Driving down Miami's I-95 in rush hour traffic, a car veers out of control. The unconscious driver has suffered a massive heart attack and careens into the center divider at over 40 mph. It's 5:30 p.m. and the clock is ticking. A call goes into 911 reporting the accident. Our anonymous Miami commuter, left unaided, has until 5:35 to receive proper medical treatment before he suffers irreversible cardiac injury and dies.
In many metropolitan areas, this man would be in an almost hopeless situation, because it will take at least five minutes for the nearest ambulance to weave its way through traffic. But this isn't a normal city; our hypothetical victim had the good sense to go into full cardiac arrest within the borders of Miami-Dade County where a team of motorcycle medics are en route to answer the call.
Motorcycle Emergency Response Team founder, Captain Roman Bas, patrols the busy streets of Miami-Dade County ready to offer medical assistance.
In a model program, Miami-Dade County has incorporated the advantages of two-wheel transportation into its Emergency Medical Services (EMS) with its Motorcycle Emergency Response Teams. Knifing though traffic and splitting lanes, MERT units are able to respond to calls far quicker than their four-wheeled comrades and are saving lives in the process.
The existence of the MERT program can be credited to Captain Roman Bas, a 19-year veteran of Miami-Dade Fire Rescue
(MDFR), who based the idea off London's Motorcycle Response Units. Years ago on a personal trip to London, Bas had paid a visit to the local firehouse and spoke with one of their MRU medics. London was combating the slow response times of its own EMS system by employing the services of motorcycle-equipped medics, which were proving invaluable in improving the survivability of cardiac patients as they were able to arrive faster and administer life-saving interventions like CPR and defibrillation.
With 2.4 million inhabitants and 1,290,000 registered vehicles on the books, Miami-Dade County feels the sting of major metropolitan transportation challenges. These inherent problems are compounded by the region's fast growth and infrastructure construction projects, all of which contribute to Miami-Dade County being ranked among the top-four in the nation for traffic congestion.
During his years of MDFR service, Bas knew all too well the frustration of big city traffic when responding to emergency calls. Serving on a rescue unit based close to the freeway, it was not uncommon for his MDFR fire engine to speed toward the scene only to get held up by gridlock freeway traffic. It was frustration not just on his end, but from the motorists as well, who were trying to help clear a path for the 10-foot-wide fire truck, but were stuck in bumper-to-bumper conditions. Remembering his encounter in London, the self-described avid motorcycle enthusiast saw the motorcycle medic concept as a potential solution.
"I thought it was interesting," explained Bas on his first encounter with the motorcycle medic idea. "I thought what a great idea this is that they're doing this in London, but it wasn't 'till I found that our department was basically in the same situation as their department that I put forward the idea of trying to implement motorcycle rescue teams for the area we serve."
Having lived almost his entire life in the Miami area, Bas joined the MDFR ranks in 1987 and went on to become a paramedic. Bas has also found time to participate in such memorable rescue efforts as those at Ground Zero and Oklahoma City in addition to his nearly 20 years in MDFR. But perhaps his greatest contribution to public service came when he pitched his motorcycle medic idea through the opened doors of his MDFR supervisors.
MERT units operate in two-rider teams and are able to reach calls much quicker due to their ability to navigate through traffic congestion. Since its inception, MERT has cut response times to life-saving calls by 60%.
In this regard Bas was aided by MDFR's reputation as a dynamic EMS system, with the nation's sixth-largest fire department featuring one of the most advanced dive rescue units in the nation as well as a renowned anti-venin program. His Fire Chief at the time, Carl Phillips, was open to the idea, provided Bas could find the resources in personnel and machinery.
"Our fire department is probably one of the most innovative, pioneering type of fire rescue departments that isn't afraid to take a new approach, and at least try it out," explained the 45-year-old Bas, "They're always willing to listen to their employees and let their employees come up with ideas, and they'll give it a shot."
After getting a heads up from the Chief in 2002, Bas started placing calls to every manufacturer who produces police motorcycles. BMW was the marque who got things rolling when it stepped up with 10 RT1100T California Highway Patrol motorcycles - a significant contribution representing a $120,000 donation to the cause.
Finding recruits out of the 1,900 uniformed firefighters to fill the seats wasn't a problem. All Bas then needed was support from the County government. In that regard he found an advocate in County commissioner Rebecca Sosa, who Bas credits to as "the mother of MERT."
