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See/Hear Dueling Testimony By LB Fire Chief DuRee And LB Firefighters Ass'n Pres. Pritchard After LB Data Show Less Expensive Paramedic System Didn't Meet County Agency's Rule Requiring Second Arriving Paramedic w/in 3 Mins Of First Paramedic 95% Of Time

  • Chief DuRee says County agency rule requiring 2nd paramedic to arrive w/in 3 mins of 1st unit 95% of time is arbitrary, not backed by empirical data...and new system has delivered 1st arriving paramedic faster than previously; LBFFA Pres. Pritchard says City "trying to move the goal post" in trying to change the rule
  • Chief DuRee tells Commission faster first arriving paramedic can begin patient assessments faster; Pritchard tells LBREPORT.com two paramedics are legally required, and first arriving paramedic must wait, to administer controlled drugs ("full scope" of services.)
  • A Comm'n member now evalating 32 patient data points indicates no adverse outcomes to date


    (Nov. 20, 2014) -- As seen LIVE on LBREPORT.com, the Los Angeles County Emergency Medical Services Commission heard sharply differing testimony at its Nov. 19 meeting from Long Beach Fire Chief Mike DuRee and Long Beach Firefighters Ass'n President Rex Pritchard after LBFD data showed that in its first two months (July-August 2014) the City's pilot test of a less expensive paramedic response system (two paramedics arriving on separate vehicles instead of a single vehicle) hadn't met the standard required by the County agency's rule allowing the test: a second paramedic arriving 95% of the time within three minutes of the first arriving paramedic.

    Chief DuRee told the Commission that under the LB test, data show that the first paramedic on average arrives faster, allowing the first arriving paramedic to begin patient assessments faster. LBFFA President Pritchard tells LBREPORT.com after the meeting that two paramedics are legally required, meaning under LB's test the first arriving paramedic must wait for the second to arrive, to administer controlled drugs ("full scope" of services.)

    LBREPORT.com provides VIDEO on-demand below.

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  • Broadcast live streaming video on Ustream

    LBFD Chief DuRee told the Commission (an advisory body to the Board of Supervisors) that the agency's rule allowing for the test, which requires a second arriving paramedic within three minutes of the first arriving paramedic 95% of the time, is aribitrary and not backed by empirical data. Chief DuRee noted that the LB "Rapid Medic Response" system now being tested in LB has delivered a first arriving paramedic faster on average than under LB's previous system (used in all other L.A. and OC jurisdictions.)

    LBFFA President Pritchard said the City is "trying to move the goal post" after LBFD said it would abide by the County agency's rule, Pritchard said the agency's rule was fully vetted with extended discussion over nearly two years by the Commission's Governance committee and said a legitimate study wouldn't change its parameters midway through the study. Pritchard said that two paramedics are legally required, meaning the first arriving paramedic must wait, to administer controlled drugs (the "full scope" of services.)

    Comments by some Commission members indicated they might be willing to modify the current rule's test requirement after viewing further data (no action taken for now.)

    Under the system previously used in LB (and still used in L.A. and OC) two paramedics arrive on the same vehicle at the same time. Most CA counties use a system providing one paramedic (not two) plus a lesser trained Emergency Medical Technician.

    One Commission member, who is currently evaluating 32 data points on the pilot test's performance for patient outcome, indicated an ongoing review of 32 data points hasn't indicated any adverse patient outcomes to date in the Long Beach test.

    As reported (first again by LBREPORT.com), an exchange of correspondence, visible on the County agency's website, indicated that instead of meeting the County agency's standard of a second arriving paramedic happened roughly 80% of the time in July and 83% in August. The second unit (carrying the second paramedic) arrived between 3-10 minutes after the first unit 19% of the time in July and 16% of the time in August. In both months, the second unit arrived more than 10 minutes after the first unit 1% of the time.

    In September, correspondence from the County agency indicates it met with LBFD Chief Mike Duree and his senior management to discuss the matter, and ultimately requested a written improvement plan for implementation no later than Oct. 1, 2014. When that plan didn't arrive, the agency sent an October 22 letter seeking an improvement plan with an implementation date no later than November 15.

    LBFD Chief Duree responded with an Oct. 28 letter in which he said that under RMD system, the first Advanced Life Support [paramedic] arrived 50 seconds faster; Paramedic Assessment Units have increased 9-17. Chief DuRee's letter says the 95% arrival time for a second paramedic isn't required for any L.A. County agency...and argued that a better metric for assessing the RMD system is to compare how quickly two paramedics arrive now compared to before RMD. Measured by that metric, Chief DuRee said arrival time for two paramedics has improved on average by 1:04 seconds.

    In his Oct. 28 letter to the County agency, Chief Duree says that as a plan for improvement, LBFD has added two peak load Basic Life Support [simple transportation ambulances], plans to add a third peak load BLS unit, is more closely monitoring dispatch data and has added a "Firestat" program enabling a more proactive approach to tracking response times.

    "With the additional BLS units and Firestat reporting, we expect to se a better performance profile in the future," Chief Duree's letter to the County agency says. Chief DuRee cc'd his letter to City Manager Pat West. [It's not immediately clear if city management informed Councilmembers of the issue as it emerged in September and LBFD management's response to it in late October.]

    Below are salient items from the exchange of correspondence. [We regret that graphs included in the correspondence reproduced poorly,]

    Correspondence b/w L.A. County Emergency Medical Services Agency and Long Beach re Paramedic system

    Under Mayors Foster and Garcia, Council majorities approved testing the RMD system on LB residents as a cost-saving budget matter [avoiding an explicit recorded policy vote on the paramedic change.] The Council acted after holding a "study session" at which city management was allowed to speak at length in support of the RMD test while the LB Firefighters Association -- which objected to the plan from its inception and predicted it create unintended negative patient consequences -- had three minutes per speaker to respond.

    As previously reported by LBREPORT.com, in brief remarks at the July 17 meeting of 3rd district neighborhood groups held by newly elected Councilwoman Suzie Price, Chief DuRee spoke extemporaneously and briefly and told the audience:

    [The changed paramedic system has] been in place a week. We've had no issues whatsoever. The system is running seamlessly and across the board citywide, we're getting a paramedic to the scene of an emergency on an average over a minute and a half faster than we were before. [applause]

    So, it's one week worth of data, folks...some laughter) We anticipate this trend continuing. We're consistently refining the program., It's only going to get better.

    I just wanted you to know that rest assured, the Long Beach Fire Department is in good hands. We're still responding to calls. It's not a degradation of service in any way and it's moving just fine.

    Chief DuRee has previously acknowledged the system is less costly but said it is a re-examination of an old L.A. Countywide model that hasn't been seriously re-examined for years and will be an improvement on its merits. The LB Firefighters Ass'n leadership has said the RMD test wasn't advanced to seek better patient care on the merits but for management/Mayor/Council budget reasons.

    The L.A. County Emergency Medical Services Agency has allowed Long Beach to test the new system for two years but on terms adopted by the agency after considerable discussion and some controversy.



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