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L.A. County Emergency Medical Services Agency Orders City To Halt Management-Sought Council-Implemented Test Of Less Expensive Paramedic System

Read details in letter: "Significant patient safety issues...environment not conducive to good patient care...issues too great to ignore and pose immediate threat to patient safety"

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(Aug. 28, 2015) -- In a story reported first (again) by LBREPORT.com earlier today (Fri. Aug. 28), the L.A. County Emergency Medical Services Agency has ordered the City of Long Beach to halt a management-sought, Council-enacted, LB Firefighters Ass'n opposed, test (begun in July 2014) of a less expensive paramedic response system ("Rapid Medic Response") and directed the City to revert back to its previous paramedic staffing by October 1.

To view the letter (dated Aug. 26, addressed to LBFD Chief Mike DuRee and cc'd to the City Manager), click here. (Caveat: our initial copy is poor)

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The letter indicates LBFD submitted 269 records to the agency of instances in which patients requiring advanced life support were transported by only one paramedic instead of the system's promised two. Although LBFD deemed all 259 instances to be an "appropriate departure from Tier 1 transport criteria," the EMS agency's Medical Director found that nearly half (48%, 128/269) "had significant concerns about patient stability in the field which may have prompted paramedics to transport instead of waiting for the second paramedic." [LBFD Chief DuRee has previously cited data publicly indicating that under RMD, the first arriving unit on scene has on-average arrived more quickly than under the previous paramedic system.]

The RMD system saves money by having two paramedics arrive on separate vehicles instead of on the same vehicle; one of the paramedics is a firefighter/paramedic aboard an arriving fire engine while a lesser trained Emergency Medical Technician drives the ambulance. The letter indicates that among patients transported without two paramedics that LBFD deemed an appropriate departure from the two-paramedic requirement were 7 pediatric patients with an "Apparent Life Threatening Event," 8 patients with abnormally low or high heart rates, 4 with heart attacks with indication of a total blood clot blockage of a coronary artery, 18 with acute strokes and 75 with abnormally low blood pressure with signs of shock.

"These issues are too great to ignore and pose immediate threat to patient safety," said the letter, signed by L.A. County Emergency Medical Services Agency Director, Cathy Chidester and the agency's Medical Director, Marianne Gausche-Hill, MD (who took office in July.) Dr. Gausche-Hill's agency biography notes that she "is nationally known for her work as an EMS researcher and educator, and for her leadership in the field of EMS and pediatric emergency medicine." Her medical expertise and awards are cited on this page on the agency's website..

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The letter says that during multiple ride alongs from July 2014 through Aug. 2015, agency staff identified what it called major concerns regarding training, mentoring, oversight and system performance and brought these issues to the letter's addressee [LBFD Chief DuRee] on what it called multiple occasions, most recently during an August 13, 2015 meeting.

The letter acknowledges that a Data Safety Monitoring Board recently found the RMD not to be inferior to the two-paramedic model, but "the metrics agreed upon prior to project implementation do not reflect the concerns identified after the project was implemeneted. the DSMB monitoring is only one aspect of the evaluation and is not reflecting of he entire program evaluation."

The agency letter said the RMD paramedic system has "significant patient safety issues...major concerns regarding training, mentoring, oversight and system performance...issues have been brought to your attention on multiple occasions, most recently [on Aug. 13, 2015.]...created an environment that is not conducive to good patient care...These issues are too great to ignore and pose immediate threat to patient safety; therefore, the EMS agency is terminating the RMD pilot project."

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In a quick telephone response/comment at early afternoon Friday (Aug. 28), Deputy City Manager Arturo Sanchez told LBREPORT.com that the City will comply with the letter's directive to restore the previous paramedic system. Mr. Sanchez also acknowledged that reverting back to the previous paramedic system will create budget issues -- since the letter's deadline is Oct. 1 which coincides with the start of the FY16 budget on which the Council is scheduled to vote in the first half of September. Deputy City Manager Sanchez indicated that management plans to address the budget issues and bring the matter forward for Council consideration in the coming week. To hear Mr. Sanchez's quick audio comments to LBREPORT.com, click here.

Meanwhile, Councilmembers Al Austin [a consistent skeptic and critic of the RMD system], Daryl Supernaw [son of a former LB Firefighter] and Roberto Uranga have agendized a Sept. 1 Council item seeking a public report from the City Manager, with input from the Fire Chief & Financial Management on "contingency plans and budgetary impacts" of L.A. County EMS agency terminating LBFD RMD pilot paramedic project with agency requirement that effective Oct. 1 all approved LBFD ALS units must be staffed with two state licensed and County Accredited Paramedics.