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‘Rapid Medic Deployment’ Model Debate Continues

County Committee May Approve Draft Policy At February 20 Meeting

Tiffany Rider - Senior Writer

February 12, 2013 – Because the proposed rapid medic deployment (RMD) paramedic model for Long Beach has not been studied, Los Angeles County’s Emergency Medical Services (EMS) Agency is working to approve a policy that would allow testing of the model as a pilot program.

“What is being proposed is a change in configuration, but the response would be the same,” Dr. William J. Koenig, medical director of the EMS Agency of Los Angeles County, told the Business Journal. Koenig is working with the agency to address concerns about the model and the process by which the county would allow it as a pilot.

Prior to the Long Beach City Council’s adoption of the annual city budget in September, which included allowing the fire department to pursue the new paramedic model, Fire Chief Mike DuRee sent a letter to Koenig explaining his reasoning for seeking approval of this pilot study.

A reenactment of a call for service by engine and paramedic rescue
personnel from Long Beach Fire Station 10. Long Beach Fire Chief Michael DuRee
is proposing a new paramedic model he said would address budget cuts
while maintaining patient outcomes. (Photograph by the Business Journal’s Thomas McConville)

“Since it’s inception the department has maintained two-paramedic staffing on all its ALS (advanced life support) units, per agency policy,” DuRee wrote in the August 31 letter obtained by the Business Journal. “This system, while intuitively good for patient care, is costly and lacks sufficient data to prove its effectiveness or necessity.”

The letter continues, “In an effort to continue the high level of patient care we seek to provide and to manage the forecasted budget reductions, the City of Long Beach and Long Beach Fire Department are seeking approval from the Los Angeles County EMS Agency to employ a pilot study program to determine if it is feasible to change the current practice of deploying two firefighter/paramedics (FF/PM) on a single ALS unit, to the response of these personnel on two separate units; one on the rescue and the other on a paramedic assessment unit. This will necessitate that every rescue in the department be staffed with a FF/PM and a single function EMT (emergency medical technician)-basic.”

Fire departments across Los Angeles County currently participate in a voluntary program staffing two paramedics per paramedic ambulance. Koenig said he doesn’t know of any literature on this configuration and has not seen any studies on effectiveness of RMD in maintaining response times and current patient care levels. At the same time, there has not been a study of the existing model for comparison purposes – as addressed in DuRee’s letter. Thus, while DuRee “wants things to be moving faster,” Koenig said, it will take four to five months before the paramedic deployment model pilot would be approved and ready for implementation.

In fact, Koenig wrote a response to DuRee on October 4 stating, “We would like to work with LB [Long Beach] on the proposal; however as stated in your letter, critical baseline information is needed before a pilot project can be considered. Therefore, the EMS Agency is requesting to work with you to conduct a study of our current two paramedic system to ensure that an adequate comparison in staffing models can be made.”

Since then, the county’s provider agency advisory committee staff has been developing a draft policy that would allow jurisdictions like Long Beach to submit proposals for such pilot programs. There is an urgency to draft such a policy in the event other jurisdictions follow Long Beach’s lead, according to Koenig. “The Long Beach Fire Department would have to meet the policy’s requirements” in its RMD proposal, he said. Those requirements would include the number and types of patients treated under RMD to draw statistical conclusions.

As reported by the Business Journal, the RMD model would include an expansion of paramedic units from eight to 11, moving five paramedics off ambulances and onto rescue engines. However, the fire engines are at full staffing on every engine with a captain, an engineer and two firefighters. DuRee said the second firefighter is likely working overtime, filling in for one of the department’s 25 firefighter positions vacant due to budget constraints. And that’s just addressing one engine.

Rex Pritchard, president of the Long Beach Firefighters’ Local 372, said those five paramedics bumped from ambulances are cuts. “When he [DuRee] takes the paramedic off the ambulance and puts him onto the engine, you don’t now have a five-person engine. You have a four-person engine. That other firefighter is getting cut. Now, we’re down people because we haven’t hired. So no one is getting laid off. But you’re cutting FTEs (full-time equivalents); you’re cutting firefighter positions.”

Long Beach firefighters’ contract requirements for minimum daily staffing of engines does allow apparatus to be filled by firefighters working overtime, or full-time equivalents, DuRee said. The model does cut firefighter overtime.

Pritchard also raised concerns over effective fire force, or the response time profiles of first alarm assignments. DuRee said the department is currently compiling this data using 600 calls for service and comparing it to national standards. This and other data may be included in the studies of the current paramedic model and RMD.

The advisory committee meets at 1 p.m. on February 20 in the first floor hearing room at 10100 Pioneer Blvd. in Santa Fe Springs. The meeting is open to the public. While the draft policy is on the agenda for the meeting, both Koenig and the agency’s director, Cathy Chidester, said it is likely committee members will put it off until its next meeting in April. If approved by the committee in April, the EMS Agency would be able to begin the pilot program in May.