An internal report by Los Angeles Fire Department paramedics says the agency's brass took four years in the mid-1990s to abandon a flawed deployment strategy that "cheated people out of full medical service and jeopardized lives."
The 1997 report says the strategy--which emphasized firefighting readiness over emergency medical care--may have affected more than 4,000 patients who died during that time.
Under the strategy, firefighters on engine companies were sent to fewer serious medical emergencies, in order to reduce their workload. This meant that paramedics did not have the initial backup they felt necessary to save lives. In some cases, engine companies could have arrived more quickly than paramedic units, possibly preventing deaths.
"The real tragedy," according to the report, "is that the [medical] data was there from the beginning and the administration never looked for it. Thousands of medical rescues were needlessly impaired."
In fact, the report states, paramedics had been filing departmental complaints about their experiences for several years, beginning in 1993. As one of the rescuers said on a "feedback" form: "Stop killing patients!"
The internal report states that Chief William R. Bamattre refused to immediately suspend the deployment strategy after the damaging effects were brought to his attention in 1996. His reported reluctance to do so prompted the investigation by a coalition of paramedics.
Even after receiving the report, the chief "seemed neutral about it," said Robert Linnell, president of the Los Angeles Paramedic Assn. and one of study's authors. He said he presented the report to Bamattre over lunch.
The chief said Friday that he could not recall seeing the report or receiving any earlier warnings of dangerous problems in the field. He said he ordered the deployment dropped as soon the department's medical director recommended a new approach, about two weeks after the report was circulated.
Now, at least two paramedics in an ambulance and four firefighters in an engine respond to the kinds of serious emergencies detailed in the report, such as seizures and chokings.
"We've made dramatic changes as fast as possible," the chief said. "And I would challenge anybody to show that we have a lack of commitment to deal with those [emergency medical service] issues."
Although the controversial deployment practice was abandoned, paramedics say problems continue because the underlying philosophy has not changed: Emergency medical crews are valued less than employees who fight fires, although 80% of the department's calls for help are medically related.
Critics say the department's weak commitment to paramedic service is evident in the agency's upper ranks, which are overwhelmingly dominated by firefighters with no paramedic experience.
The department's medical advisor, Dr. Marc Eckstein, told a recent session of the civilian Fire Commission that paramedics are treated like "second-class" employees.
"Where is that [medical] expertise high up on the chain of command?" he asked the commission, which is conducting a comprehensive review of paramedic problems.
To help address that issue, Bamattre said Friday that he hopes to place a trained paramedic in the position of new assistant chief to help monitor medical services and deal with outside agencies that oversee emergency medical care.
The controversies about the quality of emergency medical care--from dispatching to recruitment--spilled Friday onto the City Council.
Four members introduced two motions calling for the immediate hiring of at least 100 paramedics. The co-authors of one motion head the council's most influential committees, Public Safety and Budget and Finance.
"Everybody is looking at it and coming to the same conclusion: We need more paramedics on the job, and we need to find a way to hire them," said Councilwoman Cindy Miscikowski, who heads the public safety panel.
"I want to see these changes happen. The first obligation of the city is to keep people safe," said Councilman Michael Feuer, head of the budget panel. "No one has time for empty academic exercises."
Feuer and Miscikowski want to pay for the new paramedic positions--estimated to cost $14 million to $18 million--out of the city's reserve fund.
Also introducing a motion for an infusion of new paramedics was Councilman Joel Wachs, a mayoral candidate. "Some have said we should consider long-term solutions rather than quick fixes," he said. "They're wrong. We need both. And we need them now."