Los Angeles Fire Department Implements EMS Resource Plan

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The Los Angeles Fire Department is a full-spectrum life safety agency protecting approximately 4 million people who live and work in America’s second-largest city. The LAFD’s 3,376 uniformed personnel and 333 civilian support staff address multiple aspects of life safety, including fire prevention, firefighting, emergency medical care, technical rescue, public education and community service.

A professionally trained staff of 1,035 firefighters (including 195 paramedics) are on duty at all times at 103 neighborhood fire stations strategically located across the department’s 470-square-mile jurisdiction.

LAFD EMS History

The Los Angeles Fire Department has provided emergency medical services (EMS) for decades. The first fire department ambulance was implemented in 1927. By 1931, there were six fire department ambulances serving the metropolitan and harbor areas of the city.

The City of Los Angeles has provided public-sector emergency ambulance service since the early 1900s. The service originated with the Los Angeles Police Department. In the mid-1930s, the service was transferred to the city’s Receiving Hospital Department, where it continued as the Police Ambulance Service.

Private ambulance companies under city contract provided emergency service in the San Fernando Valley until 1957 and in West Los Angeles until 1973. The fire department introduced rescue ambulance service in the San Fernando Valley in 1955 by staffing six rescue ambulances with firefighters. The department introduced two-person squad units in 1957 to respond to EMS incidents in many parts of the city.

On July 1, 1970, the Receiving Hospital Department was abolished, and the emergency ambulance service was transferred to the fire department. With the transfer came 121 personnel, including a chief ambulance attendant, several senior ambulance attendants, ambulance attendants and ambulance drivers. They wore gold badges and police uniforms, worked eight-hour shifts, responded from police stations and had police radios in their ambulances. These new LAFD employees were neither police officers nor firefighters, and their medical training was only advanced first aid. They began working 24-hour shifts on a three-platoon schedule in 1973.

In 1970, a pilot program to train firefighters as paramedics was being tested in Los Angeles County. In September of that year, the first LAFD paramedic ambulance went into service at Fire Station 53 in San Pedro staffed with dual-function firefighter/ paramedics. Within eight years, 37 paramedic ambulances were in service, each staffed with two single-function civilian paramedics.

The 1970s were not without growing pains for the fire department’s EMS program. The most significant problem was attrition; from 1970 to 1983, the department hired and trained 447 rescue ambulance members and lost 265 members.

In April 1973, the first Rescue Ambulance (RA) Drill Tower of civilian rescue ambulance personnel was held at Fire Station 40 on Terminal Island with Captain Donald Anthony (now a retired deputy chief) as the drillmaster. Thirty-three civilian recruit classes were held between 1973 and 1990. From 1973 through 1992, virtually all LAFD rescue ambulances and paramedic positions were staffed with civilian EMT-Is and paramedics. In 1978, department history was made when the first three women were hired as paramedic trainees.

In July 1980, the City Council authorized the hiring of a chief paramedic, a senior paramedic assigned as the department’s EMS training officer and 24-hour field supervision by senior paramedics to improve the management of the EMS Program. Nine senior paramedics, assigned to the three division offices, responded to major EMS incidents and helped the division commanders manage EMS activities. The chief paramedic and all senior paramedics were single-function civilian paramedics.

In 1981, an emergency physician, Dr. Marshall Rockwell, was hired to assist with the management of EMS in the department. The current medical advisor is Dr. Marc Eckstein.

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.

The Board of Fire Commissioners held public meetings to study paramedic staffing. City officials, fire department management, union leaders, firefighter/paramedics and members of the medical community offered solutions.

In January 2001, faced with mounting EMS problems, Fire Chief William R. Bamattre introduced a five-year Emergency Medical Services Resource Deployment Plan (EMS Plan). The plan addressed the chief’s goals of increasing paramedic coverage, improving EMS service delivery and providing a better working environment by reducing workloads.

