Proposal Targets Paramedic Shortage

Faced with a shortage of paramedics willing to work on ambulances, Los Angeles Fire Department officials plan to experiment with a new way to assign paramedics in the San Fernando Valley next year.

Fire Chief William Bamattre’s proposal would staff all advanced life-support ambulances with one paramedic and one firefighter trained as an emergency medical technician, splitting up the paramedic teams that now operate in pairs.

The shuffle will not only help bridge the shortfall, Bamattre said, it will avoid unpopular reassignments and cut response times--a politically explosive issue in the Valley.

Paramedics and firefighters oppose the idea, and contend it will hurt emergency medical care.

And while most big-city emergency medical service agencies in the nation--as well as those in every California county except Orange--use staffing systems similar to the one proposed for the Valley, many emergency medical experts and patient-care advocates side with the paramedics.

“They’re going to water down the system and spread paramedics thinner across the city,” said Evie Anguiano, president of the county Assn. of Prehospital Care Coordinators, a group representing hospitals that direct paramedic care in the field.

The controversy comes at a time when the Fire Department is called upon to save victims of car accidents, heart attacks and other medical emergencies far more than it’s summoned to battle blazes.

Today, nearly 80% of its calls are pleas for medical service--and more than half of the patients treated require an ambulance, according to city records.

Yet the department is having trouble finding paramedics who want to work the grueling, round-the-clock, fast-paced shifts on ambulances. The tough workload--and a department culture that many veteran paramedics say favors firefighting over emergency medicine--is such that most emergency staffers prefer working on fire engines, leaving vacancies on ambulances that paramedics now must work 140% of their regular shifts to fill.

If Bamattre’s plan is approved by the Los Angeles County Department of Health Services, the Fire Department in July will launch a one-year trial program in the Valley--the area with the longest paramedic response time in the city.

Under the new plan, the first paramedic would arrive on scene in six minutes and 33 seconds, instead of the current average response time of eight minutes and four seconds, according to department projections.

Rise in Number of Valley Paramedics

The change would slightly increase the number of paramedics assigned to the Valley, from 150 to 156. More significantly, it would alter the way paramedics are dispersed across the Valley, where five stations now have no paramedic resources and borrow from nearby stations in emergencies.

At least one paramedic would be assigned to each of the Valley’s 35 fire stations, with the majority working on fire engines and the rest on ambulances. For calls requiring advanced life support, two paramedics traveling on different vehicles would meet at the scene to provide care, a so-called “one-plus-one” system.

“What I can guarantee . . . is that with the majority of calls, I’ll be able to get a paramedic there sooner,” Bamattre said.

The proposal, still being fine-tuned by fire officials, has already sparked fierce opposition. Critics say shaving a minute or two off response time won’t make up for the diminished quality of care a single paramedic would provide.

The Los Angeles Paramedics’ Assn., Los Angeles Firefighters Assn. and United Firefighters of Los Angeles all oppose the change, arguing that it would deprive paramedics of “the second pair of eyes” that their highly trained partners provide in life-or-death emergencies.

Being paired with an emergency medical technician, or EMT, who has about one-tenth the emergency medical training that paramedics have, and meeting a second paramedic later at the scene is not enough, they say.

“The concern of the paramedics is that they’re going to be hung out there to dry alone,” said Fire Department Capt. Robert Linnell, interim president of the paramedics’ association.

“They know all it takes is one case with a critically injured child when you’re out there alone, and the responsibility of saving a life falls squarely on their shoulders. I’ve had paramedics tell me that if it comes to that, they will drop their license--that they will not practice in an urban area as busy as Los Angeles if they’re put out there alone with just an EMT partner.”

Dr. Marc Eckstein, the department’s medical director, countered that the new approach would be better than the status quo.

“I think the one-plus-one system has medical merit and will save more lives than the current system, until such a time as we can get more ambulances and more paramedics,” he said.

The debate is complicated by a lack of data showing medical outcomes for patients treated under the different systems.

“There is no science to prove either side’s contention, which unfortunately leaves it in the political arena,” observed Jim Page, publisher of the Journal of Emergency Medical Services.

There are no national standards that recommend a specific number of paramedics per vehicle.

In California, the state Emergency Medical Services Authority requires only that if advanced life-support service is available--and some jurisdictions only offer basic life-support service--at least one paramedic must be present, spokeswoman Shirley Tsagris said.

Bamattre has stated he already has enough paramedics on staff--there are about 500 in the department, with more than 300 of them dual-trained as firefighters. The problem, he said, is that most of them would rather work on fire companies where the workload is lighter and opportunities for promotion have traditionally been better.

Complaints of Being ‘Second-Class Citizens’

In Los Angeles, where the Fire Department has managed emergency medical service since 1970, some paramedics speak bitterly of being “second-class citizens” in a department they say has long prized firefighting over patient care.

Former Deputy Fire Chief Alan Cowen, who served as the department’s chief paramedic from 1987 to 1996, said the system is in “critical condition.” Now retired, Cowen said as chief paramedic he requested new ambulances each year, particularly in the Valley, but never got them.

“I would be very supportive of a one-plus-one concept if the Los Angeles Fire Department could do it right, but they can’t,” Cowen said.

“We need to have EMTs--and those are firefighters--who want to work on the ambulance. But the minute they’re put on the ambulance, they’re no longer one of the guys. It’s us versus them. . . . If you’re not a firefighter, you’re nothing. 1/8That attitude 3/8 permeates the entire department.”

The bottom line, Fire Commission President David Fleming said, is that the city’s 113-year-old Fire Department is today more of an emergency medical department, but the staff levels and attitudes have yet to reflect the change.

Fleming said the one-plus-one system is “not the best program, but it’s better than what we have now.”

“Our real problem,” he added, “is we are terribly short of paramedics . . . 1/8but 3/8 the traditional firefighter thinks of himself as the gung-ho Marine who goes charging into the burning building.

“Driving around picking up sick people and taking them to the hospital isn’t what they signed up for,” he said. “It’s not the macho thing. But it’s what the public needs.”

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Reassigning of Paramedics Proposed

The Los Angeles Fire Department has proposed a plan for the San Fernando Valley that would reduce the number of paramedics assigned to each vehicle and increase the number of paramedic vehicles from 30 to 52.