LONG BEACH - As the Long Beach Fire Department struggles to find fat to trim after years of reductions, officials are considering putting a single paramedic on each responding vehicle instead of running two-paramedic teams.
Fire command staff and city officials are presenting the switch as a way to shorten response times by requiring fewer paramedics in the system, cutting more than $1 million in spending as required in the proposed fiscal year 2013 budget.
The response-time improvement would occur by placing more paramedic units in the field, going from two paramedics on eight ambulances to one paramedic and one emergency medical technician on 11 units, according to LBFD Chief Mike DuRee.
Under the proposal, each of the 16 fire engines included in next year's budget would have a paramedic, instead of nine engines now.
"It doesn't matter if it's a stubbed toe or chest pain, every call will have a paramedic responding," DuRee said.
The change, which must get approval from the Los Angeles County Emergency Medical Services Agency, is being criticized by the firefighters union.
"We're all for looking for innovative ways to deliver EMS, but the model that's being discussed compromises patient care," said Rex Pritchard, president of Long Beach Firefighters Local 372.
Currently, three of Long Beach's regular ambulances are staffed by two EMTs, who are trained in basic life support, such as CPR. A paramedic has advanced life support
Opponents of a "one-to-one" model - with one paramedic and one EMT - say two paramedics back up each other and can execute interconnected procedures, such as intubating a patient while beginning intravenous therapy, faster than a single paramedic.
A trial period
The two-paramedic system has become a minority in California, in part due to budget pressures, with only Los Angeles, Orange and Contra Costa counties using the model, according to officials.
The process to approve an EMS model shift in Long Beach could take 10 months or longer.
Before then, a written plan would be vetted by the county's EMS Commission and discussed in public meetings, according to Cathy Chidester, director of the Los Angeles County EMS Agency.
If approved, the LBFD would likely have to participate in a two-year trial period, she said.
"We would have the ability to discontinue it at any time if we felt like there was any detriment to patient care," said Chidester.
The National Fire Protection Association promotes standards that call for the first unit, with at least one paramedic, to get to the scene of an advanced life support call within a total time of eight minutes.
For basic life support calls, the first unit with at least one EMT should arrive within six minutes, the NFPA says.
In Long Beach, where almost 84 percent of the Fire Department's calls are medical incidents, a paramedic arrived at an advanced life support call site in an average six minutes and 26 seconds in 2011, according to LBFD data.
An EMT arrived at a basic life support call scene, on average, in six minutes and 21 seconds.
DuRee estimated expanding the number of paramedic units in Long Beach could lower response times on medical incidents by as much as 30 to 60 seconds.
As fire department purse strings across the country are tightened, many communities have successfully moved to a one-to-one staffing model to save money, said Ken Willette, division manager of Public Fire Protection with the NFPA.
Others still rely on the traditional, two-paramedic style, he added.
"The question is, what fits the need of the local community?" Willette asked.
Next year's Fire Department budget also calls for mothballing one of Long Beach's 17 engine companies.
The unit targeted for reduction will be selected by early September, DuRee said.
City Council members have until Sept. 15 to approve or change next year's budget, which closes a $17.2 million deficit.
The fiscal year starts Oct. 1.
Editor's note: Due to incorrect information provided by the Fire Department, the original version of this story erroneously said that paramedics can perform tracheotomies. The article has been corrected to remove this.