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In 1983, the Bureau of Emergency Medical Services (BEMS) was established and Chief Paramedic Jon A. Fasana became the bureau commander. BEMS was created in an effort to improve the delivery of pre-hospital care and provide single-function paramedics with promotional opportunities. The bureau was charged with supervising single-function EMS personnel. Administrative workload (staffing, timekeeping, vacation scheduling and other non-medical duties) limited the amount of time that the senior paramedics were available for training, supervising and evaluating members.
On July 1, 1984, BEMS was reorganized and nine additional senior paramedics were added. Instead of three divisions, six EMS districts were established with 18 senior paramedics assigned to platoon duty. The six EMS districts were to improve the supervision of patient care and the management of EMS resources and activities.
In 1992, the fire department consolidated the ranks of firefighter and paramedic into a single civil service class responsible for extinguishing fires, accomplishing physical rescues and providing all pre-hospital emergency care. This consolidation was the solution for a number of problems, including morale issues, limited workload balancing options, limitations on management flexibility, legal and employee relations difficulties, delays in fielding new resources and delays in implementing new programs. A single class of firefighter led to unity of command and organizational efficiency. In 1992, lead paramedics became firefighter/lead paramedics, paramedics became firefighter/paramedics, ambulance attendants became firefighter/ attendants, ambulance drivers became firefighter/drivers and EMS supervisors became captain/paramedics. The LAFD would no longer hire single-function paramedics. Since 1992, each new LAFD employee is a firefighter/ EMT-I and has the opportunity to be trained as a dual-function firefighter/ paramedic. Over the next six years, 148 of the 360 single-function paramedics were cross-trained as firefighter/paramedics. The remaining single-function paramedics continued to work on paramedic ambulances or at Quality Improvement or were promoted to become EMS district captains.
LAFD advanced life support (ALS) ambulances are now staffed with two single-function paramedics, two dual-function firefighter/paramedics or a combination of both. LAFD basic life support (BLS) ambulances are staffed with two firefighter/EMT-Is assigned to the fire station and rotated between the fire company and BLS ambulance.
In 1996, the department began deploying paramedic assessment engines at fire stations without paramedic ambulances to reduce paramedic response times in remote neighborhoods. A paramedic assessment engine is staffed with one firefighter/ paramedic and one firefighter/EMT-I, along with a captain and engineer.
In August 1996, BEMS and the Bureau of Fire Suppression and Rescue (BFS&R) were consolidated into the Bureau of Emergency Services (BES). The single-function EMS personnel assigned to rescue ambulances came under the control of BES. An EMS assistant chief position was created to provide management expertise in the coordination and oversight of EMS field activities, policies and procedures. An administrative EMS Division was established within BES.
By 2000, the LAFD operated 83 rescue ambulances (56 ALS and 27 BLS), 97 engine companies (27 ALS and 70 BLS), 48 Light Forces (truck and engine, all BLS) and one paramedic air ambulance (helicopter). These resources and personnel were supervised by 16 Battalion Command Teams, three Division Command Teams, and six EMS district captains all working a 24-hour shift, on a three-platoon schedule. The annual number of EMS incidents was 250,662, and the average paramedic response time was 7.2 minutes citywide. However, of the 103 neighborhood fire stations, 44 had no paramedic ambulance assigned, 28 had no ambulance assigned and 17 had no paramedic resource assigned.
EMS Crisis in Los Angeles
In September 2000, newspaper headlines were declaring a paramedic staffing crisis in Los Angeles. The LAFD had over 100 vacancies for its 447 paramedic positions. Firefighter/ paramedics were working excessive and forced overtime to maintain constant staffing. Paramedic responses in over a dozen neighborhoods averaged nearly 10 minutes. The workload of over one-third of the rescue ambulances exceeded the department’s recommended workload guidelines of 350 responses per month. Firefighter/paramedics were decertifying and requesting to get off the busy paramedic ambulances and back onto fire companies.