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'One-Plus-One' Equals Disaster

Splitting up two-person paramedic teams in hopes of quicker response would be dangerous for patients.

March 12, 2000|ROBERT LINNELL and and ERICK C. LAURIDSEN | Robert Linnell is a Los Angeles Fire Department paramedic captain assigned to the Hollywood-West L.A. EMS District as a paramedic field supervisor. He is president of the Los Angeles Paramedic Assn. Erick C. Lauridsen is a Los Angeles Fire Department captain and a paramedic field supervisor for the eastern half of the San Fernando Valley. He is vice president of the Los Angeles Paramedics Assn

A Los Angeles Fire Department proposal to reduce paramedic staffing on ambulances in the San Fernando Valley--an attempt to "do more with less"--is nothing more than a shell game.

Instead of providing the paramedics and ambulances the Valley needs and deserves, the Fire Department proposes a rationing scheme that would degrade service to the entire Valley. Called "one-plus-one staffing," the plan, a one-year trial program, would split up the teams of two paramedics now on ambulances. One paramedic would remain on the ambulance; the other would be placed on a fire engine. A medical emergency thus would require both an ambulance and a fire engine to bring the same two paramedics who now arrive together on a dedicated medical resource, the ambulance.

Put another way, most of our paramedics would be moved off ambulances and onto dual-function fire engines. There are twice as many fire engines in the Valley as ambulances, even though 80% of all emergency calls are medical rather than fire.

Twenty years ago, the Los Angeles County Department of Health Services wisely mandated a quality standard: Paramedics working on advanced life support, or ALS, units would work in pairs, as a team. Critical patients were assured that two paramedics would arrive together to deliver life-saving procedures.

Today, the Fire Department and the Department of Health Services apparently are less concerned with quality. They are willing to give up the guarantee of a paramedic team and the quality of care this team brings to a life-threatening emergency, under the guise of having one paramedic arrive slightly sooner. In addition, Health Services will evaluate this plan based on response times only.

The Fire Department justifies its plan by predicting that it will bring one paramedic on a fire engine 1.5 minutes sooner than it could bring two paramedics on an ambulance. The Fire Department promises the first paramedic in about six minutes and the second one in eight. However, the second paramedic may not arrive in a timely manner, depending on availability of resources.

Current research demonstrates that critical patients have better outcomes when treated by two paramedics working together, in regular teams. This research indicates that the two, with the same training and skill levels, work more efficiently and provide better care.

Yet instead of asking the City Council for badly needed additional paramedics and more ambulances, the Fire Department has chosen to ask Health Services to lower the quality standard. If this is done, and if county supervisors approve the change, it ultimately will allow for fewer paramedics in the entire county. We may save money but lose more lives.

It may be more costly in lives and is less efficient to place most paramedics on fire engines when 80% of all calls are emergency medical and 66% of those treated are transported in an ambulance.

Further, moving most paramedics off ambulances and onto fire engines will negatively impact fire protection. A firefighter-paramedic can only do one job at a time. Treating patients on the back of a fire engine while waiting for an ambulance is inefficient, unsafe and unnecessary. It ties up fire resources and prevents them from responding to fire calls.

The Valley needs more paramedics on ambulances, not on fire engines. We can have faster paramedic response times, maintain the quality of care that paramedic teams deliver and preserve crucial fire protection by adding the needed paramedic ambulance resources.

On Wednesday, the county Emergency Medical Services Commission will be asked to sanction the fire chief's request to lower the entire L.A. County quality standard and allow the plan to begin in the Valley in July. Don't be fooled by this paramedic rationing plan. The paramedics, nurses, doctors and others who make up the EMS Alliance are dedicated to quality patient care and they oppose it. They include the Los Angeles Paramedics Assn., United Firefighters of Los Angeles, the Assn. of Pre-Hospital Care Coordinators, Los Angeles Firefighters Assn., Emergency Nurses Assn., Trauma Nurses Assn. of Southern California, Los Angeles County Medical Assn. and homeowner groups.

Contact your L.A. County supervisor and City Council member to protest lowering the paramedic staffing standard. Valley residents deserve the fire protection they have paid for as well as a high-quality, low-risk EMS program--with more paramedics on ambulances, not fewer.

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