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City of Lincoln
Fire & Rescue Department
Emergency Medical Services

Local System Improvements

 

Lincoln Fire & Rescue has been providing Advanced Life Support (ALS) since 1995 when all LF&R engines became ALS with the addition of a Nationally Registered paramedic to each crew.

LF&R assumed sole responsibility of providing 911 ambulance service on January 1st, 2001 and has been successfully providing ALS service to the citizens of Lincoln and the surrounding counties since then.

LF&R operates six (6) front line ambulances 24 hours each day and has five (5) ready reserves that can be placed into service when demand dictates. Each front line ambulance is staffed with a Nationally Registered paramedic and a State certified EMT-B. LF&R transported over 17,000 patients in 2012 and has noted a steady rise in patient transports over the last several years. LF&R is required by ordinance to respond to “delta” and “echo” calls within eight (8) minutes 90% of the time. LF&R made their response time mandates in 2012.

LF&R receives medical direction from Dr. Jason A. Kruger, a board certified emergency room physician. Dr. Kruger is actively involved in working with LF&R and frequently rides with the EMS supervisors. Paramedics operate with open protocols and have the luxury of making base physician contact at any of the three hospitals with portable radios or cellular telephone. Protocols are reviewed each year and updated as necessary to reflect current changes in the industry.

LF&R has three (3) EMS supervisors, one for each shift. These supervisors are all Captains and between the three have over 50 years’ experience in pre-hospital emergency medicine. They are on-duty 24 hours a day and provide direct supervision to about 25 medics each. EMS supervisors respond to high acuity calls such as cardiac arrest, respiratory arrest, major trauma and other designated incidents. They also function as incident Safety Officers at major incidents and working fires.

The organization has cutting edge technology and equipment including:

  1. Physio Control LifePak 15 cardiac monitor defibrillators with 12 lead acquisition/transmission, pacemaker, cardioversion, SPO2, ETCO2, CO and met hemoglobin monitoring capabilities.
  2. Panasonic CF-19 mobile computing capabilities in each ambulance. Providers enter patient care information into ZOLL’s Tablet ePCR using the CF-19’s. Each ambulance is its own mobile Wi-Fi hotspot for data.
  3. Airway management is provided with CPAP, King Airways, ET tubes and Vivid-Trac Videolaryngoscopy. The EMS supervisors and selected paramedics are credentialed to perform rapid sequence intubation (RSI) in certain cases.
  4. 12 lead EKG’s are obtained within five (5) minutes of arrival at patient’s side and are transmitted to the hospitals via the LifeNet system. LF&R paramedics are trained to interpret EKG’s and declare “cardiac alerts” in the field. Physicians then receive a diagnostic quality EKG in the hospital. The “average” “door-to-balloon” time in Lincoln is less than 60 minutes whereas the national average is 90 minutes.
  5. Patient transportation on the front line medic units is provided with Stryker Power Cots and the organization has ordered two Stryker PowerLoad systems.
  6. Lincoln Fire & Rescue began cardio-cerebral resuscitation (CCR) on September 9th, 2013. This aggressive cardiac arrest protocol is geared to improving survivability from cardiac arrest and LF&R has noted a significant increase in the number of cardia arrest patients with a return of spontaneous circulation (ROSC).
  7. Lincoln Fire & Rescue began pre-hospital therapeutic hypothermia on a certain subset of patients that have had a ROSC from cardiac arrest. The protocol calls for cooled IV fluid that is stored in a special refrigerator carried in the EMS supervisor’s vehicle.
  8. Cardiac arrest data is obtained from the LP-15 monitor with the Code Stat Reviewer software and CPR fractions are now measured and recorded. A CPR fraction of greater than 80%, which must be obtained 90% of the time, is one of the current performance based budget indicator for LF&R. LF&R has met this indicator since its inception.
  9. Lincoln Fire has been using the Operative IQ data base system for the last several years and has significantly reduced EMS pharmacology and supply inventory across the board.
  10. Lincoln Fire & Rescue implemented the use of EMS vending machines and strategically placed them around the city. Crews can immediately restock the EMS supplies and medicines after turning over patient care in the hospitals. This has significantly reduced the amount of inventory stored at the stations.

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