Firetrucks vs. am­bu­lances

Los Angeles Times - - OPINION -

There’s noth­ing — noth­ing — that ir­ri­tates peo­ple more about the depart­ment they oth­er­wise love than watch­ing a 50-foot firetruck with a crew of fully suited fire­fight­ers show up to a 911 call for a heart attack or bee sting. In­evitably, some­one watch­ing the drama will gripe, “Why can’t they just send an am­bu­lance?”

It’s a valid ques­tion. The an­swer is an un­nec­es­sar­ily com­plex one that dates to a time when fight­ing fires was still the main mission of most fire de­part­ments. But times have changed. “Struc­ture fires” are fewer and far­ther be­tween. To­day, nearly 90% of the calls to the Los An­ge­les Fire Depart­ment are for med­i­cal ser­vice.

Yet the depart­ment still has far more lad­der trucks and en­gines than am­bu­lances, and far too of­ten it sends trucks to deal with sit­u­a­tions for which an am­bu­lance would be cheaper and more ef­fi­cient.

A pro­posal by Coun­cil­man Mitchell Eng­lan­der could start re­order­ing pri­or­i­ties at the LAFD by di­vert­ing the least-ur­gent med­i­cal calls to a team of just two peo­ple — a nurse prac­ti­tioner and a para­medic. They would use an am­bu­lance, but the goal would be to treat peo­ple who call with mi­nor med­i­cal needs right there at the scene, rather than schlep­ping them to the hos­pi­tal — thus sav­ing mil­lions of dol­lars each year on am­bu­lance rides and hos­pi­tal ad­mit­tances. Nurse prac­ti­tion­ers are able to do more than paramedics, in­clud­ing writ­ing pre­scrip­tions and per­form­ing mi­nor pro­ce­dures.

Be­tween calls, this nurse prac­ti­tioner unit would reach out to “su­pe­rusers” — peo­ple who call 911 more than 50 times a year — to help them find ser­vices and re­sources be­fore they pick up the phone again.

If the pro­gram worked as in­tended, there would be more firetrucks avail­able to re­spond quickly to se­ri­ous emer­gen­cies. Many of the peo­ple stuck in an ex­pen­sive home-to-hos­pi­tal cy­cle would be dealt with at home, more ef­fec­tively and ef­fi­ciently. That’s what hap­pened in Mesa, Ariz.

Two years ago, that city of about 450,000 peo­ple tried a sim­i­lar pro­gram with two teams to take low-ur­gency 911 calls. The trial was so suc­cess­ful — with about $3 mil­lion in sav­ings on am­bu­lance trans­ports and hos­pi­tal ad­mis­sions in 2013 alone and, anec­do­tally at least, many sto­ries of im­proved care — that Mesa rolled out an ex­panded ver­sion in Fe­bru­ary. L.A. would use just one team, de­ployed in an as-yet-uniden­ti­fied part of the city, for its year­long pi­lot pro­gram. This is the type of in­no­va­tion the depart­ment des­per­ately needs, and it’s ex­cru­ci­at­ing to have to move so slowly and on such a small scale. Fire de­part­ments are no­to­ri­ously re­sis­tant to change, but it’s time to try this rea­son­able re­form. If it works, per­haps such a unit will be de­ployed in each of the 16 LAFD bat­tal­ions.

Next week, the pro­posal will come be­fore the City Coun­cil, which should ap­prove it with­out de­lay.

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