A proposal by Bountiful emergency medical technicians to buy and operate advanced cardiac treatment equipment was given the lowest priority by the Davis County Emergency Services Council this week.
The council voted to set training programs as its highest priority, with equipment behind that, in competition for state emergency medical services grant money.The county's emergency service agencies are competing for an estimated $30,000 in state grants.
The proposal by the Bountiful Fire Department to buy cardiac defibrillators and train its EMTs in their use reopened what one observer called a "long-standing turf battle" between Bountiful and the Davis County Sheriff's Department.
The Sheriff's Department maintains two paramedic units on duty around the clock in Davis County, one in the north end and one in the south, plus operating a north end ambulance service.
Paramedics receive more advanced training and are allowed to do more sophisticated medical procedures than EMTs.
Lt. Bob Stell of the Bountiful Fire Department submitted a $15,000 grant proposal to the emergency medical services council to buy defibrillator equipment, train EMTS in their use, and certify them to start intravenous solutions for cardiac patients.
But Capt. K.D. Simpson, who oversees the Sheriff's Department paramedic program, told the council his study of emergency responses over the past couple years indicates there is little need for the EMTs to be equipped with a defibrillator unit.
A defibrillator unit administers an electric shock to a patient in full cardiac arrest, jolting the heart back into action.
Stell said his study shows in 1986, 114 emergency responses by Bountiful EMTs were heart-related, involving 17 full cardiac arrests. In 1987, there were 135 heart cases, with 33 full arrests, according to Stell's figures. In a majority of those cases over 100 each year the sheriff's department paramedics also responded and took over the patient care from the EMTs, Stell said.
Stell said in 1987 the average response time by Bountiful EMTs was 2.69 minutes while paramedics took over four minutes. Equipping the EMTs with a defibrillator would provide Bountiful residents with a better level of service, Stell said.
But his figures and basic proposal were countered by Simpson and Dr. Dennis Wyman, the Lakeview Hospital emergency room physician and medical adviser for the county's EMT and paramedic programs.
Simpson said his figures show the paramedics responded to 721 calls in Bountiful in 1987, of which 20 were total cardiac arrests. Of those 20, only eight are verified as cases of ventricular fibrillation, where the defibrillation equipment was needed, Simpson said.
"Our study shows the incidence of v-fib (ventricular fibrillation) in Bountiful is lower than we anticipated," Simpson said.
Wyman said the council needs to balance the needs of residents as a whole in allocating grant money and he believes county residents would be better served by putting money into training basic EMTs for other departments in other cities.
"Studies show the sooner you can defib a patient the better. But studies also show the sooner you can get someone to the scene to do CPR (cardiopulmonary resuscitation), the better," Wyman said. "You need to balance the needs and I feel putting more money into EMT training for other agencies would be more beneficial to the population at large.
"Only a small percentage of the people given defibrillation will walk out of the hospital alive and be productive citizens," the physician said. "Maybe in the next year you would have three out of your 12 projected cases where the people would be able to walk out of the hospital."
Wyman also said Lakeview needs to replace the radio and tape recording equipment it uses to keep in contact with paramedics and EMTs, a cost he estimated at up to $35,000, and there is no money available to add the extra equipment needed if Bountiful's EMTs are equipped with defibrillators.
Bountiful Fire Chief Jerry Lemmon moved that the EMS council set training as its highest priority in ranking the grant requests, followed by equipment acquisition.
The council agreed, setting the Kaysville Fire Department's request for $2,377 for EMT training as top priority, followed by $1,000 for training for the sheriff's department's north end ambulance crews. Bountiful's bid for $2,500 for training EMTs on the debfibrillators was placed third.
In equipment requests, the council gave top priority to the sheriff's department's request for $17,000 to buy new paramedic trucks. Simpson said the three units now in the field all have more than 110,000 miles on them and need to be replaced in 1989.
The department's request for $14,000 to replace its ambulance based at Humana Hosptial Davis North in Layton was given second priority, followed by the Bountiful Fire Department's request for $10,000 for cardiac equipment.
The council noted the requests total around $44,000 and the county received $30,000 last year, meaning the bottom priorities will probably not be funded.