Citing unacceptably slow response times in hundreds of heart attack cases, a management audit of the Los Angeles Fire Department called Thursday for basic changes in the way emergency medical services are provided to city residents.
The months-long study, conducted by a City Administrative Office team, focused on the city's overburdened paramedic service, the subject of controversy and media attention in recent months.
The key recommendation of the report called for reducing the workload for paramedics and cutting response time on critical calls by using the nearest available firefighting unit to deal with low-level medical incidents that do not require a paramedic ambulance.
Calls for emergency medical services citywide now compose 77% of all responses by the Fire Department, according to the auditors. They said that 49 rescue ambulances in the department's 103 fire stations were dispatched to 200,372 incidents last year.
"Within the Los Angeles Fire Department, paramedics are sent on virtually all (emergency) incidents, many of which are first-aid cases which do not require such a high level of service," according to the study, ordered by the City Council last September.
"In busy areas of the city this results in overworking responding units and dangerously extends response time on critical incidents such as heart complaints." The report noted that the American Heart Assn. standard for survival calls for cardiopulmonary resuscitation of a heart attack victim is within four minutes and for the use of drugs and defibrillation within eight minutes of cardiac arrest.
When the auditors checked on about 9,000 heart incidents in the Los Angeles area over a nine-month period last year, however, they found that in more than 1,000 cases a paramedic unit took 10 minutes or more from the time of dispatch to arrive on the scene.
Ambulances Tied Up
The main reason for the "poor response time" was that the closest ambulances were out on other incidents, they said.
Since "only 30%" of all medical responses require paramedic intervention, the auditors said, the many lower-level or first-aid incidents could be handled by people with less medical training.
The report recommended the development of a series of screening questions to be used by Fire Department dispatchers to determine whether to send paramedics or firefighters with less medical training on a call.
Call for Trial Program
And the auditors called for a trial program to see how the system would work, especially in the Central City and South-Central areas of Los Angeles, which have the heaviest workload.
The report recognized that Fire Department management is concerned that fire protection might be downgraded if firefighters take on additional emergency medical duties. But they suggested that a fire unit responding to a low-level medical call could be called off to fight a fire, if necessary.
"Slow response to critical paramedic incidents has not been sufficiently monitored and analyzed for corrective action by LAFD management," according to the report, the most recent of six studies done on the problem of paramedic workload between 1979 and 1986.
Fire Chief Donald O. Manning said through a department spokesman that the department has worked closely with the City Administrative Office for about a year in assisting investigators with the audit.