1. Dublin Fire Brigade Paramedics- Insight into a Pre-hospital Emergency Care Service Brief history of DFB - Oldest uniform body in the state Since 1862 (Oldest Ambulance service provider in Ireland) Since 1898 Benefits of combined Fire/Emergency Medical service (EMS) for patients Our areas of operations Statistics/ type and numbers of calls Information on range of pre-hospital treatment protocols using generic case details Some footage with real on scene experiences with DFB staff.

2. Dublin Fire Brigade Paramedics- Insight into a Pre-hospital Emergency Care Service D/O Martin O’Reilly S/O Paul Lambert

3. Dublin Fire and Ambulance Service Oldest uniform body in the state Since 1862 Oldest Ambulance service in Ireland - 1898

4. DFB-RCSI Training Institute Educational Partnership with RCSI PHECC accredited –Institution –Programmes –Tutors 2011 Education & Training Standards Cardiac First Response to Paramedic 2011

5. Practitioner Level required for Emergency Ambulance Paramedic 2 year diploma program Advanced Paramedic 2 year Graduate Diploma

6. Population served 1.2 million 464,749 Households

7. Provide a fully integrated Fire based Ambulance and EMS service In 2011 we responded to 90,000 Ambulance/EMS calls 72,000 Ambulance/EMS incidents 93,000 Ambulance/EMS mobilisations 12,000 Paramedic Fire Appliance responses

8. Eastern Regional Control Centre Receipt of 999/112 calls for assistance –Determine the location and nature of the emergency –Determine the priority –Pre-arrival instructions Provide an appropriate Response –The “Right” response for the patient ? –Nearest appropriate resource

9. Benefits of combined Fire/Emergency Medical service (EMS) for patients Strategically located- rapid response 24/7 Availability of ambulance resources Resources reduce time on scene Equipment available - early Extrication Enhances safety on scene

10. Highline Rescues from tower cranes Immediate Medical assessment and treatment

11. Swift Water Rescue SRT technicians Hypothermia Submersion Incidents

12. Road Traffic Collisions Reduce on scene time Spinal Immobilisation/ Patient handling Rapid Extrication Safety/Fend off Fire Risk

13. Medical Basic Life support Advanced Life support Acute coronary syndromes Glycaemic Emergencies Seizures Inadequate Respirations Stroke

14. Medical Septic shock Poisons/ OD Hypothermia Altered Level of consciousness

15. Trauma External Haemorrhage Shock-Blood loss Spinal Burns Limb Fractures Crush injury Head Injury Traumatic Cardiac Arrest

16. Intubation

17. Vascular Access

18. DFB-RCSI Training Institute Morphine Epinephrine 1:10 000 Amiodarone Benzopenecillin Lasix Atropine Oxygen (INH) Nitrous Oxide (INH) Salbutamol (INH) Aspirin (PO) GTN (SL) Glucose Gel (BU) Glucagon (IM) Epinephrine 1:1000 (IM) Naloxone (IM) Paracetamol (PO) Clopidogrel (PO)

19. Obstetric Emergencies Neo natal resus Haemorrhage in pregnancy Breech birth Umbilical cord complications

20. The Right Response Immediately Life threatening incidents The nature of these incidents require a rapid response and more responders on scene –Paramedic Fire Appliance –Paramedic Ambulance –Advanced Paramedic

21. Fire Appliance Paramedics 60% Ambulance Paramedics 36% Arrive together 4%

22. Mater Hospital Out of hospital cardiac Arrest study 2003-2008

23. Mater Study Improvements in the pre hospital care management of cardiac arrests over the period of the study where; –DFB fire appliance Paramedic equipped with Defibrillators and life saving medications –ERCC began providing telephone assisted CPR –Advanced Paramedics provide pre hospital Advanced Life Support on Fire appliances and Ambulances

24. Mater Study Conclusions: The improved quality of Emergency Pre Hospital Care has impacted on survival from Out Of Hospital Cardiac Arrest, particularly from Ventricular Fibrillation

25. Video of Cardiac Arrest

26. Thank you for your attention ! Questions ????