Paramedics arrive in Tulare County for first time

By Reggie Ellis

Yesterday, April 26 ambulance companies began using paramedics for the first time in Tulare County history.

Following a brief report to the Tulare County Board of Supervisors, 16 trained paramedics began working throughout the county. Two of the trained paramedics will be working for Imperial Ambulance Company, which covers the south east portion of the county including Porterville and Lindsay. Exeter District Ambulance, which provides service to Exeter, Farmersville, Lemon Cove, Woodlake and occasionally Three Rivers and Sequoia National Park, said it will not have paramedics until two of its employees take their final test on May 20.

In a letter from Central California Emergency Medical Services Agency, Tulare County EMS Administrator Daniel Lynch wrote that the last training course for the rest of the county's paramedics will be completed in March 2006. The letter also stated that "ambulance providers will be hiring paramedics from outside of Tulare County, and that most areas of Tulare County will be exclusively staffed with paramedics by the end of the year."

County ambulances are currently staffed by Emergency Medical Technicians Level II (EMT-IIs). The difference between an EMT-II and a paramedic is additional hours of education and training (110 more in the classroom and 64 more in the hospital) and the use of additional five medications, equipment and procedures (in all an additional 1,000 hours of training). For example, Transtracheal jet ventilation (TTJ), inserting a needle in the neck to open an airway, is one of the six procedures that paramedics are trained for in addition to the training that Emergency Medical Technicians Level II (EMT-II) receive.

EMTs and ambulance districts have compared the difference between EMT-IIs and paramedics to the difference between licensed vocational nurse and a registered nurse - there is more education and training to handle a broader range of situations and conditions. In other words, when an extremely critical or unique situation arises, a paramedic will be more capable of handling the situation than an EMT-II. However, EMT-IIs are trained to handle about 95% of calls.

In February 2004 the Board of Supervisors agreed to join the Fresno/Kings/Madera Emergency Medical Services Agency. The agency has overseen the training of the nearly 100 EMT-IIs in Tulare County waiting to become paramedics through a $600,000 federal grant. It is estimated that by March 2006 all of Tulare County's EMT-IIs will be licensed paramedics. EMT-IIs who were not already paramedics began training last June.

The news is especially important to the foothills area since there are currently no hospital between Visalia and Porterville on the eastern edge of the county. Both Exeter and Lindsay have lost their hospitals in the last few years - Lindsay's in November 2000 and Exeter's in December 2002. The closures have forced both Imperial Ambulance in Lindsay and Exeter District Ambulance to take all emergency care patients to either Sierra View in Porterville, Kaweah Delta in Visalia or sometimes to Tulare District Hospital.

Exeter District Ambulance Board made the decision to cut back to one full-time ambulance crew in January of last year. The district always had a backup crew on call and calls can be covered by other ambulance services. However, calls shifted to another company or backup can add to the response time. The cut was the last of a series for Exeter Ambulance District that included closing its Farmersville Station in November 2003. The financially strapped district was forced to make cuts in order to save about $150,000 due to decreased call volume, and reduced Medicare reimbursements, which make up about 30% of the district's revenue.

In an interview last March, Exeter District Ambulance Manager Don White told the Sun-Gazette that the upgrade shouldn't affect the payscale of district employees and will not be a financial burden to the district. He also said the additional procedures a paramedic is trained for could make a difference on a case-by-case basis.

"We have had a good system all along," White said. "But adding one of those procedures could help them save a life."

Paramedics work on "standing orders" which mean they are trained to provide care to the patient with out talking to a hospital. EMT-IIs must contact a hospital first before providing medications or performing skills. This is time consuming and often results in delaying or deferring treatment for the patient until they arrive at the hospital.

In addition to procedures such as transtracheal jet ventilation (inserting a needle in the neck to open an airway) and decompression of a collapsed lung, paramedics can also use five more medications such as dopamine, which keeps blood pressure low in heart attack victims until they can get to an emergency room.

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