With support from his department superiors and county government, the MERT pilot program got underway. MERT has since swapped out their Beemers for a fleet of 10 Police versions of the Harley-Davidson Road King. The decision to change was not a matter of personal preference but a financial one. The Motor Company simply won out during the county's open competitive bid system. Bas noted that both the Beemer and King worked very well and fulfilled a major requirement for MERT service by providing ABS, not to mention the vast storage spaces where his medics store their life-saving devices. Bas has continued to receive full support from the current MDFR Fire Chief, Herminio Lorenzo, who is himself an avid motorcycle rider.
Operating in two-rider teams, MERT units patrol the Interstates and major thoroughfares of the Miami-Dade area, waiting for calls to dispatch them. Their mobility is a major advantage, not just in their obvious dexterity in the closed quarters of traffic congestion, but in the fact that they are not a fixed-unit responder (like a station-bound fire truck, for example). Through radio communication MERT teams can dispatch themselves to calls they are closest to and, in the near future, MDFR will be able to keep even closer tabs on their roving MERT units with the addition of GPS systems to its fleet of Road Kings.
Once dispatched, a MERT unit is able to answer a wide array of potential calls, and MERT capabilities are maximized by working in teams of two (London's MRUs utilize lone medic riders), as they can carry twice the amount of gear. Among other valuable tools in the luggage is the all-important Automatic External Defibrillator, which is one of the most significant factors in the survival of cardiac arrest patients (like our hypothetical gentleman in the opening paragraph of this story).
MDFR's motorcycle medics take the same 80-hour course required for motorcycle police officers before they move on to a MERT-specific training. While some of the medics are still EMTs, Bas foresees having an all-paramedic force in the future.
It is MERT's responsibility to arrive as fast as possible and initiate treatment and stabilize the patient. Performing what in medical speak is termed, triage, MERT units are able to determine the priority in which patients should be treated and the appropriate level of EMS response required. In large-scale accidents, the MERT units act in a sort of reconnaissance role as first responders.
The benefits of the MERT program were immediate, with the program's first-ever call showcasing the amazing capabilities of the motorcycle teams.
"I remember the first day, first call, I was one of the riders," recalled Bas. "It was first thing in the morning, we had done a routine checkout of the motorcycles, got on the road, and no sooner did we do that than our first call came out. It was two vehicles involved in an accident and one of them was a minivan. There were children, as well as adults, trapped in that particular vehicle. It was a bad car accident. We were there in less than two minutes and made our initial assessments of all the patients. We did have two patients that were trapped and in critical condition. Immediately, I was able to make what we call an air rescue assignment, so we could expedite the patient transport to the local trauma center. By the time the other units were there we were focused on the patients that had the life-threatening injuries."
Had the MERT unit not been present, those precious minutes the four-wheeled paramedics were in transport would have meant falling odds for the critical patient's survival.
In the EMS field, response time is a matter of life and death. The preceding statement is not a figurative metaphor either; the sooner medical treatment is administered, the greater the chance of survival. In medical emergencies, it is all about the cold equation of time.
In this regard the results of the MERT units were nothing short of miraculous, as their response times to life-threatening calls dropped by a claimed 60%. Overall response times by MERT units average 2.83 minutes. These were a vast improvement over the status quo when Bas first pitched his idea, and cut response times by half.
Another major advantage of the MERT program is they are able to separate the emergency wheat from the chaff. There are many 911 calls which qualify as emergencies but do not necessitate calling in the EMS big guns, which would be better deployed on other calls or held in reserve altogether. This fact was born out by one call Bas remembers in particular, when a small child had taken a nasty tumble off the couch.
"That's one of those calls I will never forget, because there are many reasons why we believe this program will work. One of them is reduction of response times, the other one is keeping other units available for other calls when we could handle them ourselves," explained Bas.
"The parents had called 911 because the child had fallen off the couch. We heard the call, so we started responding. There was also an engine company that had initially been dispatched to respond to that call. Once we arrived, we were able to make a patient assessment and determined the child was fine and that his injuries were very minor. Once I was able to make that patient assessment I cancelled the fire engine that was responding to the call.
"That same fire engine two minutes later was doing an initial, primary search inside of a house that was on fire in their territory," Bas continued. "The officer that happened to be on that unit used to give us a hard time about the idea for the (MERT) program. So right after that happened and we had taken care of the other call, I went to the call where he was at and he looked at me and raised his hands in the air and said, 'You know what, you made a believer out of me.'"
