L.A. County Emergency Medical Services Agency Committee Votes To Table -- Until Providers Can More Fully Review & Comment On -- Draft Rule Spurred By LB City Hall Request To Test Change In Paramedic System; LB Proposal Would Use 1 Paramedic + EMT With 2nd Paramedic Arriving Separately (Instead of Current Two Paramedics On Same Unit)

(Feb. 20, 2013) -- As webcast seen LIVE by LBREPORT.com, the L.A. County Emergency Medical Services Agency's Provider Agency Advisory Committee (PAAC) voted today (Feb. 20) without dissent to table -- take no action on until firefighter/paramedic agency providers can more carefully review and comment on -- a draft rule stemming from a request by the City of Long Beach to test a paramedic response system that would allow one paramedic plus an Emergency Medical Technician to respond on a single unit (instead of a unit staffed with two paramedics) with a second paramedic arriving separately on a second unit.

The motion to table was made by Kevin Costa, Deputy Fire Chief of the City of Pasadena, just as agency staffer Richard Tadeo was about to begin discussing definitions in the draft rule. Deputy Chief Costa (back to our camera in photo below) focused on the process by which the draft rule had advanced:

...[I]t would appear from a provider that you're stacking this new committee toward a favorable outcome...[staffer colloquy]...It goes to the transparency issue of what you're trying to accomplish...Some people saw a draft as early as last week, and the majority of the providers got this yesterday, not enough time for us to sit down as providers and say OK, we're going to go through this...So you're changing what we saw in previious drafts and now you want us to take action today...I'm going to propose to table this until the providers have an opportunity to really vet this through, not discounting anything that governance has done and those folks that sit on the committee, but allowing the stakeholders to have a little more time. Less than the 24 hours is not appropriate. Motion to table.

Deputy Chief Costa's motion received a second; there was no further discussion...and the motion to table carried without dissent. The meeting chair then stated that the item would be tabled until the next meeting [next Committee meeting is in April].

To hear Deputy Chief Costa's statement, motion, colloquy with staff and the PAAC's vote, click here.

Following the vote, Matthew Bolen, an LBFD Firefighter/Paramedic, was allowed to read a statement:

I am a Firefighter/Paramedic with the Long Beach Fire Department where I have been employed for over 10 years. As a 7-Year Paramedic in Los Angeles County and a member of the Policy 407 Governance Committee, I consider myself to be familiar with both the current 2-paramedic system as well as the Alternate Staffing Configurations potentially being implemented by way of this policy.
That being said, I want to be very clear that I am Not a proponent of this policy, nor am I a supporter of going away from the 2-paramedic model currently in place in LA County.
Having worked within both the LA County and Orange County EMS Systems and having talked with members operating in various EMS Agencies across the state, it is my opinion that our current EMS System is among the top-tier EMS Delivery models not only in the State of California, but the entire nation.
Much of the success that we enjoy here in LA County comes from the 2-paramedic transport model as well as the ability to increase/decrease the response to a call for service based on tiered dispatching triage guidelines. Additionally, the ability of Engine, Truck, and Ambulance Companies to upgrade and downgrade EMS Responses once on scene, based on patient need and level of distress, allows us to ensure that an appropriate level of care is achieved and that resources are not wasted or inappropriately utilized.
The 407 Policy goes a long way to disrupt much of the success that the LA County EMS System has built over the course of the last 40 years by removing the verbiage that two paramedics shall be required to transport ALS patients to the hospital.
The Long Beach Firefighters are against this change. We believe that none of the proposed “Alternate Staffing Models” will be able to match the level of care or the level of patient safety that our current Two-Paramedic Model continues to provide today.
In breaking down the 407 Policy, there are several key areas that the Long Beach Firefighters have concern over. We would like you, the members of the Provider Agency Advisory Committee, to weigh in on these issues with the notion that you, as a body, are here to advocate for patient safety first and foremost. It is not your duty to waver under the pressure created by public safety agency budgets or the strain of fiscal dynamics.
Although we would prefer this policy to be withdrawn completely, the key areas that we would like you to focus on, IF this policy is to move forward, are as follows:
The idea of a "One and One Staffing Model" needs to be removed completely. There needs to be a requirement put into this policy that will make it necessary for all ALS incidents to be provided with a minimum of two paramedics on scene so that they may treat critical patients safely, effectively, and in a timely manner.
If the Alternate Staffing Pilot Programs implemented on account of this policy are to be continued beyond the 2-year maximum, then they need to require the approval of the LA County Board of Supervisors. It was the Board that implemented the 2-Paramedic Model, and a change this drastic should require their approval/denial as well.
There needs to be a robust orientation process put in place that will allow a brand new paramedic to become acquainted with their own Alternately Staffed EMS Delivery System prior to being allowed to operate alone on an Ambulance with a single EMT partner. Currently, the policy states that this is to be completed with only 40 ALS contacts. The original draft of the 407 Policy, however, stated that a new paramedic would require a year of experience prior to being allowed to ride on an alternately staffed ALS unit. It is our contention that this 1-year orientation should be reinstated into the policy and that it should be mandated that the 1-year orientation period be performed alongside a more veteran paramedic partner on an Ambulance or other ALS transport unit. This will ensure that the county is placing experienced paramedics into a position where they will be solely responsible for ongoing therapies vital to the safety of our citizens.

