When units from Ellicott City's fire Station 8 roll out on a cardiac arrest call, each crew member already knows who will start chest compressions, who will operate the defibrillator and who will provide artificial respiration to get oxygen flowing to the brain and heart.
It might sound like an obvious plan. But the advance coordination is part of a new effort by Howard County's first responders to get quicker and more efficient help to those in urgent need.
"Believe it or not, this is groundbreaking," said Dr. Kevin G. Seaman, the medical director of the Howard County Department of Fire and Rescue Services. Previously, responders didn't decide roles until they arrived at the scene, wasting precious seconds. "Everybody's got a role, and they know what they are doing."
These new guidelines increase the patient's chance for survival, but they also denote a shift in responsibility — 80 percent of calls in Howard County are for emergency medical services.
Officials in Howard County have not only adapted this method of responding, they're teaching other departments in Maryland, Pennsylvania and North Carolina. This week, Howard taught the "CPR Dance," which designates each responder's role for every cardiac arrest call.
The increased focus on medical services comes at a challenging time for the department, as the chief hopes the County Council will approve an increase to the fire tax, and act to improve the level of service and meet the changing demands.
Chief William F. Goddard III said the training was important because the department receives more calls for emergency medical services than for fire response. While addressing the County Council last week, he said the department was no longer looking to work on a fire-based services model but on an EMS-based model; the department expects a 3 percent increase in emergency medical calls each year.
That growing demand stretches services further as the department faces shrinking revenues. In Howard County, the fire department is funded by a separate fire tax tied to property assessments, which have been in decline as home values have fallen.
County Executive Ken Ulman has proposed an increase in the fire tax rate to 17 cents per $100 of assessed property value, up from 13.55 cents, but Goddard said the rate should be 20 cents to meet the needs of the department.
Even with Ulman's compromise of 17 cents, Goddard said, "this limits me."
He said his department needs more money to hire additional personnel and build another Waterloo station for the U.S. 1 corridor, where county officials plan to build an elementary school to accommodate the growing population. Redevelopment plans for the entire corridor are likely to bring thousands more residents to the area.
Several council members questioned why the proposed rate increase was so large, but Goddard said the department had gone without major changes even as the county's population had grown and aged.
The department, he said, has not built a new fire station since 1994. The county is expected to open a new station in Glenwood this summer and add another EMS unit based in Elkridge.
Goddard said that, given Ulman's proposal, it was a greater priority for the department to add the unit in Elkridge to handle the number of calls.
"If we are going to be successful, EMS better be the focus," he said.
The new resuscitation training was funded by grants, Goddard said, but it reflects the increase in medical calls, where money and resources are needed. Part of that effort is programs like the cardiac care planning, which streamlines efforts at hectic emergency scenes and improves efficiency in handling what are now the most common calls.
Before, Seaman said, a team of up to seven rescue personnel from a fire engine and an ambulance would arrive to a cardiac arrest call — when the heart stops beating. In the often-chaotic scene, each responder would have to figure out who took what role. When one would tire from doing chest compressions, the process would be interrupted, taking away precious moments and decreasing a patient's chance of survival.
Crouching on the floor in Station 8 for a demonstration, Capt. Louis Winston kept the time on his wristwatch, while Capt. Dale Becker, the EMS supervisor, was free to administer additional aid to the patient, such as an IV (though the training dummy was not equipped with arms).
"You don't want to step on the toes of the paramedic," Winston said, explaining that the other crew members could continue uninterrupted CPR while Becker was free to provide additional aid, depending on what a patient might need.
"Before, we were maybe hands-off for 40 seconds," Winston said.
In addition to streamlining efforts at the scene, Howard has begun tracking EMS performance, which allows the staff to strive for improved results.
Seattle has one of the highest cardiac arrest resuscitation rates in the country, at 50 percent. Howard, is not far behind, at 40 percent, though Seaman said many jurisdictions might not even keep a record of their save rates.
"A lot of the country isn't measuring what they do in EMS or using this technique now," Seaman said.
"Firefighters are very competitive," Seaman said, with bragging rights based on "who's got the best save rate."