Field Operations

Paramedic Level Out-of Hospital Care

It's more than just a ride to the hospital when it's a medical emergency involving you or a member of your family. The Emergency Medical Services (EMS) Division is a component of the Department of Public Safety, and the provider of "paramedic" level service to both the incorporated municipalities and unincorporated areas of New Castle County. New Castle County Paramedics are deployed from satellite EMS stations located throughout the county.

All New Castle County paramedics are certified by the state Board of Medical Licensure and Discipline to provide advanced life support (ALS) care. Their goal is to bring many of the same skills and procedures of a hospital emergency room directly to the patient's side. County paramedics can administer breathing treatments, insert breathing tubes directly into a patient's lungs, administer intravenous fluids and drugs, conduct heart monitoring and 12-lead electrocardiogram (ECG) interpretations, and defibrillate or externally pace a patient's heart. In most cases, advanced life support treatment may be initiated by the paramedics under the Statewide Standard Treatment Protocol and Paramedic Standing Orders before they establish radio contact with a hospital.

All of these capabilities are available in an emergency simply by dialing 9-1-1.

The New Castle County Paramedics currently deploy nine paramedic units during the day and eight paramedic units during the night hours. Additional paramedic units may be placed in service for special circumstances, such as weather contingencies, special events or major incidents. The Emergency Medical Services Division has incorporated sufficient resources to rapidly expand the number of paramedic units for internal surge capacity, or to provide mutual aid to neighboring jurisdictions without depleting paramedic coverage to New Castle County.

9-1-1 Dispatch & Tiered EMS Response

All emergency medical services resources in New Castle County are dispatched from a county-wide emergency communications center. Paramedics are assigned to the higher-priority medical emergencies as determined by a statewide call processing protocol. Examples of the types of incidents that typically receive a response from a paramedic unit include heart attacks, serious motor vehicle collisions, shootings, stabbings, difficulty breathing, and unconscious persons. The level of EMS response is determined by the emergency communications center based on the answers provided by the caller to a set of standardized questions. It is important for callers dialing 9-1-1 to report an emergency remain on the phone and answer all of the questions to the best of their ability.

The New Castle County Paramedics work in a "tiered response" configuration with the 21 county volunteer fire company basic life support (BLS) ambulances, the Wilmington Fire Department and its contractual private BLS ambulance service provider, and the student-staffed BLS ambulance at the University of Delaware. Lower-priority emergencies that typically do not require the advanced life support services of the paramedics are normally handled by the BLS ambulance companies. However, the ambulances have the ability to immediately request a paramedic response if they believe advanced life support may be required for their patient.

Advanced life support prioritized emergencies are assigned both a BLS ambulance and the closest county paramedic unit. In some cases, such as a possible cardiac arrest, police officers and fire apparatus may also be dispatched to provide a "first response" capability. In fact, many police cars are equipped with automatic external defibrillators (AEDs) to provide electric shocks in an effort to restart the heart during cases of cardiac arrest. The county paramedics will ride in the BLS ambulance and accompany the patient to the hospital whenever the patient requires advanced life support care.

Medical Coordination

A vital aspect of a paramedic's work is the coordination of care with a receiving hospital. New Castle County Paramedics will contact the receiving hospital to provide advance notice of the patient's pending arrival. In critical situations, county paramedics can mobilize special hospital resources even before the patient arrives. For instance, New Castle County paramedics routinely activate special hospital heart teams when they determine by 12-lead ECG that a patient may be having a heart attack. This has been proven to shorten the time from the patient's arrival at the hospital to their receipt of definitive care.

County paramedics will contact a hospital by radio to facilitate an orderly transfer of care from the field to the hospital. In some circumstances, the paramedics may be advised that the patient's initial hospital of choice is experiencing delays in seeing patients. The hospital may request that ambulances transport patients to other facilities to avoid extended wait times. This coordination provides an opportunity for the patient to make an informed decision regarding their selected destination and possibly avoid delays in treatment.

Air Transport

New Castle County paramedics routinely coordinate the transport of critical patients from the scene to area hospitals via helicopter. The Delaware State Police Aviation Section provides aeromedical transport capability and is dispatched on any incident with the potential of serious injury. In situations involving critical patients, the county paramedic may accompany the state police trooper-paramedic to provide a second advanced life support provider during the transport.