At present time MERT has moved beyond its pilot program phase and has been incorporated as a permanent fixture into MDFR, with Bas seeing his division grow from 10 medics to 40. As the number of motorcycle medics continues to rise, the quality of service grows as well. While there are still some EMTs (Emergency Medical Technician) in the MERT ranks, Bas soon anticipates having an all-Paramedic force (Paramedic being a more advanced level of EMS certification, able to perform more invasive medical interventions which are regulated from state to state).
To become a MERT medic, prospective candidates must experience the same initial training required of all MDFR firefighters. MERT medics then go through a comprehensive motorcycle-specific training program, which includes completing the same 80-hour course required for motorcycle police officers before then undergoing the program's own MERT-specific rider training.
Unlike their police counterparts, MERT units are not in the business of high-speed pursuit. Instead their emphasis is on navigating through dense traffic in a safe and efficient manner. MERT medics are drilled through the program's SOPs (Standard Operating Procedures), so that any two riders who go through the training are able to ride efficiently alongside the other on patrol. Beyond this extensive initial training regimen, MERT medics must re-qualify every month by undergoing a rider skills evaluation, where they hone their advanced riding techniques with braking exercises and evasive maneuvers.
Safety, of course, is a top priority for the MERT teams, and Bas was stoked about a new safety device the MERT medics are utilizing, the Airprotek vest. Bas opted for the vest rather than the long-sleeve version because of the often oppressive high temperatures of the Miami-Dade area.
"We wanted to offer our personnel the safest equipment out there in the event of an unforeseen emergency," said Bas. "Those vests were the coolest, temperature-wise, safety equipment that would work for us."
The vest works by connecting to the motorcycle with a key box and coiled wire tether system. If the rider is thrown off the machine, a ripcord is pulled. Within a half-second, a carbon-dioxide gas cartridge inflates cells in the vest that protect the neck, back and hips from major impact trauma. The MERT program is fortunate to never have had to use the system in an actual road emergency, but Bas was very impressed by their initial testing of the unit.
Geared up, the MERT units patrol Miami-Dade's busiest roads in 10-hour shifts Monday through Friday, when traffic congestion is at its peak and they are the most useful. MERT teams do not operate at night, excepting special functions and events (like the upcoming Superbowl). During inclement weather, the two scheduled MERT officers are assigned to an engine unit and supplement the regular MDFR contingent.
Another special assignment the MERT units take on is participation in presidential motorcades for visiting dignitaries. They supplement the police presence so that in the event of an emergency or crash, they can provide treatment to the fallen individual without the motorcade having to stop. This particular role took on a new importance this November when two Honolulu police officers were injured from a crash during a motorcade for President Bush. One of the officers, Steve Favela, succumbed to his injuries five days later and died.
The public response to the MERT program has been positive and well received. Bas explained that when they first pull up to cars, motorists at first think they are cops, but once they notice the Miami-Dade Fire Rescue decals, they often roll down their windows ask, "How long have you guys been around?" The question many times will be followed by, "Wow, that's a really good idea."
And the Miami-Dade public aren't the only ones who think the MERT program sounds like a good idea. Bas has already fielded calls from municipalities in California, Maryland, Georgia, New York, Michigan, Texas, and North Carolina. People are taking notice of MERT's success and, given the initial results, it would be a surprise if motorcycle medics in the years to come aren't active in every metropolitan area where traffic congestion is a major concern.
One reason why the motorcycle medic program is so appealing to government municipalities is that it helps out on the bottom line. Maintaining a fleet of MERT units proved to be cost effective for MDFR, in that it reduces maintenance costs for other fire and rescue vehicles, as well as help combat rising fuel costs. But beyond the monetary concerns, and the first thing Bas pointed out when asked about the cost-saving benefits of his medic force is that they save something far more valuable than money - human lives.
So as medical professionals nationwide continue to save lives every day, the motorcycle medic is becoming yet another valuable tool in the EMS arsenal. The beneficiary may be our hypothetical man who has suffered a heart attack on the freeway, or it may be the person who gets faster service because other units aren't being sent out to calls where they aren't needed. Either way, the motorcycle medic is making a difference in the Miami-Dade community. And as the concept spreads in the years to come, the life a motorcycle medic might save could even be yours.
For more information or questions about the MERT program, contact Miami-Dade Fire Rescue
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