Fire Dept. Plan for Better Medical Call Response Unveiled

Citing a growing crisis in emergency medical care, the Los Angeles Fire Department unveiled Thursday a three-year trial plan aimed at improving response time and patient care by expanding its resources and shifting calls from overburdened paramedics to firefighters.

The proposal calls for adoption of a medical protocol to sort out requests for medical aid and then dispatch either paramedics with advanced life-support skills in serious situations or firefighters with emergency medical service (EMS) training in so-called “Band-Aid” cases.

In addition, rescue ambulances staffed with two EMS-trained firefighters and paramedic engine companies would be deployed in the high-demand areas of the metropolitan district and eastern San Fernando Valley to handle the basic life-support cases, thus reducing the workload of paramedic units assigned there.

‘Want Best System’

“We’re taking on emergency medical service as a major component of the department and involving every element in it,” Fire Chief Donald O. Manning said. “Now we’re saying we want the best system in the country.”

Assistant Fire Chief S.A. Lenz outlined the proposal to the city Fire Commission, which took it under consideration after a lengthy hearing held at Parker Center because of a large turnout of paramedics and firefighters. The plan, if approved by the commission, would be sent to the City Council for its approval.

There were indications Thursday that the proposal will meet opposition. A United Paramedics Union of Los Angeles official suggested that the program will end up in court.

The plan was offered in response to a City Administrative Office report last month that cited unacceptably slow response times, especially in heart attack cases, and called for basic changes in the way emergency medical services are provided to Los Angeles residents.

CAO auditors reported that 49 ambulances in the Fire Department’s 103 stations were dispatched on about 200,000 incidents last year and that paramedics were sent on virtually all of the calls, many of which were first-aid cases.

The report recommended development of screening questions, called protocols, for dispatchers to identify the severity of emergency cases and suggested that the nearest available unit with EMS-trained firefighters should respond to low-level medical calls, which do not require paramedics.

The Fire Department’s proposal, drafted by a special Fire Department task force, embraced an adapted version of Clawson Dispatch Protocols, used by hundreds of cities throughout the country.

But the plan snubbed the CAO’s suggestion that the nearest firefighting unit be assigned to low-level medical calls, opting instead to create “new EMS rescue ambulances” by reassigning 18 ambulances now manned by paramedics.

By the fourth and final phase of the plan in March, 1991, the department contemplates that there also would be 10 paramedic engine companies to handle calls in the city. The proposal also calls for equipping all fire companies with automatic defibrillators, used in heart attack cases.

“Patient care and survival rates will be dramatically improved by the ready availability of this procedure citywide,” the department said.

Assistant Chief Lenz said the system will improve patient care, reduce response times, preserve paramedic skills for life-threatening cases, redistribute the EMS workload and preserve effective fire protection.

As proposed, the plan would begin on July 5 and be implemented in steps. The training of firefighters-paramedics, a new job classification for the department, would begin in October.

The cost through 1991 is estimated at $2.4 million, but Manning said it can be met out of the Fire Department’s current budget.

The president of the United Paramedics of Los Angeles, Fred Hurtado, advised the fire commissioners to proceed cautiously in considering the proposal. He reminded them that there have been about a half dozen other EMS proposals over the last several years.

“It’s a huge report,” Hurtado said in an interview, “but it’s basically a shell. It acknowledges the basic changes that are needed but then the operational plan set forth won’t get us there. It’s a rehash of hybrids that have been tried before.

“It raises significant labor issues that, if the plan in its current form is implemented, would ultimately be resolved in courts on the labor issues. It invades our bargaining unit work.”

He said he supports the CAO’s recommendations that the closest firefighting unit should respond to low-level medical emergencies.

Speaking for the United Firefighters of Los Angeles City, Kenneth E. Buzzell, first vice president, told The Times, “If that’s what the city wants to do (the Fire Department proposal), we’re willing to talk about it, but we’re going to ask for more money because they’re asking to increase our workload.”

The Fire Department reported that it recognized that elements of the plan might “raise issues of collective bargaining.” But it said the issues would be subject to negotiations with the unions.