City and County Paramedics: Key Differences in Programs

The Los Angeles County Fire Department, which provides paramedic service outside Los Angeles’ city limits, drew criticism recently when it was learned that a paramedic had racked up so much overtime that he was earning more than the fire chief.

An investigation showed that Reynoldo Wilson’s $98,483 in earnings, $59,672 of it in overtime, was only a little higher than earnings of more than 20 other firefighters, battalion chiefs and engineers who had worked substantial overtime to fill staffing shortages.

In the wake of the furor, department officials imposed a limit of five overtime shifts per month for each of the county’s 340 paramedics.

Although county paramedics have drawn most of the public attention, their workload--an average of 353 emergency runs each--was less than the average 563 calls handled by paramedics for the city Fire Department.

Moreover, county Fire Department officials say their paramedics, who provide emergency care in 46 small cities and the unincorporated areas, may be better equipped to work long hours because of some important differences between the county’s and city’s paramedic programs.

The most important difference is that county paramedics are also firefighters.

Although they work the same 24-hour “platoon” shifts as city paramedics, they rotate to firefighting duty every few shifts, permitting them a break in the heavy workload of medical emergencies at busy stations like those in East Los Angeles, Carson, Willowbrook and Bell.

Moreover, because a large number of county firefighters are former paramedics and all of them are certified as emergency medical technicians--compared to only about half of the firefighters in the city--firefighters are often available to back up paramedics when the workload is heaviest.

City paramedics have resisted becoming firefighter/paramedics, arguing that they are able to provide a higher level of medical care through specialization.

Another key difference in the two programs is the way in which help is dispatched to medical emergencies.

City paramedics are sent on all calls and aided by nearby fire engine companies only in cases deemed by the dispatcher to be life-threatening. That policy has been criticized by some doctors and paramedics because it fails to send the closest help, such as a fire engine company, on critical calls that may not seem immediately life-threatening to a dispatcher.

Los Angeles County routinely sends the nearest engine company on nearly all calls, then dispatches a paramedic unit if it seems warranted, Assistant County Fire Chief David Hanson said.

“If the firefighter is on duty there . . . and someone in his jurisdiction has a problem, there’s no better use of that person’s time than to have him go out and help. About the only thing we’re going to do is burn some fuel,” Hanson said.

City Fire Chief Donald O. Manning views it differently. The city Fire Department adopted a similar policy during the Olympics and spent an extra $60,000 on fuel with no perceptible life-saving results, he said.

Moreover, routinely dispatching fire companies on medical aid calls means that they may not be available at the station if they are needed for their primary mission--firefighting, Manning said.

A third key difference between the two departments is in the transporting of patients. City paramedics drive ambulances and take victims directly to hospitals; Los Angeles County paramedics drive equipment trucks and summon a private ambulance if one is needed.

In the view of city officials, that can lead to delays at accidents. Hanson said, however, that private ambulances are dispatched at the same time as paramedics on about 90% of the county’s medical aid calls.

The city compares favorably with the county in response times to accidents.

Using a standard of eight minutes as an ideal--because it is considered the maximum amount of time a heart-attack victim can be expected to survive without a paramedic’s help--city paramedics exceeded eight minutes on 21% of their calls, and county paramedics in the county’s urban areas took longer than eight minutes 69% of the time.

The county’s need for additional paramedics and chronic traffic congestion in the Los Angeles Basin are probably responsible for delays, department spokesman Eugene McCarthy said.

“It’s not going to get better,” he added. “It’s going to get worse.”