Alternative Paramedic Deployment

Long Beach Fire Department

Current system of Paramedic deployment has been in place in Los Angeles county since 1968. Long Beach established Paramedic program in 1972 Since 1972, EMS has grown to account for 85% of overall workload for Long Beach Fire. In California there are 32 Local EMS Agencies (LEMSAs) that govern prehospital emergency care. 28 of the 32 LEMSAs offer alternative deployment models to what is currently required in Los Angeles County. Orange County, Los Angeles County, Contra Costa County and Santa Cruz are the only 4 LEMSAs that require two Paramedics to ride to the scene on the same apparatus. Since 1972, Long Beach has been a leader in pre-hospital emergency care in the County and State. Long Beach Fire believes that two Paramedics on an Advanced Life Support (ALS) call is good for patient care. How the two Paramedics arrive on the scene is of little concern to the public, they just want to know that when they call, we will arrive with qualified people in a timely manner. Front line Engines and Trucks play a crucial role in pre-hospital emergency care. Over the last 6 years, due to budgetary constraints, Long Beach Fire has reduced 4 Engines, 1 Truck and 1 Rescue ambulance. The compounding effect of these reductions makes it important that the resources that remain are adequately staffed and can handle most calls with just the first arriving unit. Four person staffing on our apparatus allows for the first arriving unit to handle most calls with the first arriving unit alone. Diminished budgets call for creative thinking in how to best deliver service with fewer resources and dollars. Over 85% of costs associated with delivering service for Long Beach Fire are personnel costs. Our existing system utilizes 16 Engines, 4 Trucks and 8 Paramedic Rescue ambulances. We also deploy 3, full time BLS ambulances and 2 part time BLS ambulances. Of the 16 Engines, 9 of them have a Firefighter/Paramedic on board, making them Paramedic Assessment Units. The proposed system would retain the exact same number of Engines and Trucks.

The new system would place a Firefighter/Paramedic on every Engine in the City, making the entire system a Paramedic Assessment Unit system. The new system would increase the number of Paramedic Rescue Ambulances from 8 to 11. Data has shown that 11 fully functional ALS ambulances will be able to manage the system. Contingency plans have been made to add additional ambulances if needed. The new system would utilize a Fire Department, BLS ambulance operator, to drive the ambulances instead of a Firefighter/Paramedic. The Firefighter/Paramedic that is currently assigned to the ambulance would be re-deployed to the Engines, maintaining four person staffing. Currently the Fire Department has 25 vacancies in the Firefighter rank that are filled daily with overtime. The new system would reduce the number of vacancies daily by 5 and would eliminate overtime staffing. No existing Firefighters would be laid off or lose their positions under this new deployment. The new system would achieve faster on scene times, citywide, for Paramedics by over 40 seconds on average. Every patient that requires transport to a hospital in the City will be evaluated by two Paramedics. Every Patient in the City will have a Paramedic with them from the inception of the call to delivery at a local hospital. There is no data that exists, at any level, that suggests that Paramedics are more effective if they arrive on the scene in the same apparatus. The proposed system is done throughout the state and has proven to be effective and good for patient care. The medical Director from the County and our Medical Director for Long Beach Fire have agreed that this proposed system is worth studying and will provide for good patient care. In the four LEMSAs that prohibit alternatives, there is a system of a single Paramedic form of patient transport in place every single day, and has been for over 40 years. Los Angeles County, Orange County, Contra Costa County and Santa Cruz all transport patients with a single Paramedic in the back of the ambulance daily. Under this new system, we will continue to deliver 6 Fire Department employees to the scene of a medical call. 5 Firefighters and 1 Fire Department Ambulance Operator. Many other agencies in Los Angeles County only send 5 Firefighters to the scene of a medical call. The existing system of deployment has never been evaluated, for effectiveness, in over 45 years of existence. This new deployment model gives the Fire Department the ability to augment our resources for half the cost of the current program. Our focus must shift to EMS as it accounts for 85% of our workload.

98% of the time, an ALS level patient is transported to the hospital with a single Paramedic in the back of the ambulance, while the second Paramedic drives the ambulance. In those situations that require two Paramedics in the ambulance during transport, we will utilize the exact same system that has been in place since 1972. This new program allows us to reduce the cost associated with patient transport, reduce overtime and better deploy our resources to meet the need of the community. This program is not a 1 & 1 system as has been widely reported in the local media. This program is much different and much better than the program put forward by Los Angeles in 1997.