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Summary of Current Provision of Emergency Medical Services
in Hamilton and Wenham

            Hamilton and Wenham share an Emergency Center, but provide first response and ambulance service in quite different ways. The League has not performed a detailed financial analysis of the operating and capital cost of ambulance service to determine the financial impact (positive or negative) on the Towns of alternative ways of providing this service.

Hamilton-Wenham Emergency Report Center

The Hamilton-Wenham Emergency Center is an example of an important service that has been successfully shared between Hamilton and Wenham since the Center was established in 1959. Its operations are overseen by the Emergency Communications Board, which has eight members, four from each community. The Center is located at the Hamilton Police and Fire Station on Bay Road. It is funded through the Town of Hamilton budget. Hamilton bills Wenham for 35% of the joint operating and equipment costs, including the recent joint purchase of five satellite receivers. Total appropriation for FY 2003 was $260,248.

The Center is staffed 24 hours a day. The staffing goal is to have two dispatchers on the impact shift from 11 a.m. to 7 p.m. and to bring in as many as are needed in emergencies.  Center staff routinely monitor scanners when they are off duty and come in without being called when an emergency arises.

The Center staff processes calls for the fire and police departments of both towns and from alarm systems. The Center currently receives about 25,000 calls a year of which approximately 2000 are 911 emergency calls, which take priority.

A recently installed computer-aided dispatch system assists the staff in record and statistics keeping and in providing appropriate response to calls. For example, with this system in place, when a fire call comes in the Center staff can see at once the exact location of an address and can determine whether to invoke the "line box" system to call a neighboring town for a swifter response.

Wenham Medical Emergency Response

When a medical emergency call comes in from Wenham, the dispatcher calls the police and fire departments and Lyons ambulance. Often, a police office who is already on duty is first at the scene. Members of the Fire Department's Medical Aid Response Team (MART) who arrive on the scene help provide care until a Lyons ambulance arrives.

MART members are call firefighters who respond from their homes or work when paged. The Department has been certified by the state to provide Advanced Life Support. MART team has 20 members with a mix of training: some first responders, some EMTs and two trained at the ALS level through their work with Lyons. MART members are paid through the Fire Department budget when they respond to emergencies. In 2002, the Wenham Fire Department responded to approximately 230 medical emergency calls.

The Town contracts with Lyons Ambulance for ambulance service at the ALS level.  The ambulance is housed in Danvers. In FY 2003, Wenham paid a retainer of $36,480.

Hamilton Medical Emergency Response

Hamilton police provide both the first response and ambulance service, calling on Lyons Ambulance when ALS support is needed. Although many Massachusetts towns operate an ambulance service, Hamilton is the only town in which the police department, rather than the fire department, is responsible for this service. A big part of the rationale for the police operating the ambulance has been that there are full time police on duty 24 hours a day. There are now firefighters on duty during weekday hours, however, there were no full time firefighters when the service began. All Hamilton officers are trained at the EMT level.

When a medical emergency call comes into the Emergency Center, the dispatcher sends the cruiser closest to the scene to the scene and the cruiser closest to the station to the station for the ambulance.  There is usually an officer at the scene in under three minutes.

The dispatcher calls Lyons for ALS coverage automatically when one of four conditions is reported: person is unconscious, having chest pain and difficulty breathing, in anaphylactic shock or diabetic coma; or experiencing severe bleeding. The first officer on the scene assesses the situation.  He can call for ALS help if it has not already been called or cancel the coverage if it is not needed.  Approximately 18% of calls need ALS level care.

Even if Lyons has been called, the patient is loaded into the Hamilton ambulance so EMTs can begin stabilizing the patient. When they arrive, the Lyons personnel take their equipment onto the Hamilton ambulance to provide ALS care. Depending on location of the patient and of the Lyons ambulance, the Hamilton ambulance sometimes starts for the hospital rather than waiting and meets the Lyons ambulance on the way.  Occasionally, a Lyons ambulance is not immediately available and the Hamilton ambulance proceeds directly to Beverly Hospital without waiting.  The Hamilton Chief doesn't think that those situations have endangered people because the Town is so close to the emergency room - six minutes or less.

Hamilton has no contract with and pays no set annual fee to Lyons; Lyons does not have to reserve an ambulance for Hamilton, but respond if they are able (Essex and Manchester receive service under the same conditions.). When a Lyons ambulance does respond, Lyons bills the Town, which has billed the insurance company or patient for the service through a billing company. The Town pays Lyons once or twice a year for the number of runs they have made, rather than a set amount.

Hamilton established an Enterprise Fund in 1990 from which some money was returned to the Town to offset wages of officers.  In 1994 or 5, the Enterprise Fund was changed to a revolving account. In FY 2003, the Hamilton ambulance reimbursement to the general fund was $110,000 with $75,000 budgeted for FY 2004.

Police were called out for medical emergencies 600 times and made 260 ambulance runs to Beverly Hospital in 2001 and 290 ambulance runs in 2002. Typically, the officers will spend about 5 to 10 minutes at the site, before leaving for the hospital. Most calls occur during the day when three officers and the Chief are on duty. At other times, if all officers on duty become involved in a call, the Chief is called to fill in. If more officers are needed in Town for some reason, neighboring officers will cover, including those from Ipswich in the north and Wenham to the south.

Levels of Training for Medical Emergency Response

First Responder:

·        This level of training is required for every member of police or fire departments in Massachusetts

·        Training required: Initially: 20 plus hours of emergency training plus CPR training

Emergency Medical Technician (EMT)

·        Provide Basic Life Support (BLS) level of service

·        Training required:

-         Initially: 110 hour training plus CPR training

-         Recertification every 2 years requires 48 hours training

-         Community Colleges and public safety departments offer courses. Hamilton and Wenham offer independent classes.

Paramedic

·        Provide Advanced Life Support (ALS) level of service

·        Training required:

-         Initially: 1220 hours of training. Requires about 1 year of part time classes in class room and clinical rotation in hospital.  Costs approximately $7,000.
 

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