Dispatching of L.A. Paramedics May Be Revamped

Los Angeles Fire Chief William R. Bamattre said Monday that he is considering scrapping the way paramedics are dispatched in some emergencies and creating a “fail-safe” system that ensures rescuers arrive with enough backup.

“We are creating an opportunity for error,” Bamattre said of the current procedures. “And my goal is to eliminate those opportunities.”

The chief’s comments followed a report in The Times on Sunday detailing a Van Nuys mother’s futile struggle to save her 2-month-old son in the back of a speeding ambulance. She was drafted into the life-saving effort because only two paramedics--with no firefighters to help--were sent to her home Sept. 19.

A Fire Department dispatcher who took the call classified it as being about a “sick person,” even though he was told the baby was unresponsive, pale, cold, having trouble breathing and recovering from heart surgery.

Because one paramedic had to drive, Bamattre said, the other did the right thing by enlisting the mother’s help. Despite her lack of training, she was made responsible for keeping a mask over the baby’s mouth and squeezing air into his lungs.

Questioned by reporters, the chief acknowledged that the mother should not have been placed in that position.

“The parent should not be involved in the medical procedures in the back of the van,” Bamattre said after addressing the City Council’s Public Safety Committee, which is examining dispatching errors and proposed reforms.

After reading a transcript of the call, the chief also said his first impression was that the dispatcher appeared to be arguing with the father over the severity of the child’s condition.

“There’s no excuse for attitude issues,” Bamattre said.

The incident is under investigation by the Fire Department.

On Monday, Bamattre told council members that he has ordered the agency’s medical director to examine ways of simplifying dispatches so paramedics are not left short-handed in the field.

One option is to lower the threshold for a full-emergency response of two paramedics in an ambulance and four firefighters on an engine. The chief said this “fail-safe dispatch” would apply to all but the lowest level emergencies.

In theory, this also would cut down on the medical assessments that dispatchers have to make over the telephone, often under difficult circumstances.

At the same time, this proposed change in dispatching would ease the pressure on those calling the Fire Department. Frequently distraught, they may not have clear answers to questions being asked by dispatchers to determine the level of help needed.

The downside of the proposal, Bamattre said, could be a “dramatic impact” on the agency’s workload because more fire engines would be sent on medical calls.

As part of the probe surrounding the infant’s death, Bamattre said, officials are examining whether a communication foul-up may have led to fewer rescuers at the scene.

The dispatcher who took the call initially classified it a lower level emergency and sent two firefighters--who were not paramedics--in an ambulance. Seconds later, the dispatcher decided the case was more serious than he initially thought and ordered that a paramedic ambulance be sent. It arrived alone, however, because the first squad had been turned back.

Bamattre said it is unclear whether the dispatcher wanted the first squad to continue to the scene or whether the call was canceled by a nearby colleague who was responsible for actually sending the emergency crews.

The dispatch breakdowns are among the most persistent troubles in the city’s emergency medical system, now the focus of reviews by county health officials and City Hall.

The department also is struggling with a paramedic shortage so acute that rescuers are sometimes forced to work up to 100 hours straight. More than one-third of paramedics are suffering serious stress that could affect patient care, and their attrition rate is at its highest level in 20 years.

To begin addressing the heavy workload, Bamattre told council members Monday that he hopes to have 50 new paramedics in the field by mid-December.

Half of the new hires are part of an emergency plan recently announced by Mayor Richard Riordan.