Keeping health care costs under control is a goal of reforms being debated in the U.S. Congress. One hidden cost is the burden to fire departments that find themselves providing expensive primary medical care for people who have no other place to turn. For the poor and elderly in one neighborhood of the U.S. capital, firefighters are the first on the scene to treat people who otherwise might not have easy access to doctors or clinics.
A radio dispatcher calls Engine Company 10 into action.
Washington, D.C. firefighter and paramedic Jon Botwin is on the ready.
"To be good at this job you have to be able to handle every situation," he explains.
At the scene, Botwin isn't fighting a fire but helping people who need medical care.
"You are the frontlines of every aspect of health care and people-care," he said, "We do it all."
Firefighters with Engine Company 10 are trained emergency medical technicians, and they're increasingly being called on to also be primary care providers. The firefighters arrive on the scene quickly and offer medical help until an ambulance arrives minutes later.
In large cities like Washington, to ensure the fastest response to medical calls, fire departments dispatch trucks carrying a paramedic with the firefighters.
Engine Company 10 is located in Trinidad, a neighborhood plagued by poverty and crime. Many of its residents don't have health insurance, and few doctors are available. When people need medical attention they phone the emergency number, 911.
It's another emergency response call for the crew from Engine Company 10. This is one of the busiest fire stations in the country. Eighty percent of those calls were for medical emergencies.
Thirty-year-old firefighter Botwin responds to a report of a 12 year old combative patient. Botwin uses his counseling skills to help a girl who has run away from home.
Within the next hour, Botwin treats a patient for an asthma attack and arranges transportation to the hospital emergency room for someone complaining of chest and stomach pains. Botwin sees many of the same people again and again.
"An ER [Emergency Room in a hospital] is not a primary care facility, that is not a doctor. But if you don't have to pay for the extra costs of going to an ER, then what do you care what it really costs? And those people are taxing and troubling the health care system," Botwin said.
As day turns to night, Engine Company 10 responds to more medical calls. Firefighter and paramedic Kianna Loften is going to help an elderly woman with an upset stomach. Ten other firefighters and paramedics responded to this call. Loften tries to educate patients on their treatment options.
It can cost about $3,000 to run a truck and four firefighters to medical emergencies in a 24 hour period. The expense has led some to question the cost effectiveness of sending fire trucks to medical calls.
Sergeant Jonathan Johnson, a 9 year veteran of the fire department, says medical calls are putting a burden on the system. "It is kind of sad and it overwhelms the system at times," he said.
Washington D.C.'s Fire Department is trying to identify people who abuse the emergency response system and find other ways to get them health check-ups and the proper medication. Members of Engine Company 10 hope the plan can take hold so they won't be called on so often to serve as primary health care providers.