Paramedic System Plagued by Problems, Official Says

The Los Angeles Fire Department’s chief medical director testified Thursday that severe problems exist at every level of the city’s paramedic operations, from recruitment to a culture within the agency that treats the emergency crews as “second-class citizens.”

During a special session of the mayor-appointed Fire Commission, Dr. Marc Eckstein said there is such a severe shortage of paramedics that some are burning out from stress, letting their credentials lapse. Others, meanwhile, are compelled to pick up the slack, sometimes working up to 100 consecutive hours. As a result, he said, the quality of treatment can suffer.

“It’s unconscionable,” he said. “They should never be forced to work overtime.” He said that, overall, paramedics do a good job, especially considering the challenges they face.

Eckstein--a former New York paramedic and emergency care physician at County-USC Medical Center--provided his stinging assessment during a four-hour hearing filled with wrenching stories of things gone bad on the front lines. About half a dozen paramedics offered testimony that seemed, for some, as much cathartic as informational.

The session represented the first time in more than a decade that city officials had initiated a top-to-bottom evaluation of paramedic services, the arm of the Fire Department that most touches people’s lives. Eighty percent of the agency’s calls are for emergency medical help.

As paramedics and firefighters took turns addressing the panel, they told stories of fouled-up dispatches, delayed arrivals and one person who may have died because emergency personnel were stretched too thin and couldn’t arrive in time.

“If something isn’t done quickly,” warned veteran paramedic Art Sorrentino, “the house of cards will fall.”

Paramedic Ron Myers, a 20-year veteran, said he’s been shot at, bitten, spit on and punched out on the job.

“I’ve responded on about a thousand homicides, attempted homicides, dozens of suicides, dead kids, mutilated and dismembered bodies. Virtually any type of mayhem your mind can imagine,” he told the panel.

Although he said he’s still on board, many of his colleagues are bailing out. As problems have mounted, he said, the blame has tumbled down from the brass to the paramedics in the field.

“But it’s time this administration look around and ask, ‘What’s wrong with the ship?’ ”

One day, when he was not working, the weight of his job sunk in. He told the commission he was at funeral, staring at rows of headstones, and realized that he had pronounced more children dead than there were gravestones surrounding him.

Myers had to stop in mid-sentence to regain his composure. “I hate it when this happens,” he said.

Another veteran paramedic, Ralph Wintermute, said problems with dispatching have been going on for 25 years.

Wintermute said paramedics are often dispatched to emergencies alone when more backup is needed. “Sometimes,” he said, “there’s no rhyme or reason to the dispatch.”

In fact, the Fire Commission hearing followed disclosures in The Times that the department’s paramedic operations have been hampered by repeated errors in the way rescuers are dispatched. In some cases, instead of paramedics, dispatchers have incorrectly sent emergency medical technicians, who have one-tenth the training.

The dispatching breakdowns have been tied to at least three recent cases of patients who died.

On Thursday, yet another death was disclosed by Capt. Ken Buzzell, head of the city firefighters union. He said the problem was not an erroneous dispatch but a shortage of paramedics.

Buzzell said that last month a South-Central Los Angeles woman needed help. The ambulance closest to her home was covering a call for a unit in another area, where there was a lack of paramedics.

As a result, an ambulance from yet another neighborhood had to be sent to the ill woman. Buzzell said that, by the time rescuers arrived 11 minutes later, she was in cardiac arrest. The average response time should be several minutes less.

“Her chances of survival,” Buzzell told the panel, “went down to virtually zero when the response time went [to] 11 minutes.”

Department officials said after the hearing that they were unaware of the incident described by Buzzell.

To help deal with paramedic shortages, medical director Eckstein said the department needs to change its hiring practices and immediately bring on board 100 paramedics who can quickly be sent out in the field. Currently, he said, department policy requires that all recruits--including those already certified as paramedics--first be trained as firefighters. But that process typically takes 18 months.

Fire Commission President David Fleming said the panel will rely heavily on Eckstein as it drafts recommendations for changes after two more public hearings.

Although Fire Chief William R. Bamattre said he did not agree with all of Eckstein’s proposals, he said he was pleased with the hearing.

“It’s a good start,” the chief said. “We got people talking about the problems.”