Job in the Fast Lane : Firefighters, Ambulance Firm Battle Over Services

Paramedic Brian Williams saw the cluster of firefighters and teachers around a prone figure behind Ventura High and steered the ambulance up over the sidewalk, past a crowd of curious teen-agers just getting out of their first class.

As Williams knelt next to the fallen boy, a firefighter updated him on the patient’s vital signs.

The 16-year-old was experiencing some dizziness after collapsing outside the school, but otherwise was fine. Eight minutes after the school called 911, the youth was on his way to Community Memorial Hospital, needing only basic treatment and transport.

The regularity of this type of scene--about 65% of all the 911 calls that Pruner ambulances respond to require little or no medical aid--is one of the reasons Ventura firefighters want to replace Pruner Health Services, the private ambulance company that serves the county.

The firefighters say the city of Ventura would get faster and improved care if paramedic service is included in their duties. Since they are usually first on the scene, they say, why not provide all the necessary medical services?

The firefighters’ union also criticizes Pruner for hiring young and relatively inexperienced paramedics. In Ventura, their average age is 25.

In the union’s scenario, the ambulance would arrive at Ventura High along with the fire engine, a firefighter-paramedic would care for the boy, and Pruner would not make a dime.

Steve Murphy, Pruner’s chief administrative officer, disputes the union contention that Pruner’s response time averages eight minutes. Murphy said an in-house review of 1993 dispatch records showed an average response time of 5.6 minutes.

A mention of the age issue produces an exasperated sigh from Murphy.

“Look, this is a young person’s job,” he said. “I just don’t think you’re going to find a lot of people in their 40s who are going to want to get out of bed three or four times in the middle of the night. It takes a lot of energy and a lot of sheer physical strength.”

Pruner Health Services was launched in 1963 by Don and Jackie Pruner after Don Pruner bought an old ambulance on a whim. He parked it in his Thousand Oaks driveway and the business grew gradually, with the couple its only employees.

At that point, the only service they provided was transportation to the hospital. In 1975, they branched out into paramedic services. Now they have 55 paramedics working within Ventura County and 19 emergency medical technicians. Thirteen ambulances operate throughout the county during the day and 12 operate at night.

Pruner provides ambulance service for Ventura, Thousand Oaks, Simi Valley, Moorpark, Camarillo, Fillmore and Santa Paula. Ambulance service for Ojai, Port Hueneme and Oxnard is run by other private companies. Pruner also extends some limited service into Los Angeles County.

As Brian Williams sees it, the system runs smoothly, and the last thing he wants is to lose a job he loves.

He and his partner, Rob Nowaczyk, a paramedic-school graduate awaiting county certification, work 24-hour shifts out of Pruner’s central Ventura station on Loma Vista Road. Their office--the busiest of the three in Ventura--is an unmarked building next to a church.

Inside, a police scanner is always on, announcing trouble as it arises. A phone hooks Williams and Nowaczyk into Pruner’s dispatch system in Thousand Oaks.

Most of their emergency calls are with Fire Station 3 on Telegraph Road.

Because Williams and Nowaczyk work the same schedule as the firefighters--10 24-hour shifts a month--they know most of them quite well. Despite the power struggle between their bosses in City Council chambers, a trip to the fire station to partake in an enchilada dinner is still a common occurrence.

Williams, 27, has been with Pruner for seven years. During his senior year in high school he took an emergency medical-training class and liked it. After brief stints in construction and television repair, he finished his EMT training and started at Pruner.

All applicants to paramedic school, which lasts about a year for full-time students, are required to have at least six months’ experience as EMTs. Williams had about 18 months’ experience when he entered Walter S. Graf/Daniel Freeman paramedic school in Inglewood, where many Los Angeles city firefighters receive their paramedic training.

Nowaczyk, 23, also a graduate of the Inglewood program, had a more romantic introduction to the field. He remembers driving around as a child with his mother, a nurse who often stopped at traffic accidents to offer her help.

“One time it was pretty critical,” he said. “I remember the ambulance pulling up, and the door opened up, and this big, tall paramedic came out. And I thought, that’s it, I’m going to be like him. When I turned 18, that’s what I did.”

Nowaczyk worked as an EMT in Malibu for a 1 1/2 years before school, then did his required internship with the Fire Department in South Central Los Angeles. He has been certified in Los Angeles County, but has a few more steps to get certified in Ventura County. Until then, Williams performs the advanced life-support procedures.

Both Williams and Nowaczyk say they wanted to work in Ventura for the variety of medical calls they get. Although many calls are routine--such as transporting patients from one hospital to another--traffic accidents, shootings and other crime injuries provide excitement and keep the adrenaline moving.

It may sound gruesome, but the more life-threatening the call, the more the paramedics say they learn. On the other hand, neither would be eager to endure the constant stress of being a paramedic in Los Angeles County.

Days are usually more active than nights. Between regular calls, the pair sandwich in medical seminars and equipment checks, with occasional breaks for reading or watching television. They start their shifts at 7 a.m.

On a recent Wednesday morning, it was after 9 o’clock before the first call came, for the boy at Ventura High. A second call came just as the paramedics were returning to the station, this time for a toddler whose mother was worried that the child had fallen and hit her head.

