by Darrell Lorenzi, EMSCI# 071 and Jeff Youngsma, EMSCI# 073
Fremont Fire Department (CA)
It's a warm July weekend; the temperature is in the upper 80's. Your community is hosting a large concert and vendor fair in the downtown area. Eight square blocks of downtown are blocked off to motor vehicle traffic. The crowd is estimated to be close to 70,000 people. In the middle of this crowd, an elderly male suddenly complains of dizziness and collapses to the ground. How would your department respond to this incident? Do you have the capabilities to maneuver through the crowd quickly and safely and get to the patient in a timely fashion? This was an issue that confronted the Fremont (CA) Fire Department.
The city of Fremont, located 41 miles southeast of San Francisco along the east side of the San Francisco Bay, has a mixture of high-tech, industrial, and suburban living. The Fremont Fire Department is comprised of 10 ALS engine companies and two ALS truck companies in two operation battalions. The department also has a hazardous-materials response vehicle, a heavy rescue vehicle, several urban/wild land interface units, and four support divisions (operations, training/EMS, fire prevention/haz mat/code enforcement, and administration). The department has 150 members.
Need for Alternate Delivery of EMS
The city hosts a number of events every summer, including one of the largest open-air festivals in the state. In an area of six square blocks, a crowd of 200,000 can be expected during the two-day event. The city also has a large park that caters to a multitude of events that include July 4th festivities and team athletic events. Many cultural activities and antique fairs are held in various districts of the city.
For the fire department, this created an operational issue of how to supply emergency medical services for these events. With such a large population in a small constricted area, street closures, and impeded conventional mobility, we needed to find an alternative to apparatus response. In the past, we would have the responding engine stage at the events, and the crew would have to carry the equipment to the incident. This proved to be very inadequate as events grew in size and population.
In 1992, we began researching various ways to deliver our services in a more efficient manner. We looked at several options, including locating personnel more strategically and using golf carts. We decided to use bicycles to carry our equipment in pannier bags. We networked in our area and found that, to our knowledge, no other department or agency in California was delivering EMS on bikes. We did find agencies outside the state that were providing this kind of service and had been doing so for years.
We contacted these agencies, primarily the Phoenix (AZ) Fire Department, and in 1993 we put forth a proposal to implement an EMS Bicycle Response Team. Unfortunately, there was initial reluctance from our Administration Division, but after three years of persistence and some creativity on the part of the firefighters, a team was placed in operation on July 4, 1996.
The team was an instant success. On a day where the crowd was estimated to be in excess of 100,000, the team responded to several incidents, including three ALS calls. The team was also immensely popular with the citizens, who were very pleased to have this type of close contact with their firefighters. Two weeks later, two teams were put into service at our annual "Festival of the Arts." Again, they were a huge success, quickly responding to numerous medical aid requests (one team had more than 26 responses over the two-day event). The citizens enjoyed the interaction and were quite impressed with the teams' response and professionalism and were thrilled to watch the firefighters in action.
Seeing the public acceptance, the Fire Administration threw its support behind the team. Over the years, the idea continued to grow. We now have the ability to put three teams in operation and draw from a pool of 27 members.
Putting a Team Together
Each bike team is made up of two cyclists. When we put our plan in operation, we wanted to maintain our current level of service. Since our department is an ALS provider, that meant one of the riders had to be a paramedic. To allow other members of the department the opportunity to be on the team, the second rider can be an EMT. (All members of our department are trained to the minimum level of EMT I).
The teams are preassigned to an event. We usually place at least two teams in service. The teams fall under the supervision of the operational battalion chief. A preplan meeting determines which section of the event each team will cover. However, whenever an incident occurs, all teams may respond until one arrives on scene. The first on-scene team determines if additional assistance is needed or if the other teams can return to normal patrol. In addition, an ambulance is also dispatched for transportation. When not at an event, the bikes and equipment are always on standby and ready. In case of a natural disaster (California is noted for its earthquakes), the team can be moved to areas that fire apparatus can't reach.
We selected a functional mountain bike that would be durable enough to handle the weight of the equipment we expected to carry. It had to meet our needs but not be overly expensive because of budget constraints. We chose a bike with a front shock. The front shock is a necessity. It absorbs a lot of the curb jumping and off-road riding done over the course of the day, reducing fatigue.
We chose a pannier rack for its size and ability to handle the equipment bags (panniers). This rack is a little bit longer and wider that a normal one and keeps the bags out of the cyclist's way. With the normal racks, our riders would often kick the panniers while pedaling.
For the lighting, we chose a dual-light digital system. One light has a red lens and the other a clear lens. The lights can be used independently or together. This is good for a response as well as for night riding. An attached electronic siren helps with crowd dispersal during a response. A rear light attached to the pannier rack has a visibility of at least 500 feet.
Each bike has a custom-made integrated three-bag pannier system, two side bags, and one top bag-all with side-opening zippers. Each side bag has compartmentalized pouches inside that are labeled with their contents. The bike medic can remove the pouches and bring them to the patient without having to remove the entire pannier system from the bike. The top bags carry either the airway equipment or a compact monitor/defibrillator. One bike carries the ALS equipment and the other carries the BLS equipment.
Both bikes carry approximately 40 pounds of equipment, which is equally distributed on both sides of the bike. This is very important, since riding an unevenly weighted bike is asking for a crash.
A functional cyclist uniform is essential. You want something that will separate you from other agency personnel who also may be riding (i.e., the police) and at the same time be capable of wicking away moisture while keeping you cool and comfortable. In cool or inclement weather, a jacket and cycling pants are also a good investment. All clothing should have reflective striping for visibility purposes. We wear jerseys and bike shorts, an ANSI- or Snell-approved bike helmet, properly fitted bike gloves, sunglasses (or some form of protective eyewear based on the weather conditions), and sunscreen. .
A note on bike gloves: if you wear them, consider carrying latex gloves a size or two larger than you normally wear. This way you don't have to take off your bike gloves when you "glove up."
Bike shoes are a good investment. If you spend a lot of time riding, your feet will hurt if you wear tennis shoes. Stick with a pair of shoes with a stiff sole like bike-specific shoes.
Prior to 2001, we had no formal training-we were just a group of bicycle enthusiasts. Our unit had members with varied experience ranging from competitive road racers to kamikaze mountain bikers. We also had a lot of weekend warriors. Unfortunately, none of this experience prepared us for the type of events at which we were riding. With the crowds and obstacles, slow-speed riding is the name of the game.
In 2000 and 2001, our department sent three members to an EMS Cyclist Course sponsored by the International Police Mountain Bike Association (IPMBA). There they learned the basic skills of slow-speed riding and maneuvering through crowded venues. In 2002, two members returned to the IPMBA to be certified as EMS cyclist instructors. We are now in the process of training all team members to the EMS cyclist level. For consistency and liability reasons, this has proven to be a wise move, since the IPMBA is a nationally recognized organization and offers an excellent course.
Implementing Your Own Program
The fire department identified a need to provide quick response to medical emergencies in crowded venues with minimal vehicle access. Personnel on bikes equipped with medical supplies could rapidly respond to a medical emergency and provide treatment and stabilization in a timely fashion, thus reducing the time between the incident and treatment. In many medical emergencies, time is of the essence. In addition, having firefighters on bikes allows more contact with the public, which promotes good public relations.
This program has proven to be highly successful. In fact, a number of local departments have approached us about helping them to implement their own bike teams. If you are thinking about starting a bike unit for your department, contact IPMBA at http://www.IPMBA.org.
© 2003. This article first appeared in FireEMS September 2003. This article also appeared in the Spring 2004 issue of IPMBA News.