In a community where there is a large amount of an older population such as Mesquite, being able to provide quality care that is essential to survival is important.
That’s where Critical Care Treatment certification comes into play. “When I got here two years ago, I addressed this with Deputy Chief Rick Resnick,“ said Fire Chief Kash Christopher. “From a job performance perspective, we were already conducting critical care.” However, they weren’t able to claim higher costs that come with such care because they didn’t have personnel on staff that had the certification.
“We were already performing, but it wasn’t marked off on our license and we couldn’t charge for that level in the billing process,” noted Resnick. “Our main approach to the critical care stuff was to provide a level of service that is above what we were doing. Not just for interfacility transporting, but for people in the community.”
As of July 1, Mesquite Fire and Rescue (MFR) will have that certification. Obtaining that status not only makes MFR more valuable, but it also may save time, money and the life of their patients. The new license now allows them to handle different transports that they were unable to directly do before. Cardiac and respiratory arrests, intubations, infusions and certain medications will be able to be directly addressed, where as before the patient may have had to take an expensive helicopter flight to nearby Dixie Regional Hospital or somewhere in Las Vegas.
It is also worth noting that MFR is the only Fire Department-based agency with the CCT certification in the state of Nevada. Most private ambulance companies such as AMR in Las Vegas and Medic West also carry the CCT but are not tied to a fire department. This is just another unique aspect that MFR has achieved over the past two years.
But the CCT didn’t come without some cost. “It’s very expensive. $50 – $60,000 to put people through the training and get the equipment,” said Resnick. “It was definitely worth the investment on our side to get this certification. It will definitely save time and lives.”
Going back to the financials of it all, there is an estimated $250,000 or more that could be realized. However, with there being 50-60 percent that are Medicare-related, the amounts collected from those call won’t be seen, as Medicare pays a flat fee. Resnick and Christopher maintain that “the main drive was to be able to provide that care, not the financial.”
With 22 operating personnel on staff right now, MFR is one of the few agencies in Nevada to actually do the interfacility transports. Because of the limited amount of personnel, MFR turns down an average of 100 transfer calls a year. Some of those are deferred to Beaver Dam Fire Department, while others are flown by Mercy Air. “Our normal staffing pattern is not changing. It’s still going to be a challenge for us to get some of these transports out the door,” said Resnick. “Our number one priority is the 911 response and emergency response for both fire and medical. Everything else is after our primary directive.”
The education for the Critical Care Paramedics is nothing to sneeze at. For three weeks in October/November 2015, paramedics worked in Las Vegas, 40 hours each week and then did additional work all the way into January and February this year.
Jason Andrus, MFR’s first Critical Care paramedic, presented his new bag of supplies that come with the certification. Karen Hughes is their second certified paramedic and two more are currently working through the needed education and will be certified soon. Among his bag of goodies is a special medication that will allow him to help head trauma patients. “When someone has a head injury, often times their mouth clamps down and we are unable to intubate them,” said Andrus. “I have a medication now that will paralyze them temporarily and relax their jaw enough to take care of them.”
Other procedures that will be vital to their services is that MFR will now be able to transport patients who have blood transfusions and other specialized medicine drips that were only able to be flown out when transported.
According to Resnick, “We have additional protocols and procedures that they can perform that are above and beyond what a normal paramedic’s scope of practice. A lot of that includes a pretty expanded medication regime, heart equipment and ventilators.”
“With the expanded scope and knowledge base, these paramedics can apply their skills and make a difference that we weren’t able to be able to do before,” said Resnick. He also noted that the new certification will not eliminate the need for Mercy Air, but MFR will definitely be able to help relieve them of some of their calls.
“We had a stroke patient last week and had them in the CT Scan at Dixie in under an hour from the 911 call,” said Andrus.
Prior to the CCT status, paramedics were able to handle 26 medications under Clark County protocol. “With the new protocols, I think we are probably well over 75 now that we can handle,” said Andrus.
“Everybody within the department has put in a lot of hours to make this happen,” said Resnick. “We also had help from doctors locally as well as the Southern Nevada Health District and couldn’t have done it without any of them.”