City Use of Private Ambulances Tried in Pilot Program

City paramedic crews based in the San Fernando Valley have begun calling private ambulances to transport people with minor injuries to hospitals as part of a test program aimed at freeing paramedics to respond more quickly to emergencies.

Under the 1-month-old Private Ambulance Pilot Program, paramedics called to an accident examine the victim and, if the injury is not serious, the patient is turned over to a private ambulance, allowing the emergency crew to respond to more urgent calls.

The charge to patients is slightly higher under the pilot program, but officials say that a 7% increase each year in paramedic calls requires the city to use its medical teams more efficiently.

The Los Angeles Fire Department plans to continue the test program until August in the San Fernando Valley, where in 1989 paramedics received 26,000 medical calls and made nearly 10,000 trips to hospitals. Authorities hope to trim the number of hospital runs by paramedic units by nearly 4,500 a year in the test area.

If the program succeeds in relieving paramedics while not reducing the level of care, it could be used citywide, authorities said.

Fire officials said that each time a paramedic unit transports a patient to a hospital, the crew is unavailable to take another call for 20 mintes to an hour. With only 13 paramedic units available in the Valley at any given time, dispatchers often must shuffle units around to meet the demand. Because of the increasing number of calls, there are occasions when paramedics are unable to respond to an accident as soon as they would like, officials said.

“We have two ambulances at some fire stations and they still are very busy,” said Capt. Gregory West of the Fire Department’s planning unit. “We just can’t keep adding ambulances. We are looking for a way to better manage the resources we have.”

Officials said incidents in which no paramedics in the Valley were available to take a call are rare, but dispatchers often must scramble to send paramedics when the units based nearest to the call are tied up.

“When the Valley got busy, you’d get a Canoga Park unit going to a call in Van Nuys, or a Van Nuys unit going to Woodland Hills,” said Tim Wilson, a paramedic supervisor.

The Fire Department does not tabulate an overall or Valley-wide average for response time of paramedic ambulances because of variations in geography, the location of fire stations and other factors such as time of day and type of medical assistance required.

But the department sets a standard of responding to heart attack calls within eight minutes. Officials said the average response time for most calls is five to six minutes.

West said the private ambulance program, which already is used by the Los Angeles County Fire Department, could help the city department improve its response time.

Though the first month’s results are still being evaluated, West said that between 15 and 20 paramedic calls a day were turned over to private companies. Fire officials said they are monitoring the performance of the private companies to make sure medical care doesn’t decline.

“Every single run is reviewed,” West said. “We are making sure the private service is at the same level provided by the Fire Department.”

Officials said paramedics still routinely respond to calls but follow a medical protocol in determining if the patient needs “basic” or “advanced” life support. Most basic life-support calls can be turned over to private ambulance companies. The three Valley companies involved in the program are dispatched on a rotation basis. Paramedics stay with the patient until the private ambulance arrives.

The private service costs patients only slightly more than the city service, officials said. The Fire Department charges about $113 plus a mileage fee to transport a patient to a hospital. West said the base fee of the private companies involved in the pilot program is 75 cents more, while the mileage charge varies.

West said that, so far, the only drawback to the test program is the increased workload placed on fire dispatchers who have the added duty of contacting and dispatching the private ambulance companies. However, he said the department’s dispatch center has been able to manage the problem without additional dispatchers.