The Austin-Schipske-Neal item proposes to withhold implementing the new system, first proposed by Mayor Bob Foster as a budgetary measure in August 2012 and approved by a Council majority over the opposition of the LB Firefighters Ass'n, until a new Council majority takes office and deals with the FY15 budget in Aug-Sept. 2014.

The management-favored paramedic system was developed by LBFD Fire Chief Mike DuRee in response to budget cuts approved by the current Council majority. It would increase the number of paramedic ambulances with advanced life support capabilities from 8 to 11 but reduce current ambulances from 13 to 11, and reduce ambulance staffing from two paramedics aboard to one paramedic plus a lesser trained Emergency Medical Technician (EMT).

LBFD Fire Chief Mike DuRee says the new system will be an improvement on its merits despite reduced costs. The Long Beach Firefighters Ass'n says it will degrade patient care and create unintended, serious operational difficulties. Some aspects of LB's proposed RMD system (one paramedic plus lesser trained EMT responding on one vehicle) are currently in use in most other CA counties but the LB-designed RMD system hasn't been tried on residents of any other community in urbanized Los Angeles or Orange counties.

In their agendizing memo, Councilmembers Austin, Schipske and Neal state:

[Austin-Schipske-Neal agendizing memo text] RECOMMENDED ACTION:

Request the City Manager to provide to the City Council a status report on the implementation of the Rapid Medic Deployment staffing model, report on the current status of the Fire Department's FY 14 budget, and consider providing further direction to the City Manager regarding the implementation of the RMD model, including whether to delay implementation until a full discussion can be had as part of the FY 15 budget process.

BACKGROUND:

In a memo to the City Council dated May 22, 2014, City Manager Pat West reported that the Los Angeles County Emergency Medical Services Commission gave final approval for the City of Long Beach to proceed with the Rapid Medic Deployment (RMD) model, and that implementation is expected to begin after the Fourth of July.

RMD is an alternative staffing model in which all rescue ambulances will be staffed by one firefighter/paramedic and one ambulance operator/emergency medical technician (EMT), rather than the current staffing model of two paramedics on each Advanced Life Support (ALS) ambulance, and two EMTs staffing the Basic Life Support (BLS) ambulances. Long Beach would become the first agency in Los Angeles County to implement this staffing model. This change in staffing would result in 21 fewer firefighter positions, or 7 fewer firefighters on duty at any given time.

This model was first proposed for Long Beach as part of the adoption process for the FY 13 budget as a measure to save $1.8 million. Despite RMD not yet being implemented, the City's Budget Manager reported to the City Council at the April 15, 2014 Council meeting that all departments are projected to finish the fiscal year within their budgets.

Since there is no indication that the RMD implementation is necessary for the Fire Department to meet their FY 14 budget, we request that the City Council receive a report on the status of implementing RMD and the current state of the Fire Department's budget, so the Council can determine whether now is the appropriate time to begin implementation of RMD, or if it is more responsible to have further discussion on the model as part of the FY 15 budget deliberations.

FISCAL IMPACT: Undetermined.

The management-favored paramedic system would save money by no longer providing two paramedics arriving on a single responding unit, instead promising two paramedics arriving on separate vehicles with (for the first time) one firefighter trained in paramedic services guaranteed on every fire engine. The RMD system would increase the number of paramedic ambulances with advanced life support capabilities from 8 to 11 but reduce ambulances from 13 to 11 and reduce ambulance staffing from two paramedics to one paramedic + one ambulance operator Emergency Medical Technician.

LBFD Fire Chief Mike DuRee says the new system will be an improvement on its merits. The Long Beach Firefighters Ass'n says it will degrade patient care and create operational difficulties. Some aspects of LB's proposed RMD system (one paramedic plus lesser trained EMT responding on one vehicle) are used in most other CA Counties but thus far haven't been allowed in urbanized Los Angeles and Orange Counties

As reported first (again) by LBREPORT.com, the L.A. County Emergency Medical Services Agency recently gave Long Beach permission to test the new system for a year...and the day after, City Manager Pat West sent a memo to the Mayor and Council, obtained by LBREPORT.com, in which he stated:

[May 22, 2014 West memo text]

A new Council majority takes office on July 15 and is scheduled to discuss and vote on City Hall's FY15 budget in August-September. One year ago, a Council majority voted for a FY14 budget that assumed savings from deploying the new system...which wasn't deployed because the City said a software glich prevented electronic data capture required by the Council agency. The City sought a waiver of that requirement, which the County agency recently granted, clearing the way for LB to implement the one year test of the alternative paramedic system if it wishes.

If a new Council majority were direct management not to implement the new less expensive system, it would likely create budget issues, since maintaining the current paramedic system is likely not in management's proposed FY15 budet now being prepared (meaning management and the Council would have to find money from elsewhere to cover the cost of maintaining the current system.)

To date, the City Council, the city's policysetting body, hasn't taken an up-or-down vote specifically on whether to implement the paramedic change. Instead, the change has proceeded as a city management driven budget matter.

In July-August 2012, city management and Mayor Bob Foster included the proposed paramedic change in their proposed FY13 budget. In his budget recommendations at the time, Mayor Foster wrote: "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." p>The Council approved the proposed budget -- with the paramedic change savings included -- in Sept. 2012 on 6-2 vote (Austin and Neal dissenting, Andrews absent). However after an agendized March 12, 2013 update on the paramedic plan, the City Council voted 7-0 (motion by Austin and Neal, with Lowenthal and Andrews absent) to direct city management to bring the issue back to the Council before implementing the parademic change.

Long Beach Fire Chief DuRee, appointed in 2012 by City Manager Pat West, says L.A. County's current system has been in place without serious reexamination for decades...and notes that most California Counties already allow one paramedic plus an EMT -- without the assurance of a second arriving paramedic that Long Beach proposes. Chief DuRee has also said that without budget savings from the paramedic change, he would be forced to consider measures including reducing Fire Engine staffing from four to three firefighters, an action he doesn't favor.

Developing.