In closing, I would like to reiterate that neither myself, nor the firefighters that I represent here today are in favor of this policy change, and it is our hope that you will take it off the table completely. Thank you for your time and attention.

Long Beach Fire Chief Mike DuRee, who was present in the meeting room, watched the proceedings play out, then exited; LBREPORT.com followed in hot pursuit (while webcasting live) and on the way to the parking lot, Chief DuRee shared some quick off the cuff comments:

Chief DuRee: I got word this morning...that it was most likely going to get tabled because they wanted to take a longer time to review it, which I'm fine with, definitely want it to be transparent, want everybody who wants to weigh-in on it to weigh in. And so I'll have plenty of opportunities through the subsequent committees...that we need to go to talk about what our program is and more importantly what it isn't and kind of dispel some of the fears and some of the rumors that seem to be kind of pervasive when they're talking about this...
LBREPORT.com: What does this to do the timeline?
Chief DuRee: Well, nothing really. At this point, if we continue to move forward, the next PAAC meeting is in equal, Base Stations is also in April, then the next Commision meeting is in March so I'm hopeful...Sixty days to review this should be enough time to answer questions and then we'll bring it before the Commission in March and then we'll go from there.

To hear Chief DuRee's comments in full, click here.

Following the vote, LBREPORT.com also caught up with LB Firefighters Ass'n President Rex Pritchard, who commented:

...If it's a budget driven issue, there are funds coming into the city that can fix this [AB 678 state funds]....What I hope L.A. County DHS and the people in that room focus on, they are patient advocates. They look out for what is the best level of service for patient care. They need to not dive into city politics, city budgets...they need to stand as the advocates for patients in all of L.A. County...
Our current system is the better system...However the Fire Chief has been given a certain dollar amount by Councilmemebers and he's trying to come up and meet those parameters. So if it's a budget issue, those Councilmembers can alot him the money to keep our current system which is the best care for the patients...
...This [proposed change] has never been vetted publicly at City Council. This is a dramatic change to our delivery service model...The citizens of Long Beach need to understand that this program cuts firefighter staffing, it's taking us to a level of firefighter staffing from 115 daily staffing to 110, and we had more firefighters on duty in 1926 than we do right now. And yet the Fire Chief has said our call volume keeps increasing 5 to 10 percent every year, and yet we're going from 13 transportation ambulances to 11. That is less service, that's less care...I hope that it doesn't come into play, in all honesty.

To hear LBFFA President Pritchard's statement in full, click here.

The proceedings were indepedently webcast LIVE by LBREPORT.com.

The LB Firefighters Ass'n turned out in large numbers for today's meeting (in photo below, gathering outside the Agency's HQ in Santa Fe Springs prior to the meeting).

A majority of Long Beach City Councilmembers could -- but hasn't thus far -- stopped Long Beach city management from implementing the new paramedic deployment system.

On August 1, 2012, Long Beach Mayor Bob Foster and city management included the change as a budget item. In his written budget recommendations at the time: "The Fire Department has proposed a new way to deliver core services more efficiently at lower costs -- and achieve faster medical response times. I wish I could tell you it is a radically new idea; it is not. This service model is in place in Ventura, San Diego, San Bernardino and Santa Barbara counties -- and has been for years. And since 84% of all the calls for service in Long Beach are for medical response, this one change is emblematic of delivering improved service levels at a lower cost."

The change has still -- to date -- not had a straight up or down City Council vote...and management says such a vote isn't currently scheduled. A Councilmember(s) could agendize such a Council vote but hasn't thus far. Instead, a Council majority -- over the objections of the Long Beach Firefighters Association -- voted in September 2012 to approve including the new paramedic system in City Hall's FY13 budget, meaning that if the new system isn't implemented, the Council would have to make other budget changes.

For additional background leading up to today's meeting, see LBREPORT.com coverage here.

Continuing coverage...with further to follow on LBREPORT.com.