The EMS Plan would manage the significant number of new paramedics, deployment of additional resources, and expansion of field supervision. The five-year plan would increase the number of paramedics and resources to meet the following objectives:

  • Paramedic resource at every fire station
  • Ambulance at every fire station
  • EMS captains in every battalion
  • Additional paramedic ambulances to provide workload relief for busy units
  • Additional paramedic assessment engines for paramedic personnel rotation

The mayor approved the EMS Plan in January 2001. It included hiring and training 500 paramedics over five years and increased EMS field supervision, resource deployment plans and workload relief plans. In the first year of the EMS Plan (2001/2002), the LAFD:

  • Upgraded three BLS fire companies into paramedic assessment units
  • Upgraded five BLS ambulances into paramedic ambulances
  • Added six paramedic

ambulances

  • Added nine BLS ambulances
  • Added nine EMS district captain offices
  • Hired 145 paramedics
  • Hired four nurse educators for paramedic continuing education
  • Revised EMS dispatch protocols
  • Trained LAFD uniformed dispatchers to National Academy EMD standards

By the end of the first year, the number of ambulances increased from 83 to 98, paramedic ambulances increased from 56 to 67, paramedic units increased from 84 to 98 and EMS captains on duty increased from six to 12. Paramedic response times decreased from an average of 7.2 minutes to 6.9 minutes citywide. The number of paramedic ambulances exceeding the workload limit was dramatically reduced, from 22 to just three. The number of fire stations where the firefighter/paramedics could rotate between the paramedic ambulance and the fire company was increased from four to eight. EMS incidents for the year increased 5%, from 261,619 in 2000/2001 to 274,341 in 2001/2002.

During the second year of the EMS Plan (2002/2003), the LAFD:

  • Upgraded 11 BLS fire companies into paramedic assessment units
  • Upgraded 1 BLS ambulance into a paramedic ambulance
  • Added four paramedic

ambulances

  • Added 13 BLS ambulances
  • Added four EMS district captain offices • Hired and/or trained 140 firefighter/paramedics

By the end of the second year, the number of ambulances increased from 98 to 115, paramedic ambulances increased from 67 to 72, paramedic units increased from 98 to 114 and EMS captains on duty increased from 12 to 16. Paramedic response times decreased from an average of 6.9 minutes to 6.8 minutes citywide. The number of fire stations where the firefighter-paramedics could rotate between the paramedic ambulance and the fire company was increased from eight to 15. EMS incidents increased by 2% from 274,341 to 280,395.

In April 2003, the LAFD achieved an EMS Plan objective by deploying at least one paramedic resource in every fire station district. In June, the department achieved another objective by deploying EMS captains in all of the 16 geographic battalions, thereby improving EMS supervision, training and management of field personnel.

During the third year of the EMS Plan (2003/2004), the LAFD:

  • Upgraded three BLS fire companies into paramedic assessment units
  • Upgraded three BLS ambulances into paramedic ambulances
  • Will be hiring and/or training 70 to 80 firefighter/paramedics

As of Jan. 11, 2004, the number of ambulances remains at 115, paramedic ambulances increased from 72 to 75, paramedic units increased from 114 to 120 and EMS captains on duty remained at 16. Paramedic response times are projected to decrease from an average of 6.8 minutes to 6.7 minutes citywide this year. The number of fire stations where the firefighter paramedics could rotate between the paramedic ambulance and the fire company was increased from 15 to 21. The number of EMS incidents is projected to increase by 4% this year.

Budgetary approval from the City Council and the mayor was required for each year of the EMS Plan. Bamattre initiated a labor-management executive committee to prioritize, market and ultimately gain approval of each year’s budget. The committee consisted of members of the Fire Commission, fire department management, the firefighters’ union (United Firefighters of Los Angeles City Local 112) and the Los Angeles City Chief Officers Association.

The first-year implementation of the EMS Plan cost $13.8 million, the second year cost $17.6 million and the third year cost $400,000. In the fourth and fifth years of the EMS Plan (2004/2005 and 2005/2006), the department hopes to obtain funding to achieve the three remaining objectives, including the deployment of an ambulance in every fire station district.

Summary

The fire chief and the men and women of the LAFD are pleased with the results of the EMS Plan. Paramedic personnel shortages are a thing of the past, attrition has been reduced from 15% to 8% annually, response times have been reduced in nearly every neighborhood, citizen complaints have been reduced, patient lawsuits have virtually been eliminated, revenue from ambulance transports has increased to over $44 million annually and the number of firefighters volunteering to attend paramedic school continues to grow.

The people who live, work and visit Los Angeles are benefiting from the successful implementation of the LAFD five-year EMS Plan.


William Wells is a captain II/paramedic with the Los Angeles Fire Department. He has 30 years of fire-based EMS experience as an ambulance driver, paramedic, EMS supervisor and paramedic captain with the department. Wells is a past president of United Paramedics of Los Angeles (formerly the LAFD paramedic employee association). For the past five years, he has worked at headquarters in the Planning Section overseeing the creation and implementation of the EMS Plan.

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