Despite some backlash from the firefighting community, the Long Beach Fire Department maintains that a new EMT procedure that was implemented about two weeks ago is running smoothly.
The new two-year pilot program, known as Rapid Medic Deployment (RMD), was first used by the fire department on July 10 and moves from the use of two paramedics per fire engine to one. LBFD Chief Michael Duree said that because of this, each fire truck and ambulance is now equipped with a paramedic, making calls to service faster.
Prior to the program, Duree said, the department had eight paramedic rescue Advanced Life Support (ALS) ambulances—for life-threatening incidents—which were staffed with two firefighter paramedics. In addition to that, it also had three 24 hour Basic Life Support (BLS) ambulances—for minor, treatable incidents—which were staffed with licensed emergency technician staff who had the same training as a firefighter but were non-sworn employees.
"So for every paramedic rescue ambulance we have, we have three people assigned to it, so that third paramedic would be on one of the nine fire rescues," Duree explained. "That's how we ran it for 20 plus years. So, with this program, what we did was took that second paramedic off the ambulance and put him or her on the remaining fire engines that didn't have a paramedic. So, now every fire engine has a paramedic on it. We replaced that paramedic on the ambulance with one of the EMT ambulance operators, a non-sworn EMT driving the ambulance. At the core of that was an effort to maintain four-person staffing on our engines in 2011 because there was a budget savings that we achieved by doing that."
Today, the fire department has 11 ALS units—adding three to the previous eight—and two peak-load BLS units for busier times. Those two BLS units were added to the department Thursday, Duree said.
"It was a way to free up our ALS units so they can continue to run high priority calls," he said. "It's a very cost-effective way to keep our highest-ranked medical care providers available in the field. Why do we need to have an extra paramedic drive the ambulance when he or she would be better placed on a fire engine so they can respond to a different call? "
While there is one less BLS unit, he said, the amount of ALS units will compensate for that and make quality better since all paramedics now have ALS training.
The new RMD program was a long time coming, Duree said, adding that it was something the department had been working on for two-and-a-half years.
"It was very open and transparent process with management folks, labor folks, the nursing community, the physicians groups, everybody," he said. "We've done a lot of work here behind the scenes on making sure through fire operations that the transition would be seamless."
Duree said the fire department still answers the same amount of calls they were answering before, and the same types of calls. He said he recognized that the new system may make some people nervous, including firefighters and residents, but he ensures this was the right decision.
While this concept is new to Long Beach and Los Angeles County, it isn't new to California. "We didn't reinvent the wheel here," Duree said. "This program has been in place in California since the 1970s and is in place all over California. In California, there are 33 local EMS agencies. Of the 33, 29 of them operate the program we have now. It saves us $1.4 million a year."
Rex Pritchard, president of the Long Beach Firefighters Association, said he did not agree with the new RMD system. He said he worried about how it has been affecting patient care.
"Two paramedics are needed on scene to offer a full paramedic scope of care, with one on scene waiting for the second to arrive, the capacity and effectivenes of the single paramedic is greatly reduced," Pritchard said.
In response, Duree said two paramedics do still arrive to every scene, just on different apparatus, like fire engines or ambulances. He said this allows for fewer units to be available for a BLS case that one paramedic can manage and open up the opportunity for an EMT to move to an ALS case if they are needed elsewhere.
Pritchard also said the response from the public has been generally negative, as well, because of the response time it takes for a second ambulance to get to the scene. Duree maintains that both ambulances arrive at a scene, separately, within the eight-minute required response time.
"The measure is very difficult to quantify because patient outcome is predicted on so many factors," Pritchard said. "But people who have serious medical conditions and/or major traumatic injuries can see first-hand that this system waters down the efficiency of the old model and is not as effective on the more critical incidents. That is when time counts."
While the RMD service has been used throughout the state for decades, Pritchard maintains that that means very little in the long term.
"Fire departments up and down the state realize that mixing sworn and non-sworn personnel on the same ambulance is a bad service model and they don't operate in the fashion that Long Beach has," he said. " ... [Individuals] realize what we are living through are inefficiencies and liabilities, some foreseeable and some not, some measureable and some intangible, but none the less a model that no fire department should advocate."
Duree believes the model will prove successful and said he does not blame people for being wary.
"This change is a big cultural impact to the LBFD, no question," he said. "The reality is our people, although they may not like the change, are good at what they do, they're very hard-working and they're very dedicated. Despite their not liking some new program, they put their heads down and work hard to serve the community well regardless."
Of the 33 local Emergency Medical Services (EMS) agencies in California, 29 operate a program similar to Rapid Medic Deployment. Map courtesy of Long Beach Fire Department.