chief wants to add even more work and responsibility to their daily existence. It feels unfair and I can see their point. Firefighters aren’t nine to five employees banging it out in a factory or entombed in an office cubicle. They live in a dynamic and very stressful environment.

 

I have never been a fire chief, all I ever was, was just a fireman, and that is what I know. My experience was that a chief can get so involved in being an executive they forget their roots. What I also learned over the years was that a simple “good job guys” can get a lot of firefighters to the other side of an issue.

 

Nobody likes having their routine changed. I think as firefighters we see on a daily basis the worst possible outcomes of poor decisions by others, it becomes the norm. For me I think it eventually lead me to a place where all I ever saw was the worst possible outcome of any situation in life.

 

My thoughts became corrupted and I lost my ability to envision a best case scenario. So change for me was viewed through this prism, and maybe it is how other firefighters view it as well.

 

The second group of naysayers are concerned citizens that see a risk or an exposure to the taxpayer with this project. They see another type of worst case scenario. They are the “What-iffers”, what if someone stops by the firehouse and gets bad information or bad advice? What if they then leave the fire station, suffer some catastrophic event and the family then sues the department and in fact sue the taxpayer?

 

Who will be responsible, who will be blamed and who will ultimately pay? Good question. I will leave answers to those questions in the hands of people far better qualified than me.

 

Since my retirement from the service aside from writing I have looked for employment. I teach at the University of Colorado but not every semester. I am a staff writer for a fantastic magazine http://coloradospringsstyle.com/feature_story.cfm and have refused work as a paramedic.

 

Finding a job is no simple task for anyone these days and when your resume pretty much says you were good at tearing stuff up and putting out fires many employers don’t seem to feel that qualifies you for their kind of work.

 

I understand the urge to complain about a change in work assignment. It is one of the most universal skill sets you’ll find in a fire station. All I would suggest is take a moment to be grateful for a job, a really cool job that very few people get to do.

 

It is honorable work, important work, and rewarding work. I haven’t found many fellow travelers that can say that about their source of income. I know I have no right to tell anyone how to feel about anything in their lives. But I can’t help myself it is in my nature.

 

Good luck Chief, I will be a curious observer of your grand experiment. Just remember your decisions today will be the legacy by which you will be judged in the future. Right now that opinion is being formed right in front of your eyes.

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Comment by Timothy O. Casey on May 16, 2012 at 10:38am

Spoken like a true fireman Oldman, as we both know it is the nature of firefighters to gather around the table and bitch. I hope this works for everyone involved.

Comment by Oldman on May 16, 2012 at 10:35am

additional service will increase their burden; Translation: It will interfere with my ___________ (insert napping, TV, Angry Bird, etc).

more work and responsibility....It feels unfair; Translation: see above

we don’t care for visitors; Ditto above.

Somewhere, I read that we are in the public service business.

Ok, sarcastic moment over.

I see few negatives with this plan. Back in my day, (when they taught fire in fire school), one of our functions was public education. Over the years, the service evolved to include EMS responsibilities, and part of that function is.... public education. We all know physicians always take their time to explain and teach their patients everything they need to know about their conditions. Oops, sarcasm slipped out again.

This is an excellent way of getting the citizens and the department working together. Simple thing like blood pressure checks, D stix, and even 12 leads, can many times uncover a problem the citizen is not even aware of, possibly saving a life just as sure as pulling someone from a fire. This is a negative, how?

What ifs, will always be there. What if - froggies had wings? They wouldn't bust their ass every time they hopped. I am reasonably sure that a program like this would have medical oversight. Just as EMS providers have protocols, delegated or standing orders, or what ever they are called in that area, a clinic such as this most likely would too. Yes there might be an occasional unforeseen incident, But this happens even in the finest hospitals in the world.

I don't know, maybe it is because I'm old, or too many volunteer years, but I started in this business to help people. This program is just an extension of that tradition.

Comment by Timothy O. Casey on May 11, 2012 at 12:10pm

I agree Jay, even the fuel savings for running big red down the streets could be noticeable. We have had great success in teaching the public about fire safety, if we use the model on health awareness maybe we could have the same effect.

Comment by Jay Nicholson on May 11, 2012 at 10:56am

There was a recent article locally that said approx .08% of the population here, mostly homeless, account for over 22% of all EMS runs. Lots of $$$$ wasted there. If you see and treat people in a non-911 way, saves money and a lot of 2AM wake-ups.

www.utsandiego.com/search/?q=homeless+and+ems

Comment by Timothy O. Casey on May 11, 2012 at 10:43am

Thanks Cap, you have it down no doubt. Chief Brown is a through guy and I don't believe too much will be left to chance with him. I just hope the guys get on board and give it a chance. The truth is we will see these people one way or another some day, why not pick our environment.

Comment by Capt. Chris W. Button on May 11, 2012 at 10:14am

Doing more with less not only hits us in the Fire Service, it hits everyone. The people that would be coming by the station to are no different. They probably don't have insurance or can't afford a doctor so why not take advantage of a free health clinic in their naighborhood? The program builds good will with the community (voters). The community (voters) now have a favorable opinion of the Fire Department. Hopefully, in return, when budget time rolls around, the community rallies around the Department in favor of salary increases. At least that's the way it should work.

 

As far as privacy, perhaps designated hours are set, specific rooms are used, etc. This is something that should be well-publicised to the public and the Department.

 

As far as liability goes, if possible, have nurses from the community volunteer their time. If that isn't covering all the hours, and staffing allows, have a designated EMT assigned. (This is where the designated hours come in to play.) Whoever mans the clinic can only operate within their scope of practice. If the patient asks questions you can't answer, simply tell them, "Ma'am, that's a good question, but it's beyond my level of training."

 

You'll probably get people that ask what they should do about a certain medical problem they have. The default answer should be, "I'm not a doctor, but in my opinion you should discuss this further with a doctor. I'm limited in my training." Then perform a good primary survey, with a good set of vitals to make sure it's documented that this person was not experiencing obvious life threatening problems. Then send them on their merry way. This is where the Chief needs to have a written set of guidelines to follow. The EMT's should follow the guidelines and not deviate.

 

A program like this can be a big benefit for everyone, but it will take cooperation from everyone. As someone else has stated, "BE NICE."

Comment by Jack Crandell on May 9, 2012 at 8:21pm

I agree Tim that those days are gone, but I refuse to let up on my pursuit of change. I have a few years left to accomplish my dream.  You are welcome on "the other side" of my yellow tape any day. Your comments are well received.

Comment by Timothy O. Casey on May 9, 2012 at 7:42pm

I'm sorry to say Jack those days are gone. The new bread of FF is doing a job, not a career. They were created by the baby boomers, they have been raised with a different mind set than us. They will always sadly think of themselves first, they are incapable of thinking about another, and neither you or I will change that. I'm glad I'm retired it is only something I can now watch from the other side of the yellow tape.

Comment by Jack Crandell on May 9, 2012 at 7:11pm

Tim, how to we get the "old school" mentality back.  As I have moved up the ladder, this has been my concentration, but this is a difficult problem to solve, if it is solvable at all.  Thanks for your article, it certainly struck a nerve.

Comment by Timothy O. Casey on May 9, 2012 at 4:44pm

I got you 100% Jack I was trying to be a bit softer. As an old school guy like you I know your pain. And a quote from Brunacini is right on.

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