Babies are the only patients that really rattle the paramedics, Williams said, mostly because the infants can’t tell them what’s wrong or what hurts.

When they arrived at her home, the paramedics found the 20-month-old child alert and crying.

“As long as they’re crying, it’s OK,” Williams said. “It’s when they aren’t making any noise that I worry. That good healthy cry is a good sign.”

The child turned out to be fine, and Williams thought she might not even have fallen.

“Maybe she slept on (her neck) funny or something,” he said, making a note on the paperwork--filed in quadruplicate--that he fills out on every patient.

Still, the toddler was brought to Community Memorial, accompanied by anxious parents. The paramedics said they probably would not have called 911 themselves if the girl were their daughter. They would have just taken her to the doctor.

“But if they want an ambulance ride, then they get one,” Williams said. “Whether they can pay or not.”

Frequently, they can’t. Forty percent of patients in the city of Ventura don’t have insurance and pay nothing, said Murphy, Pruner’s chief administrative officer. Countywide, about 26% can’t pay for the service. Patients without insurance generally end up at the county hospital.

“The Fire Department thinks Pruner makes money on every call,” Williams said. “That’s not true.”

The Board of Supervisors regulates Pruner’s fees within Ventura County. For the most basic runs, where no advanced life-support equipment or medication is used, prices range from $250 to $400. For a run using advanced life-support--where medications are administered and heart monitors are used--costs range from $500 to $800. But for patients on Medi-Cal, Pruner makes about $62.

Transporting patients is the best source of revenue for Pruner. With a base rate of $240 and a charge of $10.67 per mile, costs rise quickly. An occasional trip to the medical center at USC, for instance, will make up for the uninsured patients Pruner loses money on.

The most complicated call of the day was for a 76-year-old man who had been vomiting blood. Getting to his home in a retirement community on the eastern edge of Ventura took about seven minutes. By the time paramedics arrived, firefighters had taken two sets of heart and blood pressure rates. The man was on his back, blood splattered around his head.

Slipping on rubber gloves, Williams began the regular drill of questions: Are you allergic to any medications? Does this hurt? Can you take a deep breath for me?

Attaching patches to the patient’s torso and chest, Williams hooked him to a portable heart monitor.

Next, he found a vein in the man’s arm and began an intravenous saline drip. Once in the ambulance, Williams continued to check the man’s blood pressure and called to advise emergency room nurses on his condition.

“His lungs are clear, heart is fine,” Williams told the nurse. “He’s maintaining a blood pressure of 104 over 62. I’ve established a normal saline IV. Our ETA is four to five minutes.”

Five minutes later, the man is wheeled into the emergency room at Community Memorial Hospital.

“That the upper G-I bleed?” a nurse asked. “Bring him over here.”

On the next run to Community Memorial, the paramedics will ask about the man’s condition, but their responsibility to this patient ends with the completion of paperwork.

Some nights, nothing happens. Hours at the station are spent eating, drinking coffee, chatting on the pay phone, keeping up on new procedures--paramedics have to pass a recertification test every two years--and watching endless hours of television. On those nights, it helps to enjoy the company of your partner, which Nowaczyk and Williams say they do.

Sitting in the station drinking a weak pot of coffee made by Nowaczyk, they talked about the controversy. It’s insulting to be accused of inexperience, they said, when the firefighters haven’t had the level of training they have.

“It would be like me going up to the doctor and telling him he doesn’t know how to do his job,” Williams said. “I’m not going to do that.”

The two men say it isn’t surprising that firefighters arrive first on the scene of most 911 calls.

“We’ve got three stations; they’ve got five,” Williams said. “Of course they’ll beat us there sometimes.”

Williams and Nowaczyk say they get to the scene with or before the firefighters about 35% of the time. Citing the Fire Department’s preliminary proposal to buy just three ambulances, they said they do not see how response times would change.

The men also see their youth as an advantage. Being a paramedic requires not just energy but strength. Each paramedic has to be able to lift a patient alone, regardless of the patient’s weight.

“You know, the paramedic chief from Los Angeles came up here and said he thought Pruner did the best job that a private ambulance company could do,” Nowaczyk said. “I find that insulting because I trained with his department. How am I different from his paramedics?”

When socializing with the firefighters, the controversy does come up. But they say discussions remain friendly.

“Everybody’s pretty professional,” Nowaczyk said. “We’ll talk about it, but our fieldwork is not being hampered one bit.”

What the whole thing comes down to, Williams said, is money.

“I can’t knock the firefighters for what they’re trying to do. They’re just trying to put more money in their pockets.”

Pruner paramedics and county firefighters receive similar salaries, starting at about $30,000 for Pruner paramedics and $32,000 for firefighters. Overtime wages usually drive yearly incomes up considerably for both.

If firefighters did take over paramedic service, both said they would probably lose their jobs. Neither wants to be firefighters, and they said it’s very unlikely they would be hired by the Fire Department anyway.

“All I’ve ever done is EMS since I was 18,” Nowaczyk said. “What would I do?”