I am writing to express concerns about the plan to charge a fee for patient transport by Mercer Island Fire Department (MIFD) firefighter/emergency medical technicians (EMTs). I helped organize the MIFD EMT defibrillation program in the early 1970s and helped train the firefighters/EMTs in management of cardiac arrest and cardiac emergencies for the subsequent 30 years. During that time, the survival rate of patients discharged from the hospital whose cardiac arrest was witnessed has been 40 to 50 percent. By way of comparison, the success rate at O’Hare Airport in Chicago and Las Vegas casinos, where automatic external defibrillators (AEDs) and rapid response teams are available, is around 70-80 percent, and when a cardiac arrest victim is in a hospital on a monitor with a defibrillator close at hand, the success rate approaches 100 percent. The key to survival is the time interval from cardiac arrest to defibrillation. The reason MIFD has one of the best records anywhere of resuscitation from cardiac arrest is the rapid response by MIFD EMTs, backed up by Bellevue Medic One. An aid car with a defibrillator that is out of service transporting a patient to hospital in Seattle or Bellevue cannot respond rapidly enough to a cardiac arrest on Mercer Island to guarantee a successful outcome.

There is also the matter of the possible effect on the King County EMS tax levy. Part of the EMS tax funds a quality assurance program that critically reviews each patient contact (including all MIFD patient contacts), and publishes data on the outcomes of victims of cardiac arrest. This is a fundamentally important program for the success of countywide EMS services. MIFD also receives $390,000 annually from the EMS tax for operational costs, about the same amount of money anticipated to be collected from patient transport fees. However, the money from patient transport fees is to go to the city’s general fund, not directly to the MIFD. The levy will be up for vote in 2011. Should voters feel that charging fees for patient transport by fire department personnel obviates the need for an EMS tax levy, the quality assurance program might well disappear for lack of funding, and there would be no EMS tax allocation to the MIFD. The MIFD has three aid cars equipped with AEDs, and each of the command cars of the MIFD is equipped with an AED, so in the absence of an aid car, a MIFD lieutenant or captain or fire chief can respond to a cardiac arrest and be able to defibrillate quickly. This plan is an experiment with some risk. However, it should be possible at the end of one or two years of experience to judge whether the fee for transport plan affects the cardiac arrest survival statistics, assuming the King County EMS quality assurance program is still around to provide the data to make the assessment.

Floyd A. Short, M.D.