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LB Fire Chief Told Council He Had No Reason To Believe, Based on Data City Submitted To County Agency And Response Received From Its Data Review Board, That County Agency Would Halt Test Of Less Costly LB Paramedic System; Eight Days Later, County Agency Did So And Said This

Chief added this when asked what LBFD mgm't would do if County nixed LB test


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(Aug. 29, 2015) -- In an August 18 City Council hearing on the management-proposed/Mayor-recommended Long Beach Fire Dept. FY16 budget, Fire Chief Mike DuRee stated (in response to a question by Councilman Rex Richardson) that he had no reason to believe, based on data that LBFD submitted to the L.A. County Emergency Medical Services Agency and the response recently received from its Data Safety Monitoring Board, that the Agency wouldn't look at the data and see that LB's test of its less costly paramedic deployment system (Rapid Medic Deployment or RMD) is effective based on the data.

However in the Agency's Aug. 26 letter to Chief DuRee directing the City to halt the test and begin reverting back to its previous paramedic deployment system [provided by all other L.A. County and OC jurisdictions], the Agency stated in pertinent part:

The EMS Agency conducted multiple ride-alongs with different Agency staff from July 2014 through August 2015 and identified major concerns regarding training, mentoring, oversight and system performance. While some of these issues are expected at the beginning of the pilot, the persistence after a year is most concerning. These issues have been brought to your attention on multiple occasions, most recently during our August 13, 2015 meeting.

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And as to the data LBFD provided to the County Agency, the Agency's letter said its review of 269 incidents involving patients requiring advanced life support whom LBFD transported with only one paramedic (instead of two) and considered 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."

To view the Agency's letter, click here. (Caveat: our initial copy is poor)

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LB's RMD paramedic model saves money by having two paramedics arrive on separate vehicles instead of one vehicle; one of the paramedics is a firefighter/paramedic who arrives on firefighting apparatus while a lesser trained (and less costly) Emergency Medical Technician drives an ambulance. Chief DuRee developed the RMD in response to Council budget cuts that left him with the unenviable options: reduce the number of firefighters arriving on fire engines -- which he has opposed -- or find another way to reduce costs and remain within the Council allocated budget. The result was RMD, which the Long Beach Firefighters Association has from its inception warned would create unintended consequences and reduce patient care...and for which LBFFA has said the Council's budget reductions are ultimately responsible.

LBFD Chief DuRee has previously cited data indicating that under RMD, the first paramedic arrived on scene on-average more quickly than under the previous paramedic system...but LBFFA has noted (along with some observant residents) that under the system, LB firefighting apparatus' are sometimes sent across town, sometimes even a ladder truck and at considerable distance from their dispatched station, to provide the second required paramedic on scene.

As to data submitted by LBFD to the agency's Data Safety Monitoring Board (DSMB), the Agency letter acknowledged that the Board found the RMD not to be inferior to the two-paramedic staffing model, but [Aug. 26 letter text] "the metrics agreed upon prior project implementation do not reflect the concerns identified after the project was implemented. The DSMB monitoring is only one aspect of the evaluation and is not reflective of the entire program evaluation."

Below is an unofficial transcript compiled by LBREPORT.com of the pertinent portion of the Q & A between Councilman Richardson and Chief DuRee on August 18:

Councilman Richardson: I know that we are still dependent on L.A. County EMS to approve or deny this program and so the question is, now that we have a fire fee, are we, if in the event that the County were to reject this program, what would be our contingency plan to make sure that there's no loss in service to our residents?

Chief DuRee: Councilmember, I don't have any indication that the County would step in given the data that has submitted to them over the past year, and given the Data Safety Monitoring Board's letter that they submit to the full EMS Commission, I don't have any indication that the agency would not look at that data and see clearly that the program is effective based on the data.

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And what would occur if the County nixed LB's less costly paramedic staffing model (as it has done)? Chief DuRee said on Aug. 18:

LBFD Chief DuRee: If the EMS Agency through the Commission came back to us, that for whatever reason they were going to shut down our pilot program, we would then be required to revert, per the 407 guidance policy, revert back to the system we had in place. With regard to how we deploy our paramedic rescue ambulances. But that would force us in fire management to take a very hard look at the overall system, the organizaton that would support those paramedics in their work. It would require probably a month or longer for us to put together a plan that I can articulate to you to tell you exactly how we're going to minimize the impact.

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As previously reported by LBREPORT.com, Councilmembers Al Austin [a consistent skeptic/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.

Developing. Further to follow on LBREPORT.com.

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.

Developing...with further to follow on LBREPORT.com



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