Likely as a result of the recent Boston Globe report on failing EMS systems, Winthrop is moving forward with evidence-based EMS system redesign changes such as emergency medical dispatch (EMD) response prioritization and certifying first response firefighters as EMTs.

Community and EMS leaders should critically evaluate their EMS delivery models, using national evidence-based, scientific studies and local data to challenge traditional myths about EMS delivery that may no longer be true.

-------------------------- 

Winthrop to revamp emergency response procedures in wake of patient deaths

By Jason Laughlin Globe Staff

December 31, 2024

https://www.bostonglobe.com/2024/12/31/metro/winthrop-toddler-ambulance-emergency-massachusetts-als-bls/

Winthrop is revamping its emergency response services following at least three deaths, including a toddler’s, that have been linked to ambulance shortages and overworked emergency crews.

The town is making the changes after a Boston Globe story earlier this month detailed statewide problems with emergency response that have left patients without critically needed care.

Winthrop Fire Chief Scott Wiley and town manager Anthony Marino declined to comment, citing the possibility of civil litigation. But earlier in December they released a statement describing changes in how the community prepares for and responds to emergency calls.

Those include paramedic training for some firefighters and a reevaluation of how ambulance services prioritize calls for help.

“No one should experience delayed paramedic service in Winthrop or anywhere else due to the unavailability of ambulances or emergency medicine,” the town officials said in their joint statement released Dec. 6.

Almost a year ago, Yuna Feeley, a Winthrop 2-year-old, went into cardiac arrest at home. The fire department responded to a 9-1-1 call from the child’s mother, but Action Ambulance, the private company that provides service to Winthrop, didn’t have a vehicle available to transport Yuna to the hospital. A backup company didn’t have the staff needed to get an ambulance on the road. Wiley, the fire chief, drove the child to Mass. General in Boston himself, but she died at the hospital.

The girl might have been saved had an ambulance stocked with the medications and equipment designed to provide advanced life support been available, experts have said.

The Globe’s reporting identified two other Winthrop patients over the past three years who died while being cared for by paramedics from Action Ambulance.

In another incident in Western Massachusetts, a state investigation determined an Action Ambulance paramedic misdiagnosed a patient and administered medications that caused the person to go into cardiac arrest.

The deaths underscore critical shortcomings plaguing emergency response services statewide. There’s little to no regional coordination to ensure coverage when a community’s primary ambulance

providers are occupied with other calls, and no central authority evaluating whether a region has the number of ambulances it needs. In addition, staffing shortages can keep needed vehicles out of circulation or lead to a lack of experienced personnel responding to serious emergencies.

Winthrop, which says it has 31 firefighters and officers, requires all firefighters to be certified as Emergency Medical Technicians. Several are now training as paramedics, who undergo additional education and can provide more advanced life saving care, according to the town’s statement. It also is consulting with a software vendor that can track the locations of fire and EMS vehicles and provide information about their status and availability.

“We believe that technology can assist communities in being as efficient and responsive as possible in the delivery of all services, emergency and non-emergency,” the town manager and fire chief said in their statement.

Winthrop officials are also discussing with Action Ambulance how to update the way the company prioritizes its calls for service and are working to introduce paramedic supervisor “chase vehicles,” which would support ambulance crews or determine the level of care a patient needs before an ambulance arrives.

“These are challenges we are working to overcome every day, and we look forward to working with our community partners and local and state governments on meaningful solutions for all residents,” Mike Woronka, Action Ambulance’s chief executive, said in a statement Friday.

While having fire personnel trained as EMTs and paramedics may help, it wouldn’t eliminate the need for ambulances and the lifesaving tools they carry, said Matt Zavadsky, a national EMS consultant with the Pennsylvania-based PWW Advisory Group.

Along with ensuring there are enough emergency vehicles in a region, what is most needed is a sophisticated system to ensure the best trained personnel are available for the most serious emergencies.

EMTs are trained to respond to most calls, but paramedics are invaluable when a patient needs an immediate medical response.

They are in short supply, Zavadsky said.

“Paramedics are very expensive and for the majority of calls they’re not necessary,” he said.

Patients requiring advanced life support account for just 30 percent of all ambulance calls, Zavadsky said, and calls that require an immediate, potentially life-saving response are even less common.

When one of those calls comes in, it can be critically important that a paramedic is among the responders.

“A person who called 9-1-1 because they twisted their ankle is different than a 65-year-old male with a history of cardiac problems complaining of chest pains,” he said.

The first call can be handled by EMTs. The second, though, needs a fast response and the patient would likely benefit from the presence of a paramedic. Software is available, Zavadsky said, to help

emergency responders prioritize those two calls, and ensure an ambulance with a paramedic isn’t tied up with a broken bone while somewhere else a patient is having a heart attack.

“Doing the two things combined, adding basic life support ambulances and triaging calls, will in essence dramatically improve this process,” Zavadsky said.