El Monte Facing Paramedic ‘Gap’ : Officials Fear Trauma Patients May Suffer Because of Insufficient Level of Service

City officials are trying to cope with what they call a “critical gap” in the emergency care system when the city’s only paramedic unit is in service, often leaving the city without paramedic coverage.

The biggest problem, according to El Monte Fire Chief Leslie E. George, is that El Monte’s paramedic team takes a majority of its trauma calls to County-USC Medical Center, about 12 miles away near downtown Los Angeles.

Also, many local emergency rooms sometimes refuse to accept patients because of overcrowding, forcing the paramedics to transport non-trauma patients to County-USC or hospitals out of the area, George said.

“Almost daily, we get incidents where we need paramedics and we don’t have them,” George said. “It can take them 20 minutes to get in (to County-USC) and an hour and a half to get back,” George said.

Although paramedics are on duty 24 hours a day, only one team is in service at any one time.

When the paramedic team is tied up, critical-care and trauma calls are handled by less-trained emergency medical technicians. The technicians, either city firefighters or ambulance operators, can perform basic life-support procedures, such as cardiopulmonary resuscitation, but lack the advanced training and equipment to adequately deal with critical trauma cases, said El Monte Battalion Chief Ernest Jensen.

“The paramedics can do almost anything that can be done in the emergency room, and they are supervised by a doctor,” George said. “(The technicians) can only do so much. . . . It’s a critical situation.”

Deepening Crisis

El Monte’s problem is caused in large part by the deepening crisis faced by the county’s emergency medical network. The Jan. 1 closure of the trauma center at Methodist Hospital in Arcadia may have brought the situation to a head, fire officials say.

Pasadena’s Huntington Memorial Medical Center, the only trauma center in the San Gabriel Valley, expanded some of its territory after Methodist Hospital dropped out of the system but cannot provide all the needed care.

Emergency rooms at local hospitals, including Greater El Monte Community Hospital, Arcadia Methodist and Terrace Plaza Medical Center in Baldwin Park, have occasionally refused to accept more patients in recent weeks. In addition, Santa Teresita Hospital in Duarte closed its emergency room permanently this month, a move expected to increase the load at surrounding hospitals.

“It’s like pond ripples,” George said. “Once one closes, it becomes more critical.”

Although no deaths have been attributed to the current problems, officials such as Mayor Don McMillen are concerned about the effect the longer rides and response times have on the patients’ chances of survival.

“(Paramedics) can’t drive around all night long with somebody dying in the back,” he said. “I really don’t understand how all these hospitals got so busy so quickly, but we’ve got to be able to take (patients) into the emergency rooms.”

Under county guidelines, paramedics, who provide advanced care during transport, can be sent to hospitals farther away when local emergency rooms are filled. By contrast, emergency medical technicians cannot be diverted except under extraordinary circumstances.

Routine Diversions

Officials say diversions have become almost routine for both county and city paramedic units.

But unlike county paramedic units in South El Monte, Temple City and Baldwin Park, El Monte does not have a backup unit.

El Monte contracts with Medevac Emergency Medical Service to provide the paramedic service along with basic ambulance service. Medevac officials say the unit routinely takes its trauma patients to County-USC now that Arcadia’s trauma center is closed.

“Without traffic, we can be there in 20 minutes,” said Karen Pointer, Medevac operations manager. “If there’s any traffic, that kind of blows it out of the water.”

On Dec. 31, paramedics could not respond to four of their 16 calls because they were tied up either treating patients or in transport outside the city, according to Fire Department logs. On a previous night, paramedics responded to 22 of 27 calls, leaving five potentially critically injured patients in the care of emergency medical technicians.

“In those cases, (the firefighter or ambulances drivers) do the best that they can until the paramedics arrive,” Jensen said.

Virginia Price-Hastings, chief of the county’s paramedic and trauma hospitals program, said most cities that cannot afford to have a unit on standby have made stopgap arrangements.

“In most other areas, the city has some kind of backup, whether it be from the county or from the (ambulance) provider,” she said. “But there are costs associated with that.”

Unfeasible Option

For El Monte, the cost of adding a second unit would be $400,000, a figure George says makes that option unfeasible.

El Monte pays $1 a year to Medevac for the paramedic service. As part of the agreement, Medevac is the sole provider of ambulance service within the city, charging patients for hospital transportation.

In the past, El Monte has occasionally received help from county paramedics when it has more calls than Medevac can handle, George said. El Monte’s paramedics have reciprocated, but on a more infrequent basis, he said.

George said he hopes new equipment will help ease part of the problem. The Fire Department wants to equip each of the city’s five fire engines with an automated heart defibrillator unit. The unit, which costs about $5,000, would increase the firefighters’ ability to respond to cardiac arrests, a frequent occurrence in a city with a high concentration of senior citizens.

The City Council authorized $16,000 toward the purchase of defibrillators and necessary training, and George has been appealing to the community to donate about $10,000. Properly used, George estimated, the portable defibrillators could increase a patient’s chances of surviving a heart attack by 30% or more.

But with more emergency rooms turning paramedics away and the lack of available funding to open more trauma centers, the defibrillators will solve only part of the problem, George said.

Fire officials cannot quantify how the lack of immediate paramedic response has affected patient recovery rates, but the assumption is that any delay is detrimental.

Increasingly, George said, dispatchers deal with apprehensive calls from fire captains in the field asking for paramedics to treat critically injured patients.

“You an hear it over the radio--the tension in the captain’s voice as he keeps asking when the paramedics are going to get there,” George said.