It was a million-dollar gamble. The City of Long Beach now has just a couple of weeks to wind down the controversial Rapid Medic Deployment (RMD) Pilot Program, now that LA County has given the non-negotiable order to end it by Oct. 1.
According to Fire Chief Michael DuRee, ending the program means that the number of rescue ambulances will be reduced from 11 to eight, and it will also affect how the fire engines are staffed. DuRee told the Long Beach City Council at their meeting on Sept. 1 that they currently have a firefighter-paramedic on every fire engine in the city, and now they are planning to reduce that number to nine engines in the city.
The impact to the budget has been estimated to be $1.4 million, according to budget manager Lea Eriksen. According to her report last week, the City will track the first-responder fee revenue that will be collected in the 2016 fiscal year to help reduce the additional cost to the department, and the fire department will be expected to make other adjustments to their budget in order to minimize the impact. Eriksen also noted that usually at the year end, there are savings in the budget, and she recommended that the fire department reserve $1.4 million out of any savings from the fiscal year-end 2015.
Although it took a while to become a reality, the RMD program has only been implemented since 2014, according to a presentation by DuRee. Long Beach initially submitted the pilot project proposal in 2013, and it was vetted by various committees, stakeholders and the Emergency Medical Services Agency (EMS) of Los Angeles County. One of the major changes that the fire department made under the pilot program involved how paramedic and non-paramedic personnel were deployed and whether they would be on a fire engine or an ambulance.
Eighth District Councilmember Al Austin specifically criticized how EMTs, or emergency medical technicians, were paired up with firefighters.
“The idea of putting a sworn firefighter on a rig with a non-sworn EMT was fatally flawed,” Austin said.
The EMS Agency sent an official letter to DuRee, highlighting several areas of concern.
According to the EMS, the City’s rescue ambulances are being operated by newly trained paramedics and EMTs with less experience, and they lacked oversight by more experienced personnel. In addition, the EMS voiced deep concern with the process of separating the paramedic personnel and allowing them to ride in different vehicles.
“Prolonged arrival of the second paramedic,” the letter stated, “while occurring intermittently, delays the transport of patients requiring advanced life support and results in the first paramedic choosing between waiting for the second paramedic to arrive on scene or transporting with only one paramedic, which is outside of the policy.”
According to the letter, the EMS medical director reviewed 269 records and found that 48 percent had “significant concerns about patient stability in the field, which may have prompted paramedics to transport instead of waiting for the second paramedic.”
“These issues are too great to ignore and pose immediate threat to patient safety,” the letter concluded, effectively terminating the program.
Steve Shea is the chief architect of the paramedic program for the City of Long Beach and the medical director for the St. Mary Medical Center. He disputed the conclusions of the EMS at last week’s council meeting.
“We have not uncovered one case where a patient was put in jeopardy because we didn’t have two paramedics in the back of the ambulance,” he said, adding that the County didn’t uncover one case example either. Along with DuRee, he praised the successes of the pilot program and disputed the number of fallouts that the County had examined. Under the new system, he said that paramedics were getting to the scene faster.
“I still believe it’s a better system,” Shea concluded.
Vice Mayor Suja Lowenthal did not encourage the council to pursue the Agency’s concerns voiced in the letter.
“I believe it was a good effort,” Lowenthal said of the fire department’s work to implement the pilot program. “I believe in our data. I don’t want to dispute our own staff information at this time. I don’t think that that’s healthy to do that. And I also don’t want to go line for line into what the letter indicated. That’s not what we are called to do today. We are called to move forward, and we are called to move forward in a very judicious way.”
DuRee acknowledged his own feelings at how the program was quickly terminated.
“This is a profound disappointment for me and my staff as well,” DuRee said, as he acknowledged the work of his staff and concluded that they will not fight the allegations of the EMS and will revert back to the old system.
“But I don’t want to diminish the!good work that our folks did,” he added. “We took a very bold step at a very uncertain time, given our budget, given a series of reductions that impacted our operational capability, and I just don’t want to minimize the impact and the chance that our folks took to do the right thing for the city.”
DuRee submitted a memo to the city manager’s office on Sept. 4, offering a progress report of just how the department will terminate the RMD program. In his memo, he noted that they are using a system to make “data-driven decisions” on where the paramedic ambulances and the fire engines with paramedics will be eventually located. They have also contacted the human-resources department to initiate talks with the International Association of Machinists and the Firefighters Association. He noted in his letter that they will be determining “how many firefighter-paramedic positions will be changed to firefighter positions.” The memo also indicated that it will be evaluating “the need to send firefighters to paramedic school.”
DuRee referred the Signal Tribune’s interview requests to the city manager’s department. Deputy City Manager Arturo M. Sanchez said that the City has not determined a new deployment model to demobilize the RMD.
“We have until Oct. 1 to complete our demobilization and are working quickly to determine the appropriate model and the appropriate deployment that will allow us to put our resources out in the best manner for the safety of our residents,” Sanchez said in a telephone interview.
