Life on the Line

It is a dreaded call to make: an emergency plea for medical help. Those who make it are concerned about just a couple of things--getting help on the line immediately and having experts arrive quickly.

Unfortunately, this can’t always be assured in the city of Los Angeles. This isn’t just a dispatch problem that can be solved with new computer software. Neither can it be solved with the hiring of 100 new paramedics, as city officials now propose. Some of the faults are rooted in 30 years of history and internal prejudices. Paramedics are part of the Fire Department, and they have long had second-class status. Yet Los Angeles paramedics carry a tremendous workload--80% of the emergency calls to the Fire Department come from people requesting medical help. Attrition among paramedics is the highest in 20 years. A Fire Department psychologist told the Fire Commission Thursday that paramedics are so stressed--as evidenced by symptoms such as sleeplessness, depression and rage--that they could be a danger to patient care.

Then there’s the dispatcher problem. All of the medical emergency dispatchers are firefighters who are also rated as emergency medical technicians and who have a fraction of the training of paramedics. Too often, dispatchers have improperly assessed a medical emergency and have sent lesser-trained personnel when paramedics should have been alerted.

Solving the fire dispatch problem will require close and cooperative work especially among the city Board of Fire Commissioners, the county’s Emergency Medical Service Agency and the City Council’s Public Safety Committee. It’s good that they are tackling the problem as a group and not separately.

Already there is strident opposition to a pilot program pushed by city Fire Chief William R. Bamattre and county regulators that would place a paramedic with every fire engine company. Supporters say it would assure a paramedic presence at every emergency medical call. We think such a pilot program is worth a try, but that’s not all that needs to be done. If the fixes were as simple as just hiring more civilian paramedics, they would have been achieved by now.

By all means, hire more paramedics since those on staff are forced to work incredibly long hours, but their employment status within the department must also be elevated. Moreover, it must be ascertained precisely who among the city dispatchers is ignoring standardized questions that would help them send the right medical personnel on calls. In this case, it’s no exaggeration to say that fixing this jury-rigged emergency medical system is a matter of life and death.