Fire Medic Program History
This section is not a formal part of the Fire Medic policy. When the medic committee considers program modifications, this history and these goals serve as a reminder of the many diverse needs the program is designed to fill. It is also intended as background material that will help to explain to anyone reviewing the program why the program has developed the way it has.
Before the Fire Medic Program
Before this program was established, providing medical care on fires was usually a cumbersome, frustrating and lengthy process that all too often caused serious problems. A fire desiring medical care would place a resource order for someone with first aid training, someone with CPR training, a Medical Unit Leader, an Emergency Medical Technician, a Registered Nurse, a Paramedic or a Physician's Assistant. Hiring generally occurred through the Fairbanks office of the State Job Service without verification of the medic's experience, current certification or professional competence. The quality and qualifications of these medical care providers varied widely.
Orders for medical supplies were generally submitted only after the arrival of the medical care provider. As orders for medical supplies and equipment arrived from the fire the suppression agency would decide on an item-by-item basis what level of medical care would be approved for that particular fire. This approval process was usually lengthy and the resulting level of medical care varied greatly from one fire to another. Lower 48 Medical Unit Leaders often submitted orders for "advanced" equipment, supplies or prescription drugs that usually, after lengthy deliberations, were not approved. Orders from fires for smokejumper Emergency Medical Technicians with medical kits were almost always denied because of the competing needs for Smokejumpers. Specific orders from fires for the Smokejumper Emergency Medical Technician kit to be used by non-smokejumpers were routinely denied because the smokejumper physician sponsor's standing orders did not cover non-smokejumper Emergency Medical Technicians. Orders for the smokejumper Emergency Medical Technician kit minus the drugs requiring standing orders were denied because there were only a small number of these kits available.
Prescription drugs were sent to fires without ensuring that the medical provider was trained to administer the drugs, authorized under state law to use the drugs or covered by standing orders from a physician. Fires made contractual arrangements with ambulance services without ensuring that the medical service included standing orders. Standing orders and the legal protection they provide suppression agencies were not provided in some of these cases. Providing prescription drugs or emergency medical care above the Emergency Medical Technician-I level without standing orders from a physician is a violation of state law and unintentionally exposed the suppression agency to potential legal liability.
Jointly Developed Program
A program was jointly developed by AFS and DOF in 1987 to solve these historic problems and offer incidents a standardized option to provide medical care. Input into program design was solicited and received from ICS, OCS, LSC, Lower 48 suppression agency offices, other State and Federal agencies in Alaska, physicians, Alaskan EMS providers and regulators, agency contracting specialists and attorneys.
A list of program goals was developed. This program was then designed to meet those goals. These goals have been updated annually as the program has evolved in response to reported problems and feedback from users and medics.
This program was first used in 1988. During slower fire seasons this program has seen little or no use. In busier seasons we have had as many as fourteen kits on fires at one time and still were unable to fill outstanding orders for kits or medics for periods longer than a week. The program has generally worked very well. Both fires and field stations have praised the program. The program has also proved to be surprisingly cost effective. Many offices have reported that the number of medical evacuations decrease substantially after the arrival of a Fire Medic even though the number of personnel on the fire has increased. In 1991 an AFS employee on DOF's Big Rex fire at Clear suffered a severe asthmatic reaction and received multiple injections of Epinephrine during the helicopter evacuation to the hospital. Emergency room personnel reported that the use of Epinephrine almost certainly saved the patient's life. Program results as dramatic as this are very unlikely to occur frequently.
The program has been modified annually in efforts to make it simpler, avoid potential liability, avoid providing "too much" medical care, or solve particular problems. The medic policy has been intensely reviewed every year, one year by more than fifty reviewers. As a result of these revisions the written program statement policy became longer. The first written policy was only eight pages long. In making revisions to the policy it was made clear that the goals of the program were limited. It was made clear that the medic has responsibilities to the suppression agency as well as the patient.
Ordering procedures were clarified after medics bumped high priority suppression items from helicopters to deliver routine medical support supplies. Antibiotics were added after lengthy discussion of the advantages and disadvantages with the sponsoring physician. Suturing was specifically prohibited in 1991 after discovering that several Fire Medics had previously sutured lacerations with the approval of their supervisor.
In 1992 the over-the-counter drugs were standardized and limited to avoid continuing to provide what the physician sponsor thought were inappropriate and potentially dangerous over-the-counter drugs. In 1993 two different Fairbanks attorneys made multiple changes reducing potential liability after review. An attorney from the DOF Regional Solicitor's office and State of Alaska Office of Risk Assessment also reviewed and approved the policy. The standing orders for the antibiotics were made more conservative by the physician advisor as a result of issues raised during the 1992 medic orientation class. Consideration of transforming the vendor into a contractor employing the medic was dropped when it became clear after review of State and Federal case law and review by attorneys that such a change would substantially increase the potential legal liability.
During the 1993 and 1994 fire season AFS and DOF purchased six Fire Medic kits that are kept and maintained at the Interagency Category 1 Fire Cache. A great deal of research and time was spent selecting the specifications and types of equipment and supplies to make up the kits.
The summer of 1994 was the first time the kit was used on an incident other than wildland fires. Four kits and six medics spent over six weeks on a flood incident.
The summer of 1996 came on fast and hard and saw heavy use of the program. The program fielded 8 kits and 19 medics total. At one time we had 6 kits and 13 medics out at once. This summer also saw the use of both private and local government ambulances on incidents.
The 2000-year was the busiest fire season on record for the nation. The Fire Medic Program added the Single Medic Kit & Line Pack to the program. We sent all the Fire Medic kits except the Single Medic kit to the lower-48 to support their fires. All where used, some twice.
2001 was a moderate year for kit deployment within the state. We sent six Fire Medic Kits to the lower-48 again but they were returned unused.
The 2004 summer fire season was one for the record books. We had many first in wildland fire fighting here in Alaska. Some of these where shipping fire engines up from the lower-48 along with bring up Type-II crews. This year was also the first time Alaska ordered Emergency Medical Technicians from the lower-48. In the end we ordered over 45 IMS personnel from R1, R3 & R6 to provide medical care on our incidents. This action has opened the door for the exchange of personnel in the future. The Fire Medic Program also used everyone of its kits and fielded many two or three times.
In the winter of 2005 the Fire Medic Program and its standing orders and guidelines where reviewed by the State of Alaska’s EMS office & the Alaska State Medical Board. The program was found to be operating within the scope and guidelines on file with the state EMS office. The program was recognized as being able to fill a needed role to the wildland fire fighters through out the state. It was also commended on not having any complaints of record.