The traditional role of the fire services in America are changing alongside healthcare. In nearly every city within every state, there is a fire department (FD) with emergency medical services available around the clock as the first point of service in the emergency management process. However, your Local FD has the expertise, the reach, and the capacity to manage the full range of public needs before an emergency occurs. As hospitals are tasked with reducing emergency department (ED) costs, the landscape of healthcare and fire services in America has a lot of varying spectrums. Washington State (one of only five states) just passed a bill permitting firefighters to provide preventative and follow-up medical care outside their traditional scope of practice. Snohomish County Fire District 1 has pioneered the use of a “Community Paramedic” to help better manage non-emergent 911 calls and to assist patients that may be falling through the gaps in the traditional healthcare system. Doug Upson, director of public relations for Cardiology from St. Peters Providence Hospital in Thurston County, just reported for 2014 that of the 6,885 ED patients, 779 were admitted. Underserved communities like Nisqually Tribe and Yelm are communities that exist within the “gaps” where paramedic/firefighters could function as an “integrated mobile medical clinic” to reduce excessive costs associated with otherwise costly ED visits. With nearly 80% of all calls for service being medical in nature and 90% of those calls resulting in transport to a local hospital, the system cost can escalate rapidly to an estimated 4.4 billion dollars annually across all states for non-urgent ED visits. Private corporation Medstar’s pilot community paramedicine (CP) program actually reduced 911 calls by 40% within their test community.

Readmissions: 14% to 27% are non-urgent visits which adds up to roughly 4.4 billion dollars annually. 8% of patients account for 28% of visits.

Currently, all CP programs are grant funded, and as existing pilot programs are proving their efficacy, the primary challenge is establishing sustainable billing practices which require change in policy and legislation. Implementing these programs statewide is largely a perceptual challenge in the public eye. The public doesn’t fully understand the capabilities of their local FD. The transition from perceived “crisis managers” to “community healthcare partners” with a strong focus on preventative care is the paradigm shift we are trying to actuate on an agency, public and legislative level.

We started with a CPR public outreach campaign

CPRsavesVR is a public outreach initiative developed out of the need to educate citizens how to perform chest compression-only CPR properly in the event of a witnessed cardiac arrest. Nearly 80% of cardiac arrests happen in the home. As emergency response workers, we know, the very first person there to help in a cardiac arrest emergency will be a citizen. If we can train our citizens to engage in chest compression-only CPR before we arrive, the victim of the arrest is 50% more likely to survive the event. Our Thurston County EMS system already has one of the highest rates of cardiac arrest survival in the world. Through rigorous training, new science, and dedicated crews, we have achieved a nearly 60% survival rate, with a national average being just 9-11%.

Why use virtual reality, 360 degree video, and google cardboard?

CPRsavesVR is community conversation starter

Our goal is to prepare citizens for the unfortunate and unexpected challenge of witnessing a cardiac arrest. The truth is, it’s scary to do CPR, and the stress and anxiety it produces may cause you to hesitate in a real emergency. Whether the person affected is someone you love or someone you hardly know, we want you to be ready to respond. Our theory is that immersive media like virtual reality ( VR ) and 360-degree video allows us to deliver true-to-life experiences in a safe and virtual way. VR affords us a sense of presence and empathy that mirrors a real-life event. We aren’t delivering this message in a light-hearted or comedic manner because we know that saving a life is a serious matter. We can build learning opportunities and reduce hesitation within virtual emergencies to prepare if you are faced with an actual cardiac arrest emergency.

"Our mission is simple. We give you a free Google Cardboard virtual reality viewer and you use your smartphone to show eight other people how to save a life." - Karen Weiss - Fire Fighter/Paramedic

Patient Data for Providence St. Peter's Hospital in Thurston County

a. Number of pts admitted annually to your ED with Chest Pain as a primary complaint? In 2014 we had 6,885 patients present to our ED with Chest Pain

b. Number of above pts who leave the ED with a definitive diagnosis that is cardiac in nature? - Pending Analysis

c. Number of Chest Px pts admitted to ED that are then admitted for additional intervention or observation? Of the 6,885 patients, 779 were admitted to the hospital.

d. What is the average cost to PSPH to have a pt in the ED with a chief complaint of Chest Px? We would prefer not to distribute financial information at this time.

e. How often do pts who come to the ED with a CC of Chest Px return to the ED with the same complaint within the year? Of the 6,885 patients, 1,230 presented back to the ED with a similar complaint within 12 months.

Nisqually Indian Nation


An underserved area or medically underserved population designation is only available for primary medical care. Medically underserved area (MUA) and medically underserved population (MUP) designation do not expire and are not updated. Qualifications are determined on an index value that includes:

  1. Infant mortality rate
  2. Poverty rate
  3. Percentage of elderly
  4. Primary care physician to population ratio

Health Professional Shortage Area designations are updated by the state and are used more frequently than MUA/P designations by state and federal programs.

If citizens can better understand how we work, then they'll have a more informed opinion when they vote. Currently, most citizens do not have an accurate understanding of how their fire department can serve them.

We are in the unique position to create a CP program in an underserved community in Thurston County and document the entire process qualitatively through story/content and quantitatively through measurable analysis with Providence St. Peter’s Hospital. Our goal is to create the TOTAL PACKAGE CP pilot program as a campaign that incorporates the data to prove efficacy, the pre/post-hospital care outreach and the human stories. This package can be delivered nationally via IAFF. At the heart of this project, we are changing the face of fire services through a multi-channeled conversation with content and public/partner education. We are starting that conversation with cardiac care. Providence St. Peter’s Hospital is the tenth leading cardiac care hospital in the nation Thurston County Medic One is leading the nation in cardiac arrest survival rates at 59%. Most citizens are largely unaware, and Washington is a major influencer. Traditionally, the FD has existed within physical communities, but as citizens are spending more time in their virtual communities, the demand for FD presence within these virtual social spaces is growing. The FD is an agency that needs to adapt to these changes, and they are in a unique position to be content providers and healthcare partners within these virtual and physical communities. There are many different aspects of fire and EMS services and for the scope of this project, we are only focusing on cardiac care. At a later stage, we can introduce stroke, diabetes, pre/post-hospital care strategies, fire, social, etc. Stage one is all about building the partnerships and introducing the CP program into a Thurston County underserved community. Stage two is demonstrating what we are doing to increase levy lid lifts and be influential on a legislative level.


Step 3: Responsive social media strategy - Capturing Survivor Stories

On the morning of Jan. 4, Heidi Walker-Seger and her husband were laying in bed talking. Then John Seger suddenly went stiff and quiet. When Heidi Walker-Seger turned on the light, his face was purple and he wasn’t breathing. Walker-Seger, a pediatric nurse, realized that her husband was having a heart attack. So she called 911 and began chest compressions. She kept performing CPR until South Bay Fire Department EMTs arrived several minutes later. Lacey Fire District 3 paramedics arrived several minutes after that. “I was just pressing on his chest as hard and as fast as I could,” Heidi Walker-Seger recalled Friday.

John Seger said he doesn’t remember the heart attack — or his wife performing CPR. But he said he’s grateful for her medical training, and for the medics who stabilized him and transported him to the hospital. By performing CPR immediately, Heidi Walker-Seger likely saved her husband’s life, said Karen Weiss, a firefighter and paramedic for Lacey Fire District 3. However, while Thurston County is outperforming much of the nation when it comes to cardiac patient survival, those numbers could still be improved through increased CPR awareness and training, Weiss said.

“The whole message is that none of this will work unless we can get citizens to do CPR,” Weiss said. Weiss said John Seger and Heidi Walker-Seger are a perfect example of how citizen awareness and medical resources can work together.


Utilizing the fire department as a change agent technology for social change.
So What is the problem?

Our survey was conducted in Thurston County within a small trailer park community. Within that small community, 72% of residents were transported to the emergency room last year. However, the data from Providence St. Peter's Hospital reports that only 11% of patients were admitted. The conclusive data supports that people use emergency services in a time of need, however their condition may not warrant admission to hospital. I know this from personal experience. I was a caregiver and I used the emergency room because they couldn't deny care when an alternative wasn't available. At the end of the day, we all want the care for the ones we love. What I can deduce from this inquiry is that more research is required throughout Thurston County to support a CP program to reduce non-emergent visits to the ED. If we can correlate the data from communities that have come to rely on the ED with local hospitals data of service, then we can justify the cost to implement a CP program within Thurston County. What is clear is that there is definitely a pattern of transporting patients to the ED, but do they need to be transported? It raises the question of empowering firefighters to provide medical services at the point of service which requires legislative change.

In 2015 at the IAFF legislative conference, the WSCFF echoed the IAFF’s directive for fire departments in Washington State to implement even the smallest of actions towards developing CP programs. Their lobbyists are securing legislation to protect this work for union FDs and public EMS agencies solely to keep it from becoming privatized. They know the ownership, pride, and connection to the community that FD have with their citizens. To open up such a fundamental portion of a community’s health and wellness to a for-profit agency would be a detrimental threat to one of the largest unionized labor forces in the United States.

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zac murphy

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