Mission Creep at the L.A. Fire Department

The LAFD has become a huge mobile health clinic. And that’s simply unsustainable

(excerpts from http://www.laweekly.com/2013-08-08/news/lafd-ambulance-service/)

The cost, and the mission drift at LAFD, are vast. A report by Chief Cummings himself concluded that in 2012, LAFD firefighters, who at the basic fireman level earn $187,000 in salary, overtime, health care and pension ($200,000 is the average when all LAFD jobs are included), spent a cumulative 3.2 years simply sitting outside emergency rooms in city ambulances or standing in ER hallways.

The city’s well-paid firefighter crews aren’t there due to emergencies. They are waiting for people they’ve transported, with non-emergency complaints, to be booked by busy ER staffs. Some firefighters call it “wall time,” as in “holding up a wall” while a patient is admitted for a broken toe or a funny burning feeling in the lower back. The courts say it’s medical malpractice to simply leave a patient at the ER.

Darren Evans, a paramedic at Station 9, says wall time is “anywhere from 20, 30 minutes — to four or five hours.”

Last year, LAFD ambulances spent a cumulative 28,239 hours parked outside ERs, twiddling their thumbs. It cost L.A. taxpayers $3.4 million in 2012. That’s a lot of cheddar.

Wall time also matters because each marooned ambulance, sitting silently outside the ER in front of a hospital’s emergency room causes other LAFD ambulances to be called to incidents outside of their own jurisdictions. That contorted situation means they arrive late, dangerously slowing LAFD’s emergency-response times.

What Cummings’ report didn’t mention is that the elected leaders of San Jose, San Diego and Denver would find the policies long embraced by LAFD brass and the Los Angeles City Council — “wall time” handled by guys making $187,000, for example — just plain weird.

Those cities use private ambulances to shepherd non-emergency patients to ERs, for a lot less money, and they avoid compromising their system for true emergencies. Good luck, however, selling that to the powerful and popular firefighters union, United Firefighters of Los Angeles City, which plays a major role in electing L.A. city councilmen, showering their campaigns with money and getting out votes for council members on Election Day.

Mostly, firefighters provide routine emergency treatment — 333,333 calls, or 88 percent, dealt with chest pains, falls, trouble breathing, heart attacks, gunshots, numb legs and so on.  Fires? Just 2 percent of LAFD’s call volume, 7,657 calls, were due to fires. Fewer than half were in homes, businesses or structures. Most of the rest were in cars, trash cans or Dumpsters. Furthermore, city firefighters don’t really fight wildfires. The most they’ll ever do is make sure flames don’t spread to houses. Far more specialized units contain wildfire blazes.

You can thank the massive decline in smoking — a lot fewer smoldering mattresses and curtains — as well as home smoke alarms and prevention efforts by fire departments and, most important, those seemingly fussy building regulations. Los Angeles is especially fire-safe.

City firefighters are so well-compensated that they enjoy lives above L.A.’s middle class; they can afford to live in distant, large suburban homes in Orange County and Santa Barbara, often supporting four- and five-member families in which nobody else works.  Many firefighters rake in even more dough by maintaining dual careers or running companies, since many work half as many days as a typical American — albeit 24-hour days, with ambulance shifts that can be particularly grueling (many others work four or five extra days to accrue OT).

The painful, honest truth — ducked by everyone at L.A. City Hall for about 20 years now — is that half of LAFD’s money-sucking vehicles, on every shift, and the men who sit on them, are intended for an activity that comprises just 2 percent of what’s undertaken — firefighting.

Under Cummings, the practice of intensely training as firefighters those who then will spend most of their time doing emergency medical work and shuttling people to hospitals, at yearly total compensation of $187,000 — on the low end — shows no sign of letting up. And Frank Lima, president of United Firefighters of Los Angeles City, wants to hire even more firefighters. Maybe build more fire stations.

A few miles east of City Hall, the Los Angeles County Fire Department headquarters is years ahead of LAFD in answering that question. Its 3,100 firefighters are, as a body, more efficient. Every county fire station employs fewer firefighters and operates fewer vehicles.

Forget the antique truck-and-engine approach. Los Angeles County firefighters use a “quint,” a hybrid that carries both the water and the aerial ladder. Together. The more nimble county vehicle looks like a small SUV; it whisks two firefighter-paramedics to the fire or medical emergency. But here’s the political blasphemy: At the scene of every L.A. County 911 call, the county folks are met by a private ambulance.  If somebody needs to go to the hospital, private paramedics, rather than highly paid L.A. County firefighters, take them to the ER. However, if a patient requires advanced life support — he’s having a heart attack, say, or was shot — an L.A. County Fire Department paramedic rides in the private ambulance with the patient.

The private EMTs with whom the county works — trained in basic life support, which includes CPR and use of a defibrillator — earn as little as $11 per hour, plus benefits. They don’t go through anything remotely like the rigorous, macho, 19-week LAFD training course involving the “drill tower,” in which future city firefighters face endurance tests to prove they’re sturdy enough to fight fires. Emergency medical technicians don’t need those skills.

Los Angeles City Hall politicians have not come close to considering that public-private system — yet. So L.A. sends firefighters out as EMTs and then bills the patient’s insurance, Medicare or Medicaid for the incredibly expensive LAFD lift to the hospital. That’ll be $978 for basic life support, $1,373 if advanced life support is given. But this massive ambulance service costs L.A. taxpayers far more than the city ever recovers. The approach taken by L.A. County, San Jose, Denver and San Diego makes “a hell of a lot of sense”.

They’re leaner, yet the county fire department performance outshines LAFD’s. A recent grand jury report found that county emergency-response times in urban areas (excluding the county’s extensive efforts on wildfire battles) average 42 seconds faster than LAFD’s.

Frank Gallo