Overhaul of Paramedic Service Gets Panel’s OK

The Los Angeles Fire Commission adopted recommendations for overhauling the city’s emergency medical services system Thursday, opting to hire an outside expert to work with the Fire Department in developing a program.

The commission directed the department to negotiate an agreement with Dr. Jeff Clawson, medical director of the Salt Lake City Fire Department and author of guidelines that permit dispatchers to distinguish the seriousness of calls and send the proper aid.

As recommended by the commission, Clawson would train medical dispatchers, design a system of quality control and, along with the Fire Department, see that the system is implemented.

‘Band-Aid’ Calls

The commission also recommended a 60-day test period to collect data on the “most appropriate response” to Basic Life Support (BLS) or so-called “Band-Aid” calls that make up 70% of all emergency medical requests.

By collecting data, the commission decided, in effect, to test which of two conflicting EMS plans offered by the Fire Department and a City Administrative Office’s audit team should be presented to the City Council.

“I don’t think we are at the point of reinventing the wheel,” said Harold Kwalwasser, commission president. “I think we are at the point of looking at that data to resolve the issue of which way we go. . . . The real issue is who is going to be the first responder in Metro and South-Central.”

The commission directed the Fire Department to work with the CAO’s team.

Despite the commission’s admonition, however, it appeared Thursday that the question of how to provide both improved emergency medical services and maintain the department’s fire-fighting ability will wind up in a battle before the City Council.

‘Clear-Cut Agenda’

Fire Chief Donald O. Manning noted that firefighters at Station 96 were on an EMS call Wednesday when a serious fire broke out almost next door, something that he said the audit team’s data did not reflect.

“My point is that when we look at the audit team’s report they don’t know their fanny from a hot rock about putting out a fire. And they have a clear-cut agenda on what they want to do and that’s cut the department’s resources, and that’s where they’re going with their whole program,” Manning said.

He added that he was “looking forward” to fighting it out in front of the City Council.

After a monthslong study, the CAO auditors cited unacceptably slow response times in hundreds of heart attack cases and called for a basic change in the way emergency medical services are provided.

Its key recommendation called for cutting response time on critical calls and reducing the workload on paramedics by using the nearest available fire-fighting units to deal with low-level medical assistance.

The CAO team noted that EMS calls citywide now make up 77% of all responses by the Fire Department. They said that 49 rescue ambulances in the department’s 103 fire stations were dispatched to 200,372 incidents last year.

In a response last month, the Fire Department also cited a growing EMS crisis and, like the CAO team, it recommended the adoption of revised Clawson medical protocols. But the department balked at sending the nearest available firefighting unit on low-level calls in busy areas.

Instead, the department called for staffing ambulances in the high-demand areas of the Metropolitan and South-Central districts and the East San Fernando Valley area with firefighters trained as Emergency Medical Technicians (EMTs). Paramedics, who have been responding to almost all medical calls heretofore, would be dispatched on more-serious Advanced Life Support calls.

Under the department’s proposal, a “new EMT rescue ambulance” resource would be created by reassigning 18 ambulances now manned by paramedics to fire stations in busy areas. Also, the department proposed that 10 paramedic engine companies would handle calls in the city, and all fire companies would be equipped with automatic defibrillators.

It appeared all but certain Thursday that proposed changes that take jobs away from either the United Firefighters of Los Angeles City or the United Paramedics of Los Angeles will be opposed by union leaders, complicating final adoption of a new EMS system.