Editorial: Let paramedics and nurse practitioners handle some 911 calls

There’s nothing — nothing — that irritates people more about the department they otherwise love than watching a 50-foot firetruck with a crew of fully suited firefighters show up to a 911 call for a heart attack or bee sting. Inevitably, someone watching the drama will gripe, “Why can’t they just send an ambulance?”

It’s a valid question. The answer is an unnecessarily complex one that dates to a time when fighting fires was still the main mission of most fire departments. But times have changed. “Structure fires” are fewer and farther between. Today, nearly 90% of the calls to the Los Angeles Fire Department are for medical service.

Yet the department still has far more ladder trucks and engines than ambulances, and far too often it sends trucks to deal with situations for which an ambulance would be cheaper and more efficient.

A proposal by Councilman Mitchell Englander could start reordering priorities at the LAFD by diverting the least-urgent medical calls to a team of just two people — a nurse practitioner and a paramedic. They would use an ambulance, but the goal would be to treat people who call with minor medical needs right there at the scene, rather than schlepping them to the hospital — thus saving millions of dollars each year on ambulance rides and hospital admittances. Nurse practitioners are able to do more than paramedics, including writing prescriptions and performing minor procedures.

Between calls, this nurse practitioner unit would reach out to “superusers” — people who call 911 more than 50 times a year — to help them find services and resources before they pick up the phone again.

If the program worked as intended, there would be more firetrucks available to respond quickly to serious emergencies. Many of the people stuck in an expensive home-to-hospital cycle would be dealt with at home, more effectively and efficiently. That’s what happened in Mesa, Ariz.

Two years ago, that city of about 450,000 people tried a similar program with two teams to take low-urgency 911 calls. The trial was so successful — with about $3 million in savings on ambulance transports and hospital admissions in 2013 alone and, anecdotally at least, many stories of improved care — that Mesa rolled out an expanded version in February. L.A. would use just one team, deployed in an as-yet-unidentified part of the city, for its yearlong pilot program. This is the type of innovation the department desperately needs, and it’s excruciating to have to move so slowly and on such a small scale. Fire departments are notoriously resistant to change, but it’s time to try this reasonable reform. If it works, perhaps such a unit will be deployed in each of the 16 LAFD battalions.

This month, the proposal will come before the City Council, which should approve it without